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Abstract
Background: Co-infection by Chlamydia trachomatis (CT) in women with Human Papillomavirus (HPV) infection has been shown to increase the risk of developing cervical intraepithelial neoplasia (CIN). The present study was designed to analyze the association between HPV e CT co-infection and the severity of cervical neoplasia. Methods: Two hundred fifty-one women with PCR-confirmed HPV infection were tested for CT co-infection by PCR, prior to cervical conizations due to CIN. Prevalence rates of CT and HPV types were reported for the histological diagnosis categories. Results: The prevalence of Chlamydia trachomatis was 15.1% (38/251). CT negative women showed a significant association between age ≥ 30 years and CIN 2 or worse diagnosis; this association was not found in CT positive women. In women < 29 years of age, negative for CT, the infection by HPV 16 /18 were detected in 50% of the women with CIN 2 or worse diagnosis and in 19.5% of women with CIN 1 or negative (OR=5.83; 95%CI: 2.19-15.57). Conclusion: No association with CIN 2 or worse diagnosis was observed for Chlamydia trachomatis positive women for all age groups. These data can suggest that HPV type and no CT infection may correlate with risk for severity of histological diagnoses in younger women.
Highlights
Human papillomavirus (HPV), a sexually transmitted deoxyribonucleic acid (DNA) virus, is widely accepted as the cause of cervical cancer [1]
Women testing positive for high-risk Human Papillomavirus (HPV) who had been submitted to excision of the transformation zone were admitted to the study, considering that these women is more likely to have cervical neoplasia
The mean age of the women who tested positive for HPV 16 and/or HPV 18 was 34.6 years, while the mean age of the women infected with other HPV types was 33.8 years, and this difference was not significant (p=0.62)
Summary
The mean age of the 251 women included in the study was 34.2 years and the median was 32 years (range 17 to 75 years). Considering the association between HPV 16 and HPV 18 and CIN 2 or worse diagnostic in young women CT negative observed in this study, there are indications that a genotype-specific natural history implicated in the development of cervical cancer precursors: one type, more frequent, HPV16/18 related, developing quickly and early in life; another one, non-16/18 HR-HPV related, developing later, slowly, through low- to high-grade lesions [23] This hypothesis may explain the results of the present study, which showed a significant association between the severity of cervical neoplasia and HPV 16 and/or HPV 18 infection in CT-negative women < 30 years of age, but failed to find a similar association in the case of women ≥ 30 years of age.
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