Abstract
BackgroundSome sexually transmitted infectious agents, such as Chlamydia trachomatis and Herpes simplex, cause local inflammation, and could contribute to Human Papillomavirus (HPV) and cervical lesion progression. Thus, the aim of this study was to determine any association between the presence of microorganisms of gynecological importance, sexual behavior, clinical and demographical variables to the development and progress of cervical lesions.MethodsOne hundred and thirty-two women between 14 and 78 years and living at Vitória da Conquista, Bahia, Brazil, were included (62 individuals with cervical lesions and 70 without lesions). They answered a questionnaire to provide data for a socioeconomic and sexual activity profile. Samples of cervical swabs were collected and analyzed by PCR to detect genital microorganisms and HPV. Quantitative PCR was used to detect and quantify Ureaplasma urealyticum and Ureaplasma parvum. Univariate and multiple logistic regression were performed to measure the association with the cervical lesions, and an odds ratio (OR) with 95% confidence intervals (95%CI) were calculated. The Mann-Whitney U test was also used to compare the microorganism load in the case and control groups. The significance level was 5% in all hypotheses tested.ResultsCervical lesions were associated with: women in a stable sexual relationship (OR = 14.21, 95%CI = 3.67–55.018), positive PCR for HPV (OR = 16.81, 95%CI = 4.19–67.42), Trichomonas vaginalis (OR = 8.566, 95%CI = 2.04–35.94) and Gardnerella vaginalis (OR = 6.13, 95%CI = 1.53–24.61), adjusted by age and qPCR for U. parvum. U. parvum load showed a statistical difference between the case and control groups (p-value = 0.002).ConclusionVariables such as stable relationship, HPV, T. vaginalis, G. vaginalis were associated with cervical lesions in epidemiological studies. U. parvum load was higher in woman with cervical lesions compared with women without lesions. Additional studies are needed to better understand the role of these factors in cervical lesion development.
Highlights
Some sexually transmitted infectious agents, such as Chlamydia trachomatis and Herpes simplex, cause local inflammation, and could contribute to Human Papillomavirus (HPV) and cervical lesion progression
The detection of the afore mentioned microorganisms by Polymerase Chain Reaction (PCR) and quantitative PCR (qPCR) methodologies was determined in samples of the case and control groups
Variables such stable relationship, HPV, T. vaginalis, G. vaginalis were associated with cervical lesions in epidemiological studies
Summary
Some sexually transmitted infectious agents, such as Chlamydia trachomatis and Herpes simplex, cause local inflammation, and could contribute to Human Papillomavirus (HPV) and cervical lesion progression. Cervical cancer is the fourth most common cancer among women in Brazil and seventh worldwide [1]. In 2012, 528,000 new cases were detected and approximately 266,000 deaths occurred, accounting for 7.5% of all deaths of women by cancer [1]. In Brazil, 15,590 new cases of cervical cancer were reported in 2014, with an incidence of approximately 15 cases per 100,000 women [2]. The development of cervical lesions depends on infection by high risk Human Papillomavirus (HPV), such as HPV-16 and HPV-18, and other factors. These HPV types express the oncoproteins E6 and E7, which interfere with cellular machinery causing cell immortalization and transformation. HPV-related carcinogenesis depends on different factors such as HPV type, virus persistence, sustained viral oncogene expression, viral load and viral genome integration [3]
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