Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

• Type of Material: Article
• Authors: Matti Lehtinen, Tampere University; Kevin Ault, Emory University; Erika Lyytikainen, University of Oulu; Joakim Dillner, Lund University; Suzanne M. Garland, Royal Womens Hospitall; Daron G. Ferris, Medical College of Georgia; Laura A. Koutsky, University of Washington; Heather L. Sings, Merck Sharp & Dohme Corp; Shuang Lu, Merck Sharp & Dohme Corp; Richard M. Haupt, Merck Sharp & Dohme Corp; Jorma Paavonen, University of Helsinki
• Language: English
• Date: 2011-08-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © 2011, Published by the BMJ Publishing Group Limited© 2011, Published by the BMJ Publishing Group Limited
• License: Creative Commons Attribution-NonCommercial 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1136/sti.2010.044354
• Title of Journal or Parent Work: SEXUALLY TRANSMITTED INFECTIONS
• Volume: 87
• Issue: 5
• Start Page: 372
• End Page: 376
• Grant/Funding Information: This study was funded by Merck Sharp & Dohme, Whitehouse Station, NJ.
• Keywords: Science & Technology; TYPE-16; EFFICACY; ASSOCIATION; VACCINE; Infectious Diseases; Life Sciences & Biomedicine; CARCINOMA; PERSISTENCE; HUMAN-PAPILLOMAVIRUS; COHORT
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Immunology

Abstract

Objectives: High-risk human papillomavirus (hrHPV) is the primary cause of cervical cancer. As Chlamydia trachomatis is also linked to cervical cancer, its role as a potential co-factor in the development of cervical intraepithelial neoplasia (CIN) grade 2 or higher was examined. Methods: The placebo arms of two large, multinational, clinical trials of an HPV6/11/16/18 vaccine were combined. A total of 8441 healthy women aged 15-26 years underwent cervicovaginal cytology (Papanicolaou (Pap) testing) sampling and C trachomatis testing at day 1 and every 12 months thereafter for up to 4 years. Protocol-specified guidelines were used to triage participants with Pap abnormalities to colposcopy and definitive therapy. The main outcome measured was CIN. Results: At baseline, 2629 (31.1%) tested positive for hrHPV DNA and 354 (4.2%) tested positive for C trachomatis. Among those with HPV16/18 infection (n=965; 11.4%) or without HPV16/18 infection (n=7382, 87.5%), the hazard ratios (HRs) associated with development of any CIN grade 2 according to baseline C trachomatis status were 1.82 (95% CI: 1.06 to 3.14) and 1.74 (95% CI 1.05 to 2.90), respectively. The results were comparable when only the 12 most common hrHPV infections were considered, but the excess risk disappeared when the outcome was expanded to include CIN grade 3 or worse. Conclusion: Further studies based on larger cohorts with longitudinal follow-up in relation to the C trachomatis acquisition and a thorough evaluation of temporal relationships of infections with hrHPV types, C trachomatis and cervical neoplasia are needed to demonstrate whether and how in some situations C trachomatis sets the stage for cervical carcinogenesis. Trial registration: NCT00092521 and NCT00092534.