Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

Matti Lehtinen, Kevin A. Ault, Erika Lyytikainen, Joakim Dillner, Suzanne M. Garland, Daron Gale Ferris, Laura A. Koutsky, Heather L. Sings, Shuang Lu, Richard M. Haupt, Jorma Paavonen

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)372-376
Number of pages5
JournalSexually Transmitted Infections
Volume87
Issue number5
DOIs
StatePublished - Aug 1 2011

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Chlamydia Infections
Cervical Intraepithelial Neoplasia
Chlamydia trachomatis
Uterine Cervical Neoplasms
Infection
Combined Vaccines
Colposcopy
Papillomavirus Infections
Triage
Cell Biology
Carcinogenesis
Placebos
Clinical Trials
Guidelines
DNA
Neoplasms

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Lehtinen, M., Ault, K. A., Lyytikainen, E., Dillner, J., Garland, S. M., Ferris, D. G., ... Paavonen, J. (2011). Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia. Sexually Transmitted Infections, 87(5), 372-376. https://doi.org/10.1136/sti.2010.044354

Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia. / Lehtinen, Matti; Ault, Kevin A.; Lyytikainen, Erika; Dillner, Joakim; Garland, Suzanne M.; Ferris, Daron Gale; Koutsky, Laura A.; Sings, Heather L.; Lu, Shuang; Haupt, Richard M.; Paavonen, Jorma.

In: Sexually Transmitted Infections, Vol. 87, No. 5, 01.08.2011, p. 372-376.

Research output: Contribution to journalArticle

Lehtinen, M, Ault, KA, Lyytikainen, E, Dillner, J, Garland, SM, Ferris, DG, Koutsky, LA, Sings, HL, Lu, S, Haupt, RM & Paavonen, J 2011, 'Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia', Sexually Transmitted Infections, vol. 87, no. 5, pp. 372-376. https://doi.org/10.1136/sti.2010.044354
Lehtinen, Matti ; Ault, Kevin A. ; Lyytikainen, Erika ; Dillner, Joakim ; Garland, Suzanne M. ; Ferris, Daron Gale ; Koutsky, Laura A. ; Sings, Heather L. ; Lu, Shuang ; Haupt, Richard M. ; Paavonen, Jorma. / Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia. In: Sexually Transmitted Infections. 2011 ; Vol. 87, No. 5. pp. 372-376.
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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.",
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AU - Ferris, Daron Gale

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