Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

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

Research output: Contribution to journalArticle

56 Scopus citations

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

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

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    Lehtinen, M., Ault, K. A., Lyytikainen, E., Dillner, J., Garland, S. M., Ferris, D. G., Koutsky, L. A., Sings, H. L., Lu, S., Haupt, R. M., & 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