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 language | English (US) |
|---|---|
| Pages (from-to) | 372-376 |
| Number of pages | 5 |
| Journal | Sexually Transmitted Infections |
| Volume | 87 |
| Issue number | 5 |
| DOIs | |
| State | Published - Aug 1 2011 |
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ASJC Scopus subject areas
- Dermatology
- Infectious Diseases
Cite this
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 journal › Article
}
TY - JOUR
T1 - Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia
AU - Lehtinen, Matti
AU - Ault, Kevin A.
AU - Lyytikainen, Erika
AU - Dillner, Joakim
AU - Garland, Suzanne M.
AU - Ferris, Daron Gale
AU - Koutsky, Laura A.
AU - Sings, Heather L.
AU - Lu, Shuang
AU - Haupt, Richard M.
AU - Paavonen, Jorma
PY - 2011/8/1
Y1 - 2011/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=79960699652&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960699652&partnerID=8YFLogxK
U2 - 10.1136/sti.2010.044354
DO - 10.1136/sti.2010.044354
M3 - Article
C2 - 21471141
AN - SCOPUS:79960699652
VL - 87
SP - 372
EP - 376
JO - Sexually Transmitted Infections
JF - Sexually Transmitted Infections
SN - 1368-4973
IS - 5
ER -