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Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

Lehtinen, Matti; Ault, Kevin A.; Lyytikainen, Erika; Dillner, Joakim LU ; Garland, Suzanne M.; Ferris, Daron G.; Koutsky, Laura A.; Sings, Heather L.; Lu, Shuang and Haupt, Richard M., et al. (2011) In Sexually Transmitted Infections 87(5). p.372-376
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... (More)
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. (Less)
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published
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Sexually Transmitted Infections
volume
87
issue
5
pages
372 - 376
publisher
BMJ Publishing Group
external identifiers
  • wos:000292867500007
  • scopus:79960699652
ISSN
1368-4973
DOI
10.1136/sti.2010.044354
language
English
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yes
id
f5a86184-89fc-43af-b74a-e792ef57442f (old id 2072565)
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2011-09-02 08:32:35
date last changed
2017-10-22 04:29:00
@article{f5a86184-89fc-43af-b74a-e792ef57442f,
  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.},
  author       = {Lehtinen, Matti and Ault, Kevin A. and Lyytikainen, Erika and Dillner, Joakim and Garland, Suzanne M. and Ferris, Daron G. and Koutsky, Laura A. and Sings, Heather L. and Lu, Shuang and Haupt, Richard M. and Paavonen, Jorma},
  issn         = {1368-4973},
  language     = {eng},
  number       = {5},
  pages        = {372--376},
  publisher    = {BMJ Publishing Group},
  series       = {Sexually Transmitted Infections},
  title        = {Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia},
  url          = {http://dx.doi.org/10.1136/sti.2010.044354},
  volume       = {87},
  year         = {2011},
}