Chlamydia trachomatisand risk of cervical intraepithelial neoplasia grade 3 or worse in women with persistent human papillomavirus infection: a cohort study

医学 沙眼衣原体 HPV感染 宫颈上皮内瘤变 人口 衣原体 宫颈癌 队列 队列研究 内科学 妇科 免疫学 癌症 环境卫生
作者
Kirsten Egebjerg Jensen,Louise T. Thomsen,Sven Schmiedel,Kirsten Frederiksen,Bodil Norrild,Adriaan van den Brule,Thomas Iftner,Susanne K. Kjær
出处
期刊:Sexually Transmitted Infections [BMJ]
卷期号:90 (7): 550-555 被引量:40
标识
DOI:10.1136/sextrans-2013-051431
摘要

Objectives

Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in women with prevalent HPV infection and in a subgroup of women with persistent HPV infection.

Methods

Participants in this population-based cohort study underwent a structured interview, including history of CT infection, and subsequently cervical exfoliated cells were obtained for HPV DNA and CT DNA testing. Women with high-risk HPV DNA infection and no prevalent cervical disease constituted the overall study population (n=1390). A subgroup of women with persistent HPV infection (n=320) was also identified. All women were passively followed for development of cervical lesions in the national Pathology Data Bank. HRs and 95% CIs for CIN3+ during follow-up (up to 19 years) were estimated in an accelerated failure time model.

Results

Women who reported more than one CT infection had a statistically significantly increased risk of CIN3+ (high-risk HPV-positive, HR=2.51, 95% CI 1.44 to 4.37) (persistent HPV infection, HR=3.65, 95% CI 1.53 to 8.70). We found no association between CT DNA and subsequent risk of CIN3+ among women who were HPV-positive or had a persistent HPV infection at baseline.

Conclusions

Repeated CT infections increased the risk of CIN3+ among women with prevalent as well as persistent high-risk HPV infection.
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