Incidence and persistence of carcinogenic genital human papillomavirus infections in young women with or without Chlamydia trachomatis co‐infection

• Published in: Cancer medicine (Malden, MA) Vol. 4; no. 10; pp. 1589 - 1598
• Main Authors: Vriend, Henrike J., Bogaards, Johannes A., Bergen, Jan E. A. M., Brink, Antoinette A. T. P., Broek, Ingrid V. F., Hoebe, Christian J. P. A., King, Audrey J., Sande, Marianne A. B., Wolffs, Petra F. G., Melker, Hester E.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-10-2015; John Wiley & Sons, Ltd
• Subjects: Adolescent; Adult; Alphapapillomavirus - genetics; Alphapapillomavirus - isolation & purification; Cancer; Cancer Prevention; Carcinogenesis; Cervical cancer; Chlamydia; Chlamydia Infections - epidemiology; Chlamydia trachomatis; Chlamydia trachomatis - isolation & purification; Coinfection - epidemiology; Coinfection - microbiology; Deoxyribonucleic acid; DNA; Epidemiology; Female; Genotypes; Health services; Human papillomavirus; Humans; Incidence; Infections; Laboratories; Netherlands - epidemiology; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Polymerase Chain Reaction; Public health; Risk Factors; sexually transmitted infection; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - virology; Vaginal Smears; viral infection; Young Adult; Netherlands; Chlamydia trachomatis; viral infection; sexually transmitted infection; Cervical cancer; human papillomavirus
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.496

We assessed whether infection with chlamydia increases the incidence of carcinogenic human papillomavirus (HPV) infections and if HPV persistence is affected by chlamydia co‐infection. For 1982 women (16–29 years‐old) participating in two consecutive rounds of a chlamydia screening implementation trial, swabs were polymerase chain reaction tested to detect chlamydia and 14 carcinogenic HPV genotypes. HPV type‐specific incidence and persistence rates were stratified for chlamydia positivity at follow‐up. Associations were assessed by multilevel logistic regression analyses with correction for sexual risk factors. HPV type‐specific incidence ranged from 1.4% to 8.9% and persistence from 22.7% to 59.4% after a median follow‐up of 11 months (interquartile range: 11–12). Differences in 1‐year HPV persistence rates between chlamydia ‐infected and noninfected women were less distinct than differences in HPV incidence rates (pooled adjusted odds ratios of 1.17 [95% CI: 0.69–1.96] and 1.84 [95% CI: 1.36–2.47], respectively). The effect of chlamydia co‐infection on HPV‐infection risk did not significantly differ by HPV genotype. In conclusion, infection with chlamydia increases the risk of infection by carcinogenic HPV types and may enhance persistence of some HPV types. Although these findings could reflect residual confounding through unobserved risk factors, our results do give reason to explore more fully the association between chlamydia and HPV type‐specific acquisition and persistence.
Persistent infection with carcinogenic human papillomavirus (HPV) is a necessary cause for development of cervical cancer. The implication of chlamydia in the pathogenesis of cervical carcinoma is controversial, as its interference has not been demonstrated at a particular stage of the carcinogenic process. In this study, which examined data on 1982 young women, results show a significantly increase incidence of HPV infections in the presence of chlamydia co‐infection and hint at an association between chlamydia and the persistence of normally fast‐clearing HPV genotypes.