title: An association of cervical inflammation with high-grade cervical neoplasia in women infected with oncogenic human papillomavirus (HPV).
abstract: Previous reports of genital conditions, such as nonspecific genital infection/sore or vaginal discharge associated with cervical cancer (L. A. Brinton et al., J. Natl. Cancer Inst. (Bethesda), 79: 23-30, 1987; C. J. Jones et al., Cancer Res., 50: 3657-3662, 1990), suggest a possible link between either genital tract inflammation or changes in bacteria flora consistent with bacterial vaginosis (BV) and cervical cancer. To test whether changes in vaginal bacterial flora or the degree of cervical inflammation are associated with women having a human papillomavirus (HPV) infection or with women infected with oncogenic HPV having high-grade cervical lesions (high-grade squamous intraepithelial lesions or cancer), we conducted a case-control study of women <50 years old enrolled in the Costa Rican natural history study of HPV and cervical neoplasia. To test whether BV and inflammation were associated with HPV DNA positivity, Analysis 1 was restricted to women with no or mild (low-grade or equivocal) cytological abnormalities, and the degree of inflammation and Nugent score (a measure of BV) were compared between women infected (n = 220) and not infected (n = 130) with HPV. To test whether BV and inflammation were associated with high-grade lesions, Analysis 2 was restricted to women infected with oncogenic HPV, and the degree of inflammation and Nugent score were compared between women with (n = 95) and without (n = 158) high-grade cervical lesions. In Analysis 1, BV and cervical inflammation were not associated with HPV infection. In Analysis 2, BV was not associated with high-grade lesions. However, we found a marginally significant positive trend of increasing cervical inflammation associated with high-grade lesions in oncogenic HPV-infected women, (P(trend) = 0.05). Overt cervicitis was associated with a 1.9-fold increase in risk of high-grade lesions (95% confidence interval, 0.90-4.1). The results of this study suggest that cervical inflammation may be associated with high-grade lesions and may be a cofactor for high-grade cervical lesions in women infected with oncogenic HPV.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA. pc95p@nih.gov
authors.forename: P E
authors.initials: PE
authors.lastname: Castle
authors.forename: S L
authors.initials: SL
authors.lastname: Hillier
authors.forename: L K
authors.initials: LK
authors.lastname: Rabe
authors.forename: A
authors.initials: A
authors.lastname: Hildesheim
authors.forename: R
authors.initials: R
authors.lastname: Herrero
authors.forename: M C
authors.initials: MC
authors.lastname: Bratti
authors.forename: M E
authors.initials: ME
authors.lastname: Sherman
authors.forename: R D
authors.initials: RD
authors.lastname: Burk
authors.forename: A C
authors.initials: AC
authors.lastname: Rodriguez
authors.forename: M
authors.initials: M
authors.lastname: Alfaro
authors.forename: M L
authors.initials: ML
authors.lastname: Hutchinson
authors.forename: J
authors.initials: J
authors.lastname: Morales
authors.forename: M
authors.initials: M
authors.lastname: Schiffman
mesh_terms: D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D015344:DNA Probes, HPV / Q000032:analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D015344:DNA Probes, HPV