title: Incidence and persistence of carcinogenic genital human papillomavirus infections in young women with or without Chlamydia trachomatis co-infection.
abstract: 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.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.|Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: Henrike J
authors.initials: HJ
authors.lastname: Vriend
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Bogaards
authors.affiliation: STI AIDS Netherlands, Amsterdam, The Netherlands.|Department of General Practices, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
authors.forename: Antoinette A T P
authors.initials: AA
authors.lastname: Brink
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Ingrid V F
authors.initials: IV
authors.lastname: van den Broek
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.|South Limburg Public Health Service, Geleen, The Netherlands.
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: King
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.|Julius Center, University Medical Center, Utrecht, The Netherlands.
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
authors.forename: Petra F G
authors.initials: PF
authors.lastname: Wolffs
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D063646:Carcinogenesis; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D060085:Coinfection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D009426:Netherlands / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult
keywords: Cervical cancer; Chlamydia trachomatis; human papillomavirus; sexually transmitted infection; viral infection