title: Association of human papillomavirus, Neisseria gonorrhoeae and Chlamydia trachomatis co-infections on the risk of high-grade squamous intraepithelial cervical lesion.
abstract: The link between high-risk human Papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) in the risk of developing cervical cancer still unclear. Thus, in this report we investigated the rates of co-infections between HPV and other important non-HPV STDs in different cervical findings using a multiplex polymerase chain reaction (M-PCR) to simultaneously detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, HSV-1 and -2, and Treponema pallidum. A total of 838 women aged 18 to 68 years were screened using Papanicolaou smears for cervical abnormalities, HPV and non-HPV STDs using PCR and M-PCR methods. A total of 614 (73.3%) of the women had normal cytology (NILM) and 224 (26.7%) women exhibited abnormal cytology (≥ ASC-US). HPV-DNA prevalence was 33.9%, and HPV-16 was the most prevalent genotype in women with NILM and ≥ ASC-US cytology. Non-HPV STDs were detected in 30.4% women and T. vaginalis was the most prevalent one (11.6%). A higher increased risk of ≥ ASC-US and HSIL occurred in co-infections of HR-HPV with C. trachomatis and N. gonorrhoeae. Co-infections of HPV-DNA and HR-HPV with HSV-2 exhibited a similar increased risk but only with ≥ ASC-US. Co-infections of HPV-DNA and HR-HPV with T. vaginalis demonstrated a similar increased risk of ≥ ASC-US and HSIL. We found that C. trachomatis and N. gonorrhoeae were the primary pathogens associated with HR-HPV for the increased risk for all grades of cervical abnormalities but mainly for HSIL, suggesting a possible synergistic action in cervical lesions progression. Our results reinforce the hypothesis that some non-HPV STDs might play a role as co-factors in HPV-mediated cervical carcinogenesis. These data improve our understanding of the etiology of SCC and may also be useful for disease prevention.
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM)Maringá, Paraná, Brazil; Department of Pharmacology, University of Illinois at ChicagoIllinois, USA.
authors.forename: André Lp
authors.initials: AL
authors.lastname: de Abreu
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM) Maringá, Paraná, Brazil.
authors.forename: Natália
authors.initials: N
authors.lastname: Malaguti
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM) Maringá, Paraná, Brazil.
authors.forename: Raquel P
authors.initials: RP
authors.lastname: Souza
authors.affiliation: Department of Medicine, State University of Maringá Paraná, Brazil.
authors.forename: Nelson S
authors.initials: NS
authors.lastname: Uchimura
authors.affiliation: Department of Statistics, State University of Maringá Paraná, Brazil.
authors.forename: Érika C
authors.initials: ÉC
authors.lastname: Ferreira
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM) Maringá, Paraná, Brazil.
authors.forename: Monalisa W
authors.initials: MW
authors.lastname: Pereira
authors.affiliation: Department of Medicine, State University of Maringá Paraná, Brazil.
authors.forename: Maria Db
authors.initials: MD
authors.lastname: Carvalho
authors.affiliation: Department of Nursing, State University of Maringá Paraná, Brazil.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Pelloso
authors.affiliation: Department of Pharmacology, University of Illinois at Chicago Illinois, USA.
authors.forename: Marcelo G
authors.initials: MG
authors.lastname: Bonini
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM) Maringá, Paraná, Brazil.
authors.forename: Fabrícia
authors.initials: F
authors.lastname: Gimenes
authors.affiliation: Clinical Cytology Laboratory, State University of Maringá (UEM) Maringá, Paraná, Brazil.
authors.forename: Marcia El
authors.initials: ME
authors.lastname: Consolaro
keywords: Cervical cancer; HPV; HSIL; co-factors; progression risk; sexually transmitted diseases