title: Association between high risk human papillomavirus infection and co-infection with Candida spp. and Trichomonas vaginalis in women with cervical premalignant and malignant lesions.
abstract: Human papillomavirus (HPV) is the necessary cause of cervical cancer. Cervico-vaginal infection with pathogens like Chlamydia is a likely cofactor. The interactions between HPV, Trichomonas vaginalis (TV) and Candida spp. are less understood, though inflammation induced by these pathogens has been demonstrated to facilitate oncogenesis.
  
  
  
  Our study aimed to evaluate the association between Candida spp. and TV co-infection with HPV in cervical oncogenesis.
  
  
  
  Women with normal cervix who were high-risk HPV-negative (N=104) and HPV-positive (N=105); women with CIN 1 (N=106) and CIN 2/CIN 3 (N=62) were recruited from a community based cervical cancer screening program. Cervical cancer patients (N=106) were recruited from a tertiary care oncology clinic. High-risk HPV was detected by Hybrid Capture II technique; Candida spp. and TV were detected by culturing the high vaginal swabs followed by microscopic examination in all. The disease status was established by histopathology in all the women.
  
  
  
  HPV-positive women had significantly higher risk of having precursor lesions (of any grade) and cancer compared to HPV-negative women. Candida spp. or TV infection did not alter the risk of low grade or high grade lesions among HPV- positive women. HPV positive women co-infected with TV had higher risk of cervical cancer but not those co-infected with Candida spp.
  
  
  
  The higher risk of cancer observed in the women co-infected with HPV and TV without any enhanced risk of CIN 3 suggests secondary infection of the malignant growth by TV rather than any causal role. Co-infection with Candida spp. and/or TV infection did not increase the carcinogenic effect of HPV on cervix.
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Ishita
authors.initials: I
authors.lastname: Ghosh
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Dipanwita
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Pratip
authors.initials: P
authors.lastname: Kundu
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mandal
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France. Electronic address: BasuP@iarc.fr.
authors.forename: Partha
authors.initials: P
authors.lastname: Basu
mesh_terms: D000328:Adult; D002181:Candidiasis, Vulvovaginal / Q000150:complications*; D016022:Case-Control Studies; D060085:Coinfection / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications*; D011230:Precancerous Conditions / Q000453:epidemiology*; D014245:Trichomonas Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*
keywords: Candida; Cervical intraepithelial neoplasia; Human papillomavirus; Trichomonas vaginalis