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    Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

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    Authors
    Lehtinen, Matti
    Ault, Kevin A
    Lyytikainen, Erika
    Dillner, Joakim
    Garland, Suzanne M
    Ferris, Daron G.
    Koutsky, Laura A
    Sings, Heather L
    Lu, Shuang
    Haupt, Richard M
    Paavonen, Jorma
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    Issue Date
    2011-04-6
    2011-08-6
    URI
    http://hdl.handle.net/10675.2/694
    
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    Abstract
    Objectives: High-risk human papillomavirus (hrHPV) is the primary cause of cervical cancer. As Chlamydia trachomatis is also linked to cervical cancer, its role as a potential co-factor in the development of cervical intraepithelial neoplasia (CIN) grade 2 or higher was examined.
    Methods: The placebo arms of two large, multinational, clinical trials of an HPV6/11/16/18 vaccine were combined. A total of 8441 healthy women aged 15â 26â years underwent cervicovaginal cytology (Papanicolaou (Pap) testing) sampling and C trachomatis testing at day 1 and every 12 months thereafter for up to 4 years. Protocol-specified guidelines were used to triage participants with Pap abnormalities to colposcopy and definitive therapy. The main outcome measured was CIN.
    Results: At baseline, 2629 (31.1%) tested positive for hrHPV DNA and 354 (4.2%) tested positive for C trachomatis. Among those with HPV16/18 infection (n=965; 11.4%) or without HPV16/18 infection (n=7382, 87.5%), the hazard ratios (HRs) associated with development of any CIN grade 2 according to baseline C trachomatis status were 1.82 (95% CI: 1.06 to 3.14) and 1.74 (95% CI 1.05 to 2.90), respectively. The results were comparable when only the 12 most common hrHPV infections were considered, but the excess risk disappeared when the outcome was expanded to include CIN grade 3 or worse.
    Conclusion: Further studies based on larger cohorts with longitudinal follow-up in relation to the C trachomatis acquisition and a thorough evaluation of temporal relationships of infections with hrHPV types, C trachomatis and cervical neoplasia are needed to demonstrate whether and how in some situations C trachomatis sets the stage for cervical carcinogenesis.
    Trial registration: NCT00092521 and NCT00092534.
    Citation
    Sex Transm Infect. 2011 Aug 6; 87(5):372-376
    ae974a485f413a2113503eed53cd6c53
    10.1136/sti.2010.044354
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    Department of Obstetrics and Gynecology: Faculty Research and Presentations

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