Journal List > Korean J Obstet Gynecol > v.53(12) > 1006373

Korean J Obstet Gynecol. 2010 Dec;53(12):1100-1109. Korean.
Published online December 21, 2010.  https://doi.org/10.5468/kjog.2010.53.12.1100
Copyright © 2010 Korean Society of Obstetrics and Gynecology
The study of association between human papillomavirus and Chlamydia trachomatis infection in cervical intraepithelial neoplasia
Jung-Sun Yang, M.D., Yun-Hee Jeong, M.D. and Jong-Soo Kim, M.D.
Department of Obstetrics and Gynecology, Dankook University College of Medicine, Cheonan, Korea.

Corresponding author (Email: soo8541@hanmail.net )
Received July 21, 2010; Revised October 18, 2010; Accepted November 17, 2010.

Abstract

Objective

The aim of this study is to comparing the prevalence and correlationships between human papillomavirus (HPV) and Chlamydia trachomatis (CT) infection in cervical samples among women with abnormal cervical cytology.

Methods

This study was included three hundred seventy four patients with a abnormal liquid-based cytology in Dankook University hospital. All of them underwent HPV DNA test and CT analysis with polymerase chain reaction. All patients also went through colposcopic directed cervical biopsies or Loop Electrosurgical Excision Procedure, conization. The histo-pathologic results were classified as normal, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and carcinoma in situ (CIS).

Results

Abnormal liquid-based cytology patients were pathologically proven to have CIN. Among 374 patients, the number of within normal limits (chronic cervicitis) and koilocytosis was 186 cases (49.7%), CIN 1, 64 cases (17.1%), CIN 2 16 cases (4.3%) CIN 3, 55 cases (14.7%), and CIS, 53 cases (14.2%). HPV DNA positive patients were 235 cases and HPV DNA negative patients were 139 cases. The impact of CT infection seems not to interfere with the development or even the progression of CIN. Thirty one patients had positive infection of CT (8.3%) and 343 patients were negative infection of CT (91.7%). Both HPV and CT positive infected patients were 25 cases (6.7%) in abnormal cytologic women. The correlation between HPV and CT DNA positive among women with abnormal cytology was statistically significant. (P=0.022)

Conclusion

This study suggests that CT infection is associated with HPV infection, but the clinical significance of the association between CT and HPV infection remains to be elucidated.

Keywords: Cervical intraepithelial neoplasia; Human papilloma virus; Chlamydia trachomatis; Liquid-based cytology

Figures


Fig. 1
Species-specific DNA amplification by multiples polymerase chain reaction in clinical specimens. M: STD6 marker: Trichomonas vaginalis (580 bp), Mycoplasma hominis (502 bp), Ureaplasma urealyticum (435 bp), Chlamydia trachomatis (348 bp), Mycoplasma genitalium (253 bp), Neisseria gonorrhoeae (214 bp). N: negative. 1~6: clinical samples.

Sample 1 Trichomonas vaginalis, Chlamydia trachomatis.

Sample 2 Ureaplasma urealyticum.

Sample 3 Mycoplasma hominis, Chlamydia trachomatis.

Sample 4 Neisseria gonorrhoeae.

Sample 5 Mycoplasma genitalium.

Sample 6 Ureaplasma urealyticum, Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae.

Click for larger image

Tables


Table 1
Histologic diagnosis of each abnormal liquid-based cytology result
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Table 2
Correlation between cytopathological results and type specific HPV DNA in abnormal cervical cytologic women
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Table 3
Correlation between cytopathological results and C. trachomatis DNA detection
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Table 4
Correlation between cytopathological results and HPV and C. trachomatis co-infection
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Table 5
The correlation between HPV and C. trachomatis DNA positive among women with abnormal cytology
Click for larger image

References
1. Cohen CR, Brunham RC. Pathogenesis of Chlamydia induced pelvic inflammatory disease. Sex Transm Infect 1999;75:21–24.
2. Lehmann M, Groh A, Rodel J, Nindl I, Straube E. Detection of Chlamydia trachomatis DNA in cervical samples with regard to infection by human papillomavirus. J Infect 1999;38:12–17.
3. Smith JS, Bosetti C, Munoz N, Herrero R, Bosch FX, Eluf-Neto J, et al. Chlamydia trachomatis and invasive cervical cancer: a pooled analysis of the IARC multicentric case-control study. Int J Cancer 2004;111:431–439.
4. Hwangbo HJ, Ahn JH, Jang TK, Park YK, Lee DJ, Lee SH. Clinical significance of identification of chlamydia trachomatis by polymerase chain reaction in pregnant women with preterm labor and preterm premature rupture of membrane. Korean J Obstet Gynecol 1998;41:1126–1136.
5. Kim SH, Kim EK, Jee BC, Suh CS, Choi YM, Kim JG, et al. Prevalence of chlamydia infection in iInfertile women: application of polymerase chain reaction for detection of chlamydia trachomatis DNA. Korean J Obstet Gynecol 2000;43:475–480.
6. Anttila T, Saikku P, Koskela P, Bloigu A, Dillner J, Ikaheimo I, et al. Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. JAMA 2001;285:47–51.
7. Claas EC, Melchers WJ, Niesters HG, van Muyden R, Stolz E, Quint WG. Infections of the cervix uteri with human papillomavirus and Chlamydia trachomatis. J Med Virol 1992;37:54–57.
8. Silins I, Ryd W, Strand A, Wadell G, Tornberg S, Hansson BG, et al. Chlamydia trachomatis infection and persistence of human papillomavirus. Int J Cancer 2005;116:110–115.
9. Silins I, Tedeschi RM, Kallings I, Dillner J. Clustering of seropositivities for sexually transmitted infections. Sex Transm Dis 2002;29:207–211.
10. Finan RR, Tamim H, Almawi WY. Identification of Chlamydia trachomatis DNA in human papillomavirus (HPV) positive women with normal and abnormal cytology. Arch Gynecol Obstet 2002;266:168–171.
11. Mitrani-Rosenbaum S, Tsvieli R, Lavie O, Boldes R, Anteby E, Shimonovitch S, et al. Simultaneous detection of three common sexually transmitted agents by polymerase chain reaction. Am J Obstet Gynecol 1994;171:784–790.
12. Franco EL, Rohan TE, Villa LL. Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst 1999;91:506–511.
13. Schiffman MH. New epidemiology of human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst 1995;87:1345–1347.
14. de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H. Classification of papillomaviruses. Virology 2004;324:17–27.
15. Lorincz AT, Temple GF, Kurman RJ, Jenson AB, Lancaster WD. Oncogenic association of specific human papillomavirus types with cervical neoplasia. J Natl Cancer Inst 1987;79:671–677.
16. Wallin KL, Wiklund F, Angstrom T, Bergman F, Stendahl U, Wadell G, et al. Type-specific persistence of human papillomavirus DNA before the development of invasive cervical cancer. N Engl J Med 1999;341:1633–1638.
17. Dyson N, Howley PM, Munger K, Harlow E. The human papilloma virus-16 E7 oncoprotein is able to bind to the retinoblastoma gene product. Science 1989;243:934–937.
18. Scheffner M, Werness BA, Huibregtse JM, Levine AJ, Howley PM. The E6 oncoprotein encoded by human papillomavirus types 16 and 18 promotes the degradation of p53. Cell 1990;63:1129–1136.
19. Paquette RL, Lee YY, Wilczynski SP, Karmakar A, Kizaki M, Miller CW, et al. Mutations of p53 and human papillomavirus infection in cervical carcinoma. Cancer 1993;72:1272–1280.
20. Werness BA, Levine AJ, Howley PM. Association of human papillomavirus types 16 and 18 E6 proteins with p53. Science 1990;248:76–79.
21. Quinn TC, Gaydos C, Shepherd M, Bobo L, Hook EW 3rd, Viscidi R, et al. Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA 1996;276:1737–1742.
22. Mpiga P, Ravaoarinoro M. Chlamydia trachomatis persistence: an update. Microbiol Res 2006;161:9–19.
23. Black CM. Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clin Microbiol Rev 1997;10:160–184.
24. Miller KE. Diagnosis and treatment of Chlamydia trachomatis infection. Am Fam Physician 2006;73:1411–1416.
25. Geisler WM, Suchland RJ, Rockey DD, Stamm WE. Epidemiology and clinical manifestations of unique Chlamydia trachomatis isolates that occupy nonfusogenic inclusions. J Infect Dis 2001;184:879–884.
26. Madeleine MM, Anttila T, Schwartz SM, Saikku P, Leinonen M, Carter JJ, et al. Risk of cervical cancer associated with Chlamydia trachomatis antibodies by histology, HPV type and HPV cofactors. Int J Cancer 2007;120:650–655.
27. Munoz N, Kato I, Bosch FX, Eluf-Neto J, De Sanjose S, Ascunce N, et al. Risk factors for HPV DNA detection in middle-aged women. Sex Transm Dis 1996;23:504–510.
28. Fischer N. Chlamydia trachomatis infection in cervical intraepithelial neoplasia and invasive carcinoma. Eur J Gynaecol Oncol 2002;23:247–250.
29. Koskela P, Anttila T, Bjorge T, Brunsvig A, Dillner J, Hakama M, et al. Chlamydia trachomatis infection as a risk factor for invasive cervical cancer. Int J Cancer 2000;85:35–39.
30. Samoff E, Koumans EH, Markowitz LE, Sternberg M, Sawyer MK, Swan D, et al. Association of Chlamydia trachomatis with persistence of high-risk types of human papillomavirus in a cohort of female adolescents. Am J Epidemiol 2005;162:668–675.
31. Tamim H, Finan RR, Sharida HE, Rashid M, Almawi WY. Cervicovaginal coinfections with human papillomavirus and Chlamydia trachomatis. Diagn Microbiol Infect Dis 2002;43:277–281.