Association of Chlamydia trachomatis With Persistence of High-Risk Types of Human Papillomavirus in a Cohort of Female Adolescents

Human papillomavirus (HPV) infection is the necessary but not sufficient cause of cervical cancer. Most infections resolve by the host immune response, and it is thought that host or external cofactors are required for progression to cancer. The association between a history of STD infection and cervical cancer has been studied most thoroughly for chlamydia. While an association has been found, its meaning remains unclear, the authors report. The current report analyzed data from a prospective longitudinal cohort study to evaluate whether concurrent genital tract infections are associated with HPV persistence, a precursor to cervical cancer.

From 1999 to 2003, interview data and biologic samples for HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and bacterial vaginosis testing were obtained from female adolescents in Atlanta at six-month visits between 1999 and 2003. HPV persistence was assessed among subjects who had two to five visits and six or more months of follow-up.

Using logistic regression analysis and methods for correlated data, type-specific persistence of high-risk HPV types was detected in 77 of 181 (43 percent) analyzed visit pairs (two sequential visits). Concurrent chlamydia infection was independently associated with persistence of high-risk HPV types (adjusted odds ratio=2.1, 95 percent confidence interval: 1.0, 4.1). Infection with more than one HPV type at initial visit was also associated with persistence of high-risk types (AOR=2.8, 95 percent CI: 1.6, 4.9).

"The association between chlamydia infection and cervical cancer may be due to an effect of chlamydia infection on persistence of high-risk HPV," concluded authors.

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