HPV-Chlamydial Coinfection, Prevalence, and Association with Cervical Intraepithelial Lesions: A Pilot Study at Mbarara Regional Referral Hospital

Abstract

Background Human Pappilloma Virus (HPV) is the necessary cause of cervical cancer. A number of risk factors are believed to influence the role of HPV in the development of cervical cancer. This is so because majority of HPV infections are cleared and only a few are able to result into cancer. Chlamydia trachomatis (CT) is considered a potential cofactor in the development of cervical intraepithelial neoplasia (CIN), although different studies have produced contradicting information (Silins et al., 2005, Bellaminutti et al., 2014, and Bhatla et al., 2013). The objective of this cross-sectional study was to determine the prevalence and association of HPV-Chlamydial coinfection with cervical intraepithelial lesions and other risk factors for cervical intraepithelial lesions at a hospital in south western Uganda (MRRH). Methods The study included 93 participants, with an age range of 25 to 80 years, from whom cervical specimens were collected and enrolment forms were completed upon consent. Experienced midwives collected one cervical smear and two endocervical swabs from each participant. The swabs were used for HPV DNA and Chlamydia trachomatis antigen testing. Data was entered in Microsoft excel and analysed using STATA 12 software. With the help of spearman's correlation at the 0.05 level of significance, bivariate and multivariate analysis were done by logistic regression, to determine associations of risk factors to cervical lesions. Results The results showed the prevalence of HPV-Chlamydial coinfection to be 8.6% (8/93). Positive Pap smear results were found in 60.22% (56/93) participants, most of whom had low grade squamous intraepitherial lesion (LSIL) (54.84%). HPV-Chlamydial coinfection showed a significant correlation with a positive cytology result and only relatively significantly correlated with LSIL grade of cytological positivity. HPV was found to be the risk factors associated with cervical intraepithelial lesions at MRRH. Conclusion HPV, Chlamydia, and HPV-Chlamydial coinfection are prevalent infections and there is a likelihood of association between HPV-Chlamydial coinfection and with cervical intraepithelial lesions. This study recommends general sexually transimitted infections (STIS) screening for every woman that turns up for cervical cancer screening and a larger study, probably a multicentre study.

Human papillomavirus and Chlamydia trachomatis in oral and genital mucosa of women with normal and abnormal cervical cytology

“…In women with abnormal cytology we detected 18% HPV DNA positive, surprisingly prevalence lower than women with normal cytology but in agreement with Ji, who detected 18.4% HPV in women with abnormal cytology, who visited the department of gynecology of the hospital from China [ 5 ]. To difference with our results, Beyazit detected 51% of genital HPV in women with intact uterus with distinct gynecologic complaints [ 18 ], Ssedyabane 63.4% in patients that presented at the cervical cancer clinic [ 27 ] and a local study conducted by Venezuela detected 51.6% in women with abnormal cytology with antecedents of squamous intraepithelial lesions who attended private clinics and public health centers in Córdoba, Argentina [ 28 ]. When the patient had HPV positive test and normal cytology, a gynecological follow up is important to verify if HPV then is negative or if the cytology lesions has appeared [ 26 ].…”

Human Papillomavirus and Chlamydia trachomatis in oral and genital mucosa of women with normal and abnormal cervical cytology

“…In women with abnormal cytology we detected 18% HPV DNA positive, surprisingly prevalence lower than women with normal cytology but in agreement with Ji, who detected 18.4% HPV in abnormal cytology [5]. To difference with our results, Beyazit detected 51% of genital HPV [14], Ssedyabane 63.4% [25] and a local study conducted by Venezuela detected 51.6% in women with abnormal cytology [26].…”

Chlamydia coinfection inhibits HPV-induced safeguards of the cellular and genomic integrity in patient-derived ectocervical organoids

“…Cofactors like immune status, hormones, and coinfections are emerging as a causal link in cervical cancer development (Koskela, Anttila et al 2000, Brake and Lambert 2005, Zhu, Shen et al 2016. Coinfections with C. trachomatis are seen at an increased incidence in patients with invasive cervical and ovarian cancers (Koskela, Anttila et al 2000, Ssedyabane, Amnia et al 2019), yet the coinfection dynamics and the underlying mechanisms are entirely unknown. Unlike tumor viruses whose DNA can be found within the tumors, bacteria linked to cancers rarely leave any traceable elements.…”