Ureaplasma parvum as a possible enhancer agent of HPV‐induced cervical intraepithelial neoplasia: Preliminary results

Abstract

We read with interest the paper recently published on your journal by Magaña-Contreras et al. [2015] examining the prevalence and the role of sexually transmitted pathogens associated with Human papillomavirus (HPV) infection in cervical samples. However, since the authors were unable to differentiate Ureaplasma parvum (UP) from Ureaplasma urealyticum (UU) in their study, we would like to supplement their observations with the data we collected about HPV-UP co-infection.In a series of 46 asymptomatic patients, who gave written informed consent, examined at the Dermatology Department of the University of Genoa, as part of a screening program on sexually transmitted infections (STIs), we have collected cervical samples, testing them for HPV and UP infection. A cytological evaluation of the samples was also performed.To collect the samples we used the ThinPrep liquidbased cytology preparation system and polymerase chain reaction (PCR) to detect HPV types 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 58; liquidbased cytology slides were examined by a cytologist at the Galliera Hospital. Furthermore, we collected a second cervical swab that was analyzed with a multiplex-PCR for DNA detection of seven sexually transmitted bacterial pathogens, including UP.Overall, HPV infection was detected in 31 patients, 11 of them had high-risk HPV (HR-HPV). UU infection was detected in three patients: one of them had normal cytology, HPV infection, and no UP infection, two had CIN1 and UP-HPV co-infection.Chlamydia trachomatis (CT) infection was detected in three patients: one of them had normal cytology and UP-HPV co-infection, two had CIN1 and UP-HPV co-infection.Twenty-one patients were positive for UP: three of them (14%) were negative for HPV and eighteen (86%) were co-infected by UP and HPV. Of the 18 patients with UP and HPV co-infection only 2 (11%) had normal cytology whereas 16 (89%) had abnormal cytology, showing cervical intraepithelial neoplasia of grade 1 (CIN1) ( Table I).As a control group, we selected seven age-matched patients that had HPV infection but were negative for UP infection: four of them (57%) had normal cytology whereas three (43%) had abnormal cytology (CIN1).The age-matched control group was selected among the 25 UP negative patients. Excluding the 7 patients mentioned above, forming the control group, of the remaining 18, 12 were HPV negative and with normal cytology, 4 were HPV positive with a normal cytology, and 2 were HPV positive with CIN 1.Sixteen (89%) of the co-infected patients had CIN1 lesions while only 43% of the patients without UP co-infection had CIN1 lesions. We assessed the statistical significance between the two groups with the Fisher's exact test (two-tailed P-value ¼ 0.0324).HPV infection is a definite human carcinogen, but only few of the HPV infected population develop cancer, suggesting that other risk factors may play a promoting role. Other STIs can be significant in the carcinogenic pathway of HPV, increasing the risk of cancer and cervical intraepithelia...

Evaluation of the Associations Between Cervical Microbiota and HPV Infection, Clearance, and Persistence in Cytologically Normal Women

“…Among them, the Ureaplasma parvum and their related taxa manifested higher richness in the baseline HPV-positive group compared with the baseline HPVnegative group. This is consistent with previous studies in different populations of the world indicating that Ureaplasma parvum was associated with a significantly increased risk of overall HPV infection and increased risk of abnormal cervical cytopathology (20)(21)(22). It was reported that the infection of Ureaplasma could lead to scarring and damage of the epithelium (23), suggesting that infection of the reproductive tract with Ureaplasma parvum might also increase the risk of HPV infection by facilitating viral infections.…”

Association of Righ-Risk Human Papillomavirus and Ureaplasma parvum Co-Infections with Increased Risk of Low-Grade Squamous Intraepithelial Cervical Lesions

“…Our results are consistent with the hypothesis that mycoplasmas can exert a synergistic action with hrHPV and possibly act as cofactors in the development of cervical lesions (Ho et al, 1998;Bodily et al, 2011;Tota et al, 2011). Therefore, detecting and eradicating U. parvum infection might contribute to reduce HPV-related carcinogenesis (Drago et al, 2016).…”

Interplay among Vaginal Microbiome, Immune Response and Sexually Transmitted Viral Infections

“…Recently, much attention has been given to the role of vaginal microbiota in the progression of epithelial lesions up to carcinogenesis. Drago et al [63] found a strong correlation between Ureaplasma parvum -HPV co-infection and CIN1. Mitra et al [64] have studied a cohort of 169 women with different degrees of cervical lesions and showed that increasing severity of cervical lesions was associated with higher vaginal microbiome diversity and decreased relative abundance of Lactobacillus species.…”