Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2–3 among HPV16 positive female: a large population-based study

Abstract

Background: Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). Methods: From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. Results: Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42-2.31). Co-infection with TV increased the risk of CIN 2-3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16-2.53). Conclusions: Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.

The knowledge of young women about cervical cancer

“…Intimate infections also increase probability of cervical cancer occurrence in patient -attention is paid, among others, to vaginal trichomoniasis, which, with HPV co-infection, significantly increased the risk of this cancer development [9]. Over 80% of women taking part in the own study knew the risk concerning intimate infections (Figure 2), which is a satisfactory result.…”

“…Cervical cancer risk factors include age, early onset of sexual intercourse, big number of sexual partners, [12], highly processed food and vitamins deficiencies [6], smoking cigarettes [7], oral hormonal contraception [8], intimate infections [9], disorders of the vaginal flora [10], number of births [11] and persistent human papillomavirus infection [12].…”

“…In numerous research the focus was on relationship of cervical cancer development with other pathogenic microorganisms. It was proved that Trichomonas vaginalis infection enables development of HPV infection [9]. What also proved to be important, was the composition of the vaginal microbiome, if it is dominated by Lactobacillus bacteria, the chance for cervical cancer development is lower [10].…”

Paradigms of Protist/Bacteria Symbioses Affecting Human Health: Acanthamoeba species and Trichomonas vaginalis

“…T. vaginalis infection has been considered as a risk factor for cervical cancer ( Tao et al, 2014 ) as well as with aggressive prostate cancer ( Sutcliffe et al, 2006 ) and prostate hyperplasia ( Mitteregger et al, 2012 ). In addition, Trichomonas infection has been correlated with an increased risk of high-grade cervical cancer in patients with HPV16, suggesting that the protist may affect carcinogenicity of viruses ( Yang et al, 2020 ).…”

Protozoan-Viral-Bacterial Co-Infections Alter Galectin Levels and Associated Immunity Mediators in the Female Genital Tract

“…TV accounts for close to half of the annual incidence of nearly half-a-billion sexually transmitted infections (STIs) according to WHO estimates (WHO, 2012;Rowley et al, 2019). Adding to the public health care burden, TV is associated with adverse pregnancy outcomes, high-risk HPV genotypes and cancer (Fichorova, 2009;Yang et al, 2020), as well as with HIV acquisition (Cu-Uvin et al, 1999;Van Der Pol et al, 2008) and transmission (Kissinger et al, 2009). Bacterial vaginosis (BV), a common syndrome of disturbed vaginal microbiota, goes handin-hand with TV infection (Onderdonk et al, 2016) and is also associated with HIV acquisition (Atashili et al, 2008), shedding and transmission (Low et al, 2014) and with HPV infection (Oh et al, 2015;Yang et al, 2018;Liang et al, 2019;Brusselaers et al, 2019;Norenhag et al, 2019) and lower rates of HPV clearance (King et al, 2011).…”