Sexually transmitted agents and cervical neoplasia in colombia and Spain

Abstract

Case-control studies of cervical intra-epithelial neoplasia grade III (CIN III) and of invasive cervical cancer were carried out in Spain and Colombia to assess the relationship between cervical cancer and 6 common sexually transmitted agents (STAs). The CIN-III studies included 525 cases and 512 controls matched for age and for the place of recruitment; the invasive-cancer studies included 373 histologically confirmed cases of squamous-cell carcinoma and 387 age-stratified controls selected randomly from the populations that generated the cases. Antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus type II (HSV-2) and cytomegalovirus (CMV) were tested in 88% of the women. Cervical scrapes were examined for HPV DNA in 63% of the women using a polymerase-chain-reaction assay (PCR). Among controls, the highest antibody prevalence was to CMV (96.5%), followed by HSV-2 (31.4%) and C. trachomatis (23.3%). For all STAs, the sero-prevalence was markedly higher in Colombia than in Spain both for cases and for controls. After adjustment for the presence of HPV DNA, C. trachomatis was the only STA associated with CIN III in both countries; Spain and Colombia. In both countries, the risk of CIN III increased with increasing of C. trachomatis antibody titers. Among Spanish women, an increase in risk of invasive carcinoma was found for those with antibodies to N. gonorrhoeae; those with antibodies to HSV-2 and those with antibodies to C. trachomatis. These associations were present only in HPV-DNA-negative women. Among HPV-DNA-positive women, none of the STAs considered were associated with cervical neoplasia. Our findings could be interpreted as indicating that past infections with HSV-2, N. gonorrhoeae and C. trachomatis are surrogate markers of HPV, but because HPV DNA may have escaped detection, we cannot exclude that these STAs are also of separate etiological significance.

A population‐based prospective study of Chlamydia trachomatis infection and cervical carcinoma

“…Several seroepidemiologic studies have also found that C. trachomatis is a risk determinant for the development of cervical neoplasia. [7][8][9][10] The fact that our study was based on archival smears rather than fresh specimens might conceivably have resulted in some falsenegative results, e.g., if the DNA is degraded on storage. However, although the proportion of prediagnostic smears positive for HPV DNA decreased with increasing lag time (time until cancer was diagnosed), HPV positivity was not dependent on storage time (calendar time between smear taking and testing of the archival specimen), suggesting that there was no major degradation over time.…”

“…Exposure to C. trachomatis has been consistently associated with cervical cancer and its precursors. [7][8][9][10][11][12] However, this association has commonly been attributed to confounding by infection with HPV. Poor epidemiologic study designs and/or inaccurate diagnostic assays used have made it particularly difficult to disentangle the effects of these STIs.…”

Cross‐sectional analysis of oncogenic HPV viral load and cervical intraepithelial neoplasia

“…27 The HPV genotype strip contains 29 probe lines, detecting 27 individual HPV genotypes and two concentrations of the b-Globin control probe (All reagents were kindly provided by Roche Molecular Systems, Alameda, CA). The following types were detected: 6,11,16,18,26,31,33,35,39,40,42,45, 51 to 59, 66, 68, 73, 82, 83 and 84.…”

“…1 Since the majority of cervical lesions regress to normal cytology after a period of 12 months from presumed first infection, it is thought that the remaining cervical lesions persist due to environmental, host and viral cofactors that have a pleiotropic effect on HPV viral replication, the immune system and tissue microenvironment. [2][3][4][5][6][7][8][9][10] Recent studies suggest that HPV16 viral load may be a possible molecular biomarker in the natural history of HPV infection. Using a semi-quantitative measure of HPV16 DNA levels, several observational studies have found a high correlation between high viral load and high-grade intra-epithelial lesions.…”

Adeno‐associated virus seropositivity and HPV‐induced cervical cancer in Spain and Colombia

“…50 In brief, antibodies to cytomegalovirus (CMV) were measured using an ELISA assay; 51 herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) antibodies were detected with an ELISA assay based on a HSV-2 (gC2) antigen and on an HSV-1 and HSV-2 common type antigen; 51 and antibodies to Chlamydia trachomatis were ascertained using a microimmunofluorescence (MIF) test, 52 simplified to serotype L2.…”