The Role of Chlamydia Trachomatis in the Pathogenesis of Cervical Cancer

Abstract

Chlamydia trachomatis (CT) is an obligate intracellular, Gram-negative bacterium that causes a variety of infections in both humans and animals. It is the causative agent of one of the most common sexually transmitted infections (STIs) with sequelae such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Furthermore, Chlamydia infections have been epidemiologically linked to cervical cancer (CC) in patients with human papillomavirus (HPV) coinfection. However, a molecular mechanism linking Chlamydia to CC is yet to be established, and we still do not know if more aggressive diagnosis and treatment of Chlamydia could possibly lead to lower incidences of CC and associated mortality. Since CC is a leading cause of death among women worldwide, and HPV infection alone is insufficient to cause cancer, our goal was to determine the link between Chlamydia, HPV, and CC. This literature review aimed to understand the pathologic model of CC and how Chlamydia might induce or promote carcinogenesis alone or alongside HPV. In addition, we compared multiple studies attempting to associate Chlamydial infection with CC in different populations and aimed to determine whether there is an epidemiological correlation or not.

Prevalence of Human Papillomavirus (HPV) among Females in the General Population of the Split and Dalmatia County and Its Association with Genital Microbiota and Infections: A Prospective Study

“…Some other authors have also found a relationship between Uu and HPV infection. Their results suggest that Uu infection increases the risk of HPV infection, which may have a synergistic effect on the development of HPV-related cervical dysplasia [ 14 , 16 , 17 ]. It has always been controversial whether Ureaplasma can be considered colonization or infection.…”

“…A cut-off value of more than 10 4 CCU/mL Uu in a sample is an additional criterion to distinguish colonization from infection, and Kim et al also indicated that only a Uu with ≥ 10 4 CCU/mL was significantly associated with HPV infection. They also found this relationship in asymptomatic women and, based on this, they recommended HR-HPV testing for women with Uu infection, regardless of symptom status because of a possible synergistic effect between Ureaplasma and HPV in cervical dysplasia caused by HPV [ 17 ].…”

Bacterial Infections and Cancer: Exploring This Association And Its Implications for Cancer Patients

“…Chlamydia trachomatis is a gram-negative bacterium and a prevalent cause of curable sexually-transmitted bacterial infections (STIs) worldwide [ 86 ]. The infection presents as urethritis in men and endocervicitis in women [ 87 ].…”

“…The infection presents as urethritis in men and endocervicitis in women [ 87 ]. Persistent Chlamydia infections have also been identified as a risk factor for developing cervical carcinoma [ 87 ], especially in patients with the human papillomavirus (HPV) coinfection [ 86 , 88 ]. Recent elaborate meta-analysis studies have also corroborated the link between C. trachomatis and cervical cancer [ 89 ].…”

“…The association between C. trachomatis and cervical cancer is usually seen in the presence of HPV infections [ 86 ]. Since HPV infections have long been implicated in the etiology of cervical cancer [ 90 ], it is difficult to directly classify the bacterial infection as solely causative, even though it contributes significantly to an increased incidence.…”