RT Journal Article
SR Electronic
T1 <em>Chlamydia trachomatis</em> and risk of cervical intraepithelial neoplasia grade 3 or worse in women with persistent human papillomavirus infection: a cohort study
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP 550
OP 555
DO 10.1136/sextrans-2013-051431
VO 90
IS 7
A1 Kirsten E Jensen
A1 Louise T Thomsen
A1 Sven Schmiedel
A1 Kirsten Frederiksen
A1 Bodil Norrild
A1 Adriaan van den Brule
A1 Thomas Iftner
A1 Susanne K Kjær
YR 2014
UL http://sti.bmj.com/content/90/7/550.abstract
AB Objectives Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in women with prevalent HPV infection and in a subgroup of women with persistent HPV infection. Methods Participants in this population-based cohort study underwent a structured interview, including history of CT infection, and subsequently cervical exfoliated cells were obtained for HPV DNA and CT DNA testing. Women with high-risk HPV DNA infection and no prevalent cervical disease constituted the overall study population (n=1390). A subgroup of women with persistent HPV infection (n=320) was also identified. All women were passively followed for development of cervical lesions in the national Pathology Data Bank. HRs and 95% CIs for CIN3+ during follow-up (up to 19 years) were estimated in an accelerated failure time model. Results Women who reported more than one CT infection had a statistically significantly increased risk of CIN3+ (high-risk HPV-positive, HR=2.51, 95% CI 1.44 to 4.37) (persistent HPV infection, HR=3.65, 95% CI 1.53 to 8.70). We found no association between CT DNA and subsequent risk of CIN3+ among women who were HPV-positive or had a persistent HPV infection at baseline. Conclusions Repeated CT infections increased the risk of CIN3+ among women with prevalent as well as persistent high-risk HPV infection.