The correlation between Trichomonas vaginalis infection and reproductive system cancer: a systematic review and meta-analysis

Abstract

Background: Trichomonas vaginalis (T. vaginalis) is a microaerophilic protozoan parasite which is responsible for trichomoniasis, the most common non-viral sexually transmitted infection in the world. The infection greatly damages the reproductive system. However, whether T. vaginalis infection can cause reproductive system cancer remains controversial.

Methods: This study systematically searched PubMed, EMBASE, Ovid and Google scholar, and 144 relevant articles were retrieved and classified into three categories: epidemiological investigations (68), reviews (30) and research articles (46). These three types of articles were verified according to their respective inclusion and exclusion criteria. Stata 16 was used to conduct a meta-analysis on the articles of epidemiological investigations for analysing the correlation between T. vaginalis infection and reproductive system cancer.

Results: The result of meta-analysis indicated that the rate of T. vaginalis infection in the cancer group was significantly higher than that in the non-cancer group (OR = 1.87, 95% CI 1.29-2.71, I² = 52%). Moreover, the cancer rate of the population infected with T. vaginalis was significantly higher than that of the population without T. vaginalis infection (OR = 2.77, 95% CI 2.37-3.25, I² = 31%). The review articles and most research articles stated that the infection of T. vaginalis could lead to cancer and the pathogenic mechanisms were as follows: T. vaginalis promoting inflammatory response, T. vaginalis infection changing the internal environment around parasitic sites and signal transduction pathway, the metabolites secreted by T. vaginalis inducing carcinogenesis and T. vaginalis increasing other pathogenic microbial infection to promote the occurrence of cancer.

Conclusions: Our study confirmed that there was a correlation between the infection of T. vaginalis and reproductive system cancer, and provided some possible research directions for clarifying the carcinogenic mechanisms caused by T. vaginalis infection.

Keywords: Cancer; Correlation; Infection; Systematic review; Trichomonas vaginalis.

Fig. 1

Flow diagram of articles retrieval, identification, classification and inclusion

Fig. 2

The articles concerned the incidence of T. vaginalis infection among patients with cancer. A Forest plot of the meta-analysis. The heterogeneity test yielded Chi² = 27.01, p = 0.01, and I² = 52%. The OR and 95% confidence interval were calculated as 1.87 and 1.29–2.71, respectively, and z and p values of the combined effect size were as 3.29 and less than 0.001. T. vaginalis infection among patients with cervical tumor: The heterogeneity test yielded Chi² = 17.22, p = 0.05, and I² = 48%. The OR and 95% confidence interval were calculated as 1.81 and 1.10–2.96, respectively, and z and p values of the combined effect size were as 2.36 and 0.02. B Funnel plot of the meta-analysis. C Galbraith plot. D Begg and Egger plot of the meta-analysis. P = 0.696 (P > 0.1) E Sensitivity analysis of the articles

Fig. 3

The articles concerned the incidence of cancer among people with T. vaginalis infection. A Forest plot of the meta-analysis. The heterogeneity test yielded Chi² = 10.21, p = 0.18, and I² = 31%. The OR and 95% confidence interval were calculated as 2.77 and 2.37–3.25, respectively, and z and p values of the combined effect size were as 12.64 and 0 (P < 0.05). B Funnel plot of the meta-analysis. C Begg and Egger plot of the meta-analysis. P = 0.051 (P < 0.1). D Sensitivity analysis of the articles