The Impact of Specific Sexually Transmitted Pathogens on Cervix: A Prospective Study Based on Cervical Cancer Screening Cohort

Abstract

Previous studies showed the association between sexually transmitted infections (STIs) and cervical lesions remains ambiguous. This study was conducted among 8371 women from a screening cohort. Seven specific sexually transmitted pathogens (STPs), including one viral [high-risk human papillomavirus (hrHPV), low-risk HPV (lrHPV)], five bacterial [Ureaplasma parvum (UP), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), and Mycoplasma genitalium (MG)], and one parasitic [Trichomonas vaginalis (TV)] pathogen, were tested by Next Generation Sequencing assay using well-stored baseline samples. Odds ratios (ORs) for incident cervical lesions with different STPs were calculated by Logistic Regression analysis. Within 3-year follow-up, 133 and 72 participants were diagnosed with histopathological cervical intraepithelial neoplasia grade 1 (CIN1) and CIN2+, respectively. The adjusted ORs (aORs) of atypical squamous cells of undetermined significance or worse (ASC-US+) for women with hrHPV, lrHPV, UP, MH, TV, CT, and MG infections were 2.62 (95% CI: 2.19-3.13), 1.94 (95% CI: 1.55-2.43), 1.48 (95% CI: 1.26-1.74), 1.47 (95% CI: 1.25-1.73), 1.65 (95% CI: 1.27-2.15), 1.26 (95% CI: 0.79-2.01) and 2.33 (95% CI: 1.41-3.85), respectively. The aORs of cytological high-grade squamous intraepithelial lesions (HSIL) for women with hrHPV, TV, and MG infections were 13.01 (95% CI: 5.78-29.31), 3.48 (95% CI: 1.38-8.75), and 5.87 (95% CI: 1.58-21.77). The aORs of CIN1 for hrHPV, lrHPV, and MH were 6.88(95% CI: 4.79-9.90), 2.04(95% CI: 1.29-3.14), and 1.47(95% CI: 1.02-2.11). The aOR of CIN2+ for women with hrHPV infection was 17.56 (95% CI: 10.31-29.92), no significance was observed for CIN2+ with non-hrHPV STIs. Specific STP infections were significantly associated with subsequent cervical cytological ASC-US+ (hrHPV, lrHPV, UP, MH, TV, and MG) and HSIL (hrHPV, TV, and MG). Infection with lrHPV and MH could increase the CIN1 risk in future though no obvious CIN2+ risk elevation was observed.

Keywords: atypical squamous cells of undetermined significance or worse (ASC‐US+); cervical precancer; human papillomavirus; risk; sexually transmitted infections.