This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Castle, P. E. Articles by Schiffman, M. Search for Related Content PubMed PubMed Citation Articles by Castle, P. E. Articles by Schiffman, M.

An Association of Cervical Inflammation with High-Grade Cervical Neoplasia in Women Infected with Oncogenic Human Papillomavirus (HPV)¹

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland 20892 [P. E. C., A. H., M. S.]; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 [S. L. H.]; Magee Womens Research Institute, Pittsburgh, Pennsylvania 15213 [L. K. R.]; Caja Costarricense de Seguro Social, San Jose, Costa Rica 1000 [R. H., M. C. B., A. C. R., M. A., J. M.]; The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287 [M. E. S.]; Albert Einstein College of Medicine, Bronx, New York 10461 [R. D. B.]; and Womens and Infants’ Hospital, Providence, Rhode Island 02905 [M. L. H.]

Previous reports of genital conditions, such as nonspecific genital infection/sore or vaginal discharge associated with cervical cancer (L. A. Brinton et al., J. Natl. Cancer Inst. (Bethesda), 79: 23–30, 1987; C. J. Jones et al., Cancer Res., 50: 3657–3662, 1990), suggest a possible link between either genital tract inflammation or changes in bacteria flora consistent with bacterial vaginosis (BV) and cervical cancer. To test whether changes in vaginal bacterial flora or the degree of cervical inflammation are associated with women having a human papillomavirus (HPV) infection or with women infected with oncogenic HPV having high-grade cervical lesions (high-grade squamous intraepithelial lesions or cancer), we conducted a case-control study of women <50 years old enrolled in the Costa Rican natural history study of HPV and cervical neoplasia. To test whether BV and inflammation were associated with HPV DNA positivity, Analysis 1 was restricted to women with no or mild (low-grade or equivocal) cytological abnormalities, and the degree of inflammation and Nugent score (a measure of BV) were compared between women infected (n = 220) and not infected (n = 130) with HPV. To test whether BV and inflammation were associated with high-grade lesions, Analysis 2 was restricted to women infected with oncogenic HPV, and the degree of inflammation and Nugent score were compared between women with (n = 95) and without (n = 158) high-grade cervical lesions. In Analysis 1, BV and cervical inflammation were not associated with HPV infection. In Analysis 2, BV was not associated with high-grade lesions. However, we found a marginally significant positive trend of increasing cervical inflammation associated with high-grade lesions in oncogenic HPV-infected women, (P_trend = 0.05). Overt cervicitis was associated with a 1.9-fold increase in risk of high-grade lesions (95% confidence interval, 0.90–4.1). The results of this study suggest that cervical inflammation may be associated with high-grade lesions and may be a cofactor for high-grade cervical lesions in women infected with oncogenic HPV.

This article has been cited by other articles:

				S. M. Garland, M. Hernandez-Avila, C. M. Wheeler, G. Perez, D. M. Harper, S. Leodolter, G. W.K. Tang, D. G. Ferris, M. Steben, J. Bryan, et al. Quadrivalent Vaccine against Human Papillomavirus to Prevent Anogenital Diseases N. Engl. J. Med., May 10, 2007; 356(19): 1928 - 1943. [Abstract] [Full Text] [PDF]

				D. van Hamont, L.H.C. Nissen, A.G. Siebers, J.C.M. Hendriks, W.J.G. Melchers, J.A.M. Kremer, and L.F.A.G. Massuger Abnormal cervical cytology in women eligible for IVF Hum. Reprod., September 1, 2006; 21(9): 2359 - 2363. [Abstract] [Full Text] [PDF]

				N. F. Schlecht, R. W. Platt, A. Negassa, E. Duarte-Franco, T. E. Rohan, A. Ferenczy, L. L. Villa, and E. L. Franco Modeling the Time Dependence of the Association between Human Papillomavirus Infection and Cervical Cancer Precursor Lesions Am. J. Epidemiol., November 1, 2003; 158(9): 878 - 886. [Abstract] [Full Text] [PDF]

				P. E. Gravitt, R. D. Burk, A. Lorincz, R. Herrero, A. Hildesheim, M. E. Sherman, M. C. Bratti, A. C. Rodriguez, K. J. Helzlsouer, and M. Schiffman A Comparison between Real-Time Polymerase Chain Reaction and Hybrid Capture 2 for Human Papillomavirus DNA Quantitation Cancer Epidemiol. Biomarkers Prev., June 1, 2003; 12(6): 477 - 484. [Abstract] [Full Text] [PDF]

				P. E. Castle and A. R. Giuliano Chapter 4: Genital Tract Infections, Cervical Inflammation, and Antioxidant Nutrients--Assessing Their Roles as Human Papillomavirus Cofactors J Natl Cancer Inst Monographs, June 1, 2003; 2003(31): 29 - 34. [Abstract] [Full Text] [PDF]

				M. H. Schiffman and P. Castle Epidemiologic Studies of a Necessary Causal Risk Factor: Human Papillomavirus Infection and Cervical Neoplasia J Natl Cancer Inst, March 19, 2003; 95(6): E2 - E2. [Full Text]

				S. E. Hawes and N. B. Kiviat Are Genital Infections and Inflammation Cofactors in the Pathogenesis of Invasive Cervical Cancer? J Natl Cancer Inst, November 6, 2002; 94(21): 1592 - 1593. [Full Text] [PDF]

				F X Bosch, A Lorincz, N Munoz, C J L M Meijer, and K V Shah The causal relation between human papillomavirus and cervical cancer J. Clin. Pathol., April 1, 2002; 55(4): 244 - 265. [Abstract] [Full Text] [PDF]