Reproductive Endocrinology and Infertility, Medicine School, State University of Western Paraná, Cascavel PR, Brazil; Clinical Cytology and STD Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, PR, Brazil.
Clinical Cytology and STD Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, PR, Brazil.
Reprod Biomed Online. 2019 Jun;38(6):926-937. doi: 10.1016/j.rbmo.2018.11.032. Epub 2019 Jan 8.
Is there an association between the presence of sexually transmitted pathogens in the lower (LGT) and upper (UGT) female genital tract with endometriosis and infertility?
Case-control study with 60 women submitted to gynaecological laparoscopic surgery. Samples from the UGT and LGT were collected and analysed by single polymerase chain reaction (PCR) for human papillomavirus (HPV) and by multiplex PCR for other sexually transmitted infections (STI). Patients were initially divided into two clinical groups: infertile patients (n = 25) with conjugal infertility and fertile control patients (n = 35). After the surgical findings patients were further divided for additional analysis: an endometriosis group (n = 29) and non-endometriosis control group (n = 31).
Sixty per cent of patients were positive for DNA-HPV in some of the genital tract sites sampled. Infertile patients were associated with high-risk HPV (hrHPV) positivity in the UGT sites (P = 0.027). The endometriosis group was associated with hrHPV positivity in the LGT and UGT sites (P = 0.0002 and P = 0.03, respectively). Only hrHPV types were detected in the UGT in both groups. It may be that there is a hrHPV infection continuum, from LGT to UGT, in infertile and endometriosis patients. No association was observed among the other seven STI studied.
This study shows both an association between hrHPV infections in the UGT with infertility and endometriosis, and a possible hrHPV infection continuum, from LGT to UGT. Larger studies are needed to fully investigate the role of hrHPV as a cause of endometriosis and infertility.
女性下生殖道（LGT）和上生殖道（UGT）中是否存在性传播病原体与子宫内膜异位症和不孕之间存在关联？
对 60 名接受妇科腹腔镜手术的女性进行病例对照研究。通过单一聚合酶链反应（PCR）对 UGT 和 LGT 样本进行人乳头瘤病毒（HPV）分析，通过多重 PCR 对其他性传播感染（STI）进行分析。患者最初分为两组临床组：有配偶不孕的不孕患者（n=25）和有生育能力的对照组患者（n=35）。手术后，患者进一步分为两组进行额外分析：子宫内膜异位症组（n=29）和非子宫内膜异位症对照组（n=31）。
60%的患者在采样的生殖道部位中 HPV DNA 呈阳性。不孕患者与 UGT 部位高危型 HPV（hrHPV）阳性相关（P=0.027）。子宫内膜异位症组与 LGT 和 UGT 部位的 hrHPV 阳性相关（P=0.0002 和 P=0.03）。两组 UGT 均仅检测到 hrHPV 型。可能在不孕和子宫内膜异位症患者中存在从 LGT 到 UGT 的 hrHPV 感染连续体。在研究的其他七种 STI 中未观察到相关性。
本研究表明，UGT 中的 hrHPV 感染与不孕和子宫内膜异位症相关，并且可能存在从 LGT 到 UGT 的 hrHPV 感染连续体。需要更大的研究来充分研究 hrHPV 作为子宫内膜异位症和不孕的病因的作用。
