Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay.
Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay.
PLoS One. 2024 Oct 29;19(10):e0312947. doi: 10.1371/journal.pone.0312947. eCollection 2024.
To determine the prevalence of genital infections (GIs), including sexual transmitted STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and opportunistic pathogens that generally do not cause STIs, non-classic STI: Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis, in women with high-risk oncogenic human papillomavirus (hr-HPV) infection and their association with cervical lesions.
A cross-sectional study was carried out including 231 hr-HPV positive women. Of these, 46 has histologically confirmed cervical intraepithelial neoplasia 3 (CIN3) or more (including CIN3 and cervical cancer lesions-CIN3+). GIs were detected by multiplex real time PCR. Odds ratios (OR) were estimated to explore possible associations between GIs and the presence or absence of CIN3+ lesions. Additionally, we examined associations between sociodemographic, sexual, and clinical characteristics and the presence of GIs.
In total, there were 174/231 cases of GIs corresponding to an overall prevalence of 75.3% (95%CI: 69.4-80.4), being non-classic STIs the most common (72.3%) compared to STIs (12.6%). The most prevalent non-classic STI and STI were U. parvum (49.8%) and C. trachomatis (7.4%), respectively. The odds of presenting GIs were 3 times higher in women under 46 years compared to older counterparts (OR: 3.32, 95%CI: 1.74-6.16), and in women with a normal Pap smear with inflammation compared to those without inflammation (OR: 3.31, 95%CI: 1.15-9.77). GIs were equally present in women with and without CIN3+ lesions.
We observed an association of GIs with inflammation in the Pap smear, but no association with CIN3+, as some of them are very common and likely part of the normal vaginal flora, suggesting that such infections do not appear to be cofactors in cervical carcinogenesis, although larger prospective studies are needed.
确定患有高危型致癌人乳头瘤病毒（hr-HPV）感染的女性中，包括性传播感染性疾病（STIs）在内的生殖系统感染（GIs）的流行情况：淋病奈瑟菌、沙眼衣原体、生殖支原体、阴道毛滴虫和一般不会引起 STIs 的机会性病原体；非经典性 STIs：解脲脲原体、微小脲原体和人型支原体的流行情况，并分析其与宫颈病变的关系。
本研究采用横断面研究方法，共纳入 231 名 hr-HPV 阳性女性。其中 46 名患者经组织学检查确诊为宫颈上皮内瘤变 3 级（CIN3）或更高级别病变（包括 CIN3 和宫颈癌病变-CIN3+）。通过多重实时 PCR 检测生殖系统感染情况。采用比值比（OR）来探索生殖系统感染与 CIN3+病变之间的可能关联。此外，我们还检查了社会人口学、性行为和临床特征与生殖系统感染之间的关系。
231 例患者中，174 例（75.3%）患有生殖系统感染，包括非经典性 STIs（72.3%）和经典性 STIs（12.6%）。最常见的非经典性 STI 和 STI 分别为微小脲原体（49.8%）和沙眼衣原体（7.4%）。与年龄较大的女性相比，46 岁以下的女性生殖系统感染的风险增加 3 倍（OR：3.32，95%CI：1.74-6.16）；与巴氏涂片无炎症的女性相比，巴氏涂片有炎症的女性生殖系统感染的风险增加 3 倍（OR：3.31，95%CI：1.15-9.77）。有和没有 CIN3+病变的女性生殖系统感染的发生率没有差异。
我们观察到巴氏涂片有炎症的女性生殖系统感染与炎症有关，但与 CIN3+病变无关，因为其中一些感染非常常见，可能是正常阴道菌群的一部分，这表明这些感染似乎不是宫颈癌发生的协同因素，但需要更大规模的前瞻性研究。
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