Cervical Squamous Intraepithelial Lesions Are Associated with Differences in the Vaginal Microbiota of Mexican Women.

Cervical cancer is an important health concern worldwide and is one of the leading causes of death in Mexican women. Previous studies have shown changes in the female genital tract microbe community related to human papillomavirus (HPV) infection and cervical cancer; yet, this link remains unexplored in many human populations. This study evaluated the vaginal bacterial community among Mexican women with precancerous squamous intraepithelial lesions (SIL). We sequenced the V3 region of the 16S rRNA gene in cervical samples from 228 Mexican women, including 121 participants with SIL, most of which were HPV positive, and 107 healthy women without HPV infection or SIL. The presence of SIL was associated with changes in composition (beta diversity) and with a higher species richness (Chao1). A comparison of HPV-positive women with and without SIL showed that microbiota changes occurred even in the absence of SIL. Multivariate association with linear models (MaAsLin) analysis yielded independent associations between HPV infection and an increase in the relative abundance of Brachybacterium conglomeratum and Brevibacterium aureum as well as a decrease in two Lactobacillus iners operational taxonomic units (OTUs). We also identified a positive independent association between HPV-16, the most common HPV subtype linked to SIL, and Brachybacterium conglomeratum. Our work indicates that HPV infection leading to SIL is primarily associated with shifts in vaginal microbiota composition, some of which may be specific to this human population. IMPORTANCE Human papillomavirus (HPV) plays a critical role in cervical carcinogenesis but is not sufficient for cervical cancer development, indicating the involvement of other factors. The vaginal microbiota is an important factor in controlling infections caused by HPV, and, depending on its composition, it can modulate the microenvironment in vaginal mucosa against viral infections. Ethnic and sociodemographic factors influence differences in vaginal microbiome composition, which underlies the dysbiotic patterns linked to HPV infection and cervical cancer across different populations of women. Here, we provide evidence for associations between vaginal microbiota patterns and HPV infection linked to ethnic and sociodemographic factors. To our knowledge, this is the first report of the species Brevibacterium aureum and Brachybacterium conglomeratum linked to HPV infection or squamous intraepithelial lesions (SIL).

Microbiome and Cervical Cancer.

Persistent infection with some types of mucosal human papillomavirus (HPV) is the etiological factor for the development of cervical cancer and its precursor lesions. Besides, several cofactors are known to play a role in cervical disease onset and progression either by favoring or by preventing HPV infection and persistence. The microbiome of a healthy female genital tract is characterized by the presence of 1 or few varieties of lactobacilli. However, high-throughput studies addressing the bacterial diversity and abundance in the female genital tract have shown that several factors, including hormonal levels, hygiene habits, and sexually transmitted diseases may disrupt the natural balance, favoring the outgrowth of some groups of bacteria, which in turn may favor some pathological states. Recently, the vaginal microbiome has emerged as a new variable that could greatly influence the natural history of HPV infections and their clinical impact. In this context, changes in the vaginal microbiome have been detected in women infected with HPV and women with HPV-associated lesions and cancer. However, the role of specific bacteria groups in the development/progression or prevention/regression of HPV-associated pathologies is not well understood. In this review we summarize the current knowledge concerning changes in vaginal microbiome and cervical disease. We discuss the potential functional interplay between specific bacterial groups and HPV infection outcomes.

The Role of the Cervicovaginal Microbiome on the Genesis and as a Biomarker of Premalignant Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer.

The microbiome is able to modulate immune responses, alter the physiology of the human organism, and increase the risk of viral infections and development of diseases such as cancer. In this review, we address changes in the cervical microbiota as potential biomarkers to identify the risk of cervical intraepithelial neoplasia (CIN) development and invasive cervical cancer in the context of human papillomavirus (HPV) infection. Current approaches for clinical diagnostics and the manipulation of microbiota with the use of probiotics and through microbiota transplantation are also discussed.

Vaginosis-associated bacteria and its association with HPV infection. / Bacterias relacionadas con vaginosis bacteriana y su asociación a la infección por virus del papiloma humano.

BACKGROUND AND OBJECTIVE: Cervical cancer is an important health problem in our country. It is known that there are several risk factors for this neoplasm, and it has been suggested that cervical microbiome alterations could play a role in the development and progress of cancer. Bacterial vaginosis associated bacteria such as Atopobium vaginae and Gardnerella vaginalis has been suggested as potential risk factor for cervical lesions and cervical cancer. MATERIAL AND METHODS: DNA from 177 cervical scraping samples was studied: 104 belonged to women without cytological or colposcopic alterations and 73 samples from precursor lesions with previous human papillomavirus (HPV) infection history. All samples were screened for Atopobium vaginae, Gardnerella vaginalis and HPV by PCR. RESULTS: High HPV prevalence was found in precursor samples, and 30% of samples without lesions were positive for HPV. Virtually all samples contained sequences of both bacteria, and interestingly, there was not HPV association observed; these results could suggest that these microorganisms could be part of the cervical microbiome in Mexican population. CONCLUSIONS: The results obtained indicate that the bacteria analysed could be part of normal biome in Mexican women, suggesting a potential reconsideration of the pathogen role of these microorganisms.

Profile of women with cervical cancer attended for treatment in oncology center / Perfil de mulheres com câncer de colo do útero atendidas para tratamento em centro de oncologia

Abstract Objectives: to evaluate the sociodemographic, clinical, histopathological, cytopathological and microbiological profile of women with cervical cancer treated at Oncology Center in Pernambuco, located in the city of Caruaru-PE. Methods: a retrospective study was carried out to evaluate the medical records of women with cervical cancer treated for radiotherapy and/or chemotherapy between January 2014 and December 2016. For the analysis of variables, the absolute and relative frequencies were calculated. Results: there was a predominance of cases in the age range between 40 and 59 years (45.37%), non-white race/color (91.75%) and incomplete primary education (44.32%). Squamous carcinoma was present in 85.19% of the cases, with a moderately differentiated histological grade being the most common (53.41%). Most women underwent radiotherapy and associated chemotherapy (72.72%) and had 3 or more pregnancies before diagnosis (73.44%). Cytopathology has more frequently identified high-grade squamous intraepithelial lesion (HSIL) cases (45.83%) and cocci and/or bacilli (66.67%) were the most evident microorganisms. Conclusions: the results showed that the perimenopause age, low educational level, multiparity, cytopathologic result of HSIL and histopathological examination evidencing moderately differentiated squamous cell carcinoma were among the characteristics most related to cervical cancer in the population studied.

Resumo Objetivos: avaliar o perfil sociodemográfico, clínico, histopatológico, citopatológico e microbiológico de mulheres com câncer de colo do útero atendidas em Centro de Oncologia Pernambucano. Métodos: estudo retrospectivo, que avaliou os prontuários de mulheres com câncer de colo do útero atendidas para tratamento radioterápico e/ou quimioterápico entre janeiro de 2014 e dezembro de 2016. Para a análise das variáveis foram calculadas as frequências absolutas e relativas. Resultados: houve predominância de casos na faixa etária entre 40 a 59 anos (45,37%), de raça/cor não branca (91,75%) e com até o ensino fundamental incompleto (44,32%). O carcinoma escamoso esteve presente em 85,19% dos casos, sendo o grau histológico moderadamente diferenciado o mais comum (53,41%). A maioria das mulheres realizaram radioterapia e quimioterapia associadas (72,72%) e apresentaram 3 gestações ou mais antes do diagnóstico (73,44%). A citopatologia identificou, com maior frequência, casos de high-grade squamous intraepithelial lesion(HSIL) (45,83%) e cocos e/ou bacilos (66,67%) foram os microrganismos mais evidentes. Conclusões: os resultados revelaram que a idade perimenopausa, baixo grau de escolaridade, multiparidade, resultado citopatológico de HSIL e exame histopatológico evidenciando carcinoma escamoso moderadamente diferenciado, estavam entre as características mais relacionadas ao câncer de colo do útero na população estudada.

Atypical Squamous Cells in Liquid-Based Cervical Cytology: Microbiology, Inflammatory Infiltrate, and Human Papillomavirus-DNA Testing.

OBJECTIVE: The aim of this study was to assess the correlation between atypical squamous cells (ASC) and inflammatory infiltrate and vaginal microbiota using cervical liquid-based cytological (SurePath®) and high-risk human papillomavirus (HR-HPV) tests. STUDY DESIGN: A cross-sectional study was conducted using a 6-year database from a laboratory in Fortaleza (Brazil). Files from 1,346 ASC cases were divided into subgroups and results concerning inflammation and vaginal microorganisms diagnosed by cytology were compared with HR-HPV test results. RESULTS: An absence of specific microorganisms (ASM) was the most frequent finding (ASC of undetermined significance, ASC-US = 74%; ASC - cannot exclude high-grade squamous intraepithelial lesion, ASC-H = 68%), followed by bacterial vaginosis (ASC-US = 20%; ASC- H = 25%) and Candida spp. (ASC-US = 6%; ASC-H = 5%). Leukocyte infiltrate was present in 71% of ASC-US and 85% of ASC-H (p = 0.0040), and in these specific cases HR-HPV tests were positive for 65 and 64%, respectively. A positive HR-HPV test was relatively more frequent when a specific microorganism was present, and Candida spp. was associated with HR-HPV-positive results (p = 0.0156), while an ASM was associated with negative HR-HPV results (p = 0.0370). CONCLUSION: ASC-US is associated with an absence of inflammation or vaginosis, while ASC-H smears are associated with Trichomonas vaginalis and inflammatory infiltrate. A positive HR-HPV is associated with Candida spp. in ASC cytology.

Analysis of the cervical microbiome and potential biomarkers from postpartum HIV-positive women displaying cervical intraepithelial lesions.

The cervical microbiota composition and diversity of HIV-positive women in the postpartum period is unknown. Using a high-throughput bacterial 16S rRNA gene sequencing, we identified four community state types (CSTs). CST III (Lactobacillusdominant) and CST IV (IV-A, IV-B.1, IV-B.2; high-diversity) were found in 41% and 59% of samples, respectively. We did not find association of any CST to postpartum period (six or twelve months), HPV infection or cytology (normal or lesion). However, five bacterial genera were associated with cervical lesions (Gardnerella, Aerococcus, Schlegelella, Moryella and Bifidobacterium), with significant odds ratio (OR) of 40 (2.28-706) for the presence of Moryella and 3.5 (1.36-8.9) for Schlegelella. Longitudinal analysis of samples at postpartum that regressed (lesion to normal), progressed (normal to lesion) and maintained the cytology (lesion or normal) evidenced Gardnerella with a significantly higher abundance in regressing lesions. In the current study, we report the first data on the cervical microbiota of HIV-positive women in the postpartum period. Consistent with previous studies of HIV-negative cohorts, HIV-positive women present a stable cervical microbiota of high-diversity in the postpartum period. Our results highlight that specific microbiota species may serve as sensors for changes in the cervical microenvironment associated with cervical lesions.

Detection of Actinomyces spp. in cervical exudates from women with cervical intraepithelial neoplasia or cervical cancer.

PURPOSE: Under certain circumstances, Actinomyces behaves as an opportunistic microorganism and can cause actinomycosis, a chronic and inflammatory granulomatous infection. The purpose of this project was to detect the presence of Actinomyces in cervical exudates from women with cervical intraepithelial neoplasia (CIN) and women with cervical cancer. METHODOLOGY: Cervical samples from 92 women were divided into three groups: CIN, cervical cancer and healthy women. Metagenomic DNA extraction was performed following the Qiagen QIAamp Mini Kit protocol. A specific fragment (675 bp) was amplified by PCR in order to detect the presence of Actinomycetales. Samples in which Actinomycetales was detected were subjected to separate amplification reactions with primer pairs for A. israelii, A. viscosus, A. meyeri and A. odontolyticus. Amplified products were observed by 2 % agarose gel electrophoresis. RESULTS: Actinomyces were found in 10 % of women with CIN, 36.6 % of women with cervical cancer and 9 % of healthy women. The species identified in this study were A. meyeri in 14/92 samples (15.2 %), A. viscosus in 10/92 samples (10.8 %), A. odontolyticus in 4/92 samples (4.3 %) and A. israelii in 6/92 samples (6.5 %). CONCLUSION: Patients with cervical cancer had a higher prevalence of the presence of Actinomyces compared to the CIN and control groups. This is the first study in which a deliberate search of this genus has been performed in women with cervical pathologies. The use of specific primers for each species facilitated their detection in comparison with traditional isolation methods. More information is necessary to understand the molecular mechanisms involved in the complex role that bacterial communities may play in the development of cancer (and vice versa).

Association of human papillomavirus and Chlamydia trachomatis with intraepithelial alterations in cervix samples.

The influence of different infectious agents and their association with human papillomavirus (HPV) in cervical carcinogenesis have not been completely elucidated. This study describes the association between cytological changes in cervical epithelium and the detection of the most relevant aetiological agents of sexually transmitted diseases. Samples collected from 169 patients were evaluated by conventional cytology followed by molecular analysis to detect HPV DNA, Chlamydia trachomatis, herpes simplex virus 1 and 2,Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, andTreponema pallidum, besides genotyping for most common high-risk HPV. An association between cytological lesions and different behavioural habits such as smoking and sedentariness was observed. Intraepithelial lesions were also associated with HPV and C. trachomatis detection. An association was also found between both simple and multiple genotype infection and cytological changes. The investigation of HPV and C. trachomatisproved its importance and may be considered in the future for including in screening programs, since these factors are linked to the early diagnosis of patients with precursor lesions of cervical cancer.

Association of human papillomavirus and Chlamydia trachomatis with intraepithelial alterations in cervix samples

The influence of different infectious agents and their association with human papillomavirus (HPV) in cervical carcinogenesis have not been completely elucidated. This study describes the association between cytological changes in cervical epithelium and the detection of the most relevant aetiological agents of sexually transmitted diseases. Samples collected from 169 patients were evaluated by conventional cytology followed by molecular analysis to detect HPV DNA, Chlamydia trachomatis, herpes simplex virus 1 and 2,Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, andTreponema pallidum, besides genotyping for most common high-risk HPV. An association between cytological lesions and different behavioural habits such as smoking and sedentariness was observed. Intraepithelial lesions were also associated with HPV and C. trachomatis detection. An association was also found between both simple and multiple genotype infection and cytological changes. The investigation of HPV and C. trachomatisproved its importance and may be considered in the future for including in screening programs, since these factors are linked to the early diagnosis of patients with precursor lesions of cervical cancer.

Cryptococcus laurentii fungaemia in a cervical cancer patient

ABSTRACT Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia byCryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentiiwas isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Cryptococcus laurentii fungaemia in a cervical cancer patient.

Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia by Cryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentii was isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach.

BACKGROUND: Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. METHODS: In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs. RESULTS: Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%). CONCLUSION: Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.

Uterine cervical ectopy during reproductive age: cytological and microbiological findings.

Cervical ectopy is common in adolescents, pregnant women, and those taking high doses of estrogen-containing contraceptives. The majority of cases have spontaneous reversion, but some cases can be persistent. Studies suggested that the adequacy of a Pap smear could be affected and there is an increased risk cervical infections. This study is a cross-sectional study conducted from December 2009 to February 2011 with 457 women with cervical ectopy and 736 without ectopy. Cervical samples were collected in vials for analysis by ThinPrep cytology (Hologic, Marlborough, MA). The Mann-Whitney test and Fisher's exact test (95% CI) were applied. The study was approved by the ethics committee of the Federal University of Ceará. The mean ages of the study group and control group were 28.7 (±14.8) and 33.6 (±7.5) years old, respectively (P < 0.0001). Negative diagnosis for malignancy and intraepithelial lesion was present in 399 (87%) cases and 705 (96%) in the study and control groups, respectively (P < 0.0001). Shift in the flora suggestive of bacterial vaginosis (BV) was observed more frequently in the study group: 74 (16.2%) than in the control group: 86(11.7%) (P = 0.017). The differences among the other morphotypes showed no significance. The smears were atypical in 12.7% (58/457) of the patients from the study group and in 4.2% (31/736) in the control group (P < 0.001; RR = 3 [2.033-4.712]). The association between ectopy and inflammatory cytology, the presence of the shift in the flora suggestive of BV and cytological atypia is evident.

Presence of high-grade intraepithelial lesions among women deprived of their liberty: a documental study.

The aim of this study was to analyze the results of the Pap smears of women deprived of their liberty. It is a retrospective, documental study, with a quantitative approach, performed in a female prison of Ceará, Brazil, with a sample of 672 patient records. Regarding the microbiological findings, it was verified that the main cervical-vaginal colonization was by bacilli suggestive of Gardnerella/Mobiluncus (21.8%), followed by Trichomonas vaginalis (12%), and Candida sp (5.8%). The frequencies of samples with atypical cells presented rates of 4.1% for Atypical Cells of Undetermined Significance; 3.2% for Low-grade Intraepithelial Lesions; and 2.5% for High-grade Intraepithelial Lesions. The importance of screening for cervical cancer in female prisons was highlighted, as well as the inclusion of the nurse in this environment, ensuring individualized, quality care for women deprived of their liberty.

Presence of high-grade intraepithelial lesions among women deprived of their liberty: a documental study / Presença de lesões intraepiteliais de alto grau entre mulheres privadas de liberdade: estudo documental / Presencia de lesiones intraepiteliales de alto grado a las mujeres privadas de libertad: estudio documental

The aim of this study was to analyze the results of the Pap smears of women deprived of their liberty. It is a retrospective, documental study, with a quantitative approach, performed in a female prison of Ceará, Brazil, with a sample of 672 patient records. Regarding the microbiological findings, it was verified that the main cervical-vaginal colonization was by bacilli suggestive of Gardnerella/Mobiluncus (21.8%), followed by Trichomonas vaginalis (12%), and Candida sp (5.8%). The frequencies of samples with atypical cells presented rates of 4.1% for Atypical Cells of Undetermined Significance; 3.2% for Low-grade Intraepithelial Lesions; and 2.5% for High-grade Intraepithelial Lesions. The importance of screening for cervical cancer in female prisons was highlighted, as well as the inclusion of the nurse in this environment, ensuring individualized, quality care for women deprived of their liberty.

Objetivou-se analisar os resultados dos exames citopatológicos de mulheres privadas de liberdade. Estudo documental, retrospectivo, com abordagem quantitativa, desenvolvida em uma penitenciária feminina do Ceará, Brasil, com amostra de 672 prontuários. Quanto aos achados microbiológicos, foi verificado que a principal colonização cérvico-vaginal foram os bacilos sugestivos de Gardnerella/Mobiluncus com 21,8%, seguidos de Trichomonas vaginalis 12,% e Candida sp em 5,8%. As frequências de amostras com atipias celulares mostraram índices de 4,1% para atipias de significado indeterminado; lesões intraepiteliais de baixo grau 3,2% e lesões intraepiteliais de alto grau 2,5%. Conclui-se sobre a importância do rastreio do câncer cervical nos presídios femininos, bem como a inserção do enfermeiro nesse ambiente, garantindo cuidado individualizado e de qualidade para as mulheres privadas de liberdade.

El objetivo fue analizar los resultados de la prueba de Papanicolaou de mujeres privadas de libertad. Tipo de estudio documental, con un enfoque cuantitativo, desarrollado en una cárcel de mujeres en Ceará-Brasil, con muestra de 672 archivos. En cuanto a los resultados microbiológicos se comprobó que el principal colonización de cáncer cervical-vaginal fueron los Bacilos sugestivos de Gardnerella/Mobiluncus con 21,8%, seguido de Trichomonas vaginalis 12% y Cándida sp 5,8%. Las frecuencias de las muestras con atipia celular se registraron tasas de 4,1% para Atipias de significado indeterminado; Lesiones Intraepiteliales de bajo grado 3,2% y Lesiones Intraepiteliales de alto grado 2,5%. La conclusión es la importancia de la detección del cáncer cervical en las cárceles de mujeres, así como la inclusión de los enfermeros en este entorno al tiempo que garantiza una calidad y una atención individualizada a las mujeres presas.

Chlamydia trachomatis as a probable cofactor in human papillomavirus infection in aboriginal women from northeastern Argentina

Objectives: High-risk types of human papillomavirus (HPV) are strongly associated with cervical cancer (CC), and Chlamydia trachomatis (CT), the most frequent sexually transmitted bacterial infection (STBI) worldwide, seems to be a risk factor for HPV infection and for CC. It is also known that both agents are more prevalent in vulnerable communities where lack of adequate primary health care is a cause for concern. The aim of this work was to determine the impact of CT and HPV infections in women belonging to an isolated aboriginal population (Pilaga community) from a poor region in Northern Argentina (province of Formosa). For this purpose, a cross-sectional study was performed in all sexually active Pilaga women, who attended a local community-based gynecological health screening project. The polymerase chain reaction (PCR) method on a cervical brush specimen was used to detect both agents. Results: A total of 227 women (20 percent of the total female population of the Pilaga community) were studied and the overall prevalence was 26.4 percent for CT, 46.7 percent for HPV and 16.3 percent for concurrent infection. CT infection was higher in HPV DNA positive (34.2 percent) than in HPV DNA negative women (19 percent; OR: 2.22/95 percent CI = 1.16-4.28 / p = 0.009) and the most prevalent HPV types were HPV-16 (19.4 percent), 6 and 18 (5.3 percent), 58 (3.5 percent) and 33 (3.1 percent). Conclusions: The prevalence of CT and HPV observed in Pilaga women are among the worst registered in Latin America. Also, data collected suggest that chlamydial infection may play an important role in the natural history of HPV infection. On this respect, we propose that the association between these two agents seems to be more related to a mutual potentiation than to the fact that they share a common route of transmission.

Chlamydia trachomatis as a probable cofactor in human papillomavirus infection in aboriginal women from northeastern Argentina.

OBJECTIVES: High-risk types of human papillomavirus (HPV) are strongly associated with cervical cancer (CC), and Chlamydia trachomatis (CT), the most frequent sexually transmitted bacterial infection (STBI) worldwide, seems to be a risk factor for HPV infection and for CC. It is also known that both agents are more prevalent in vulnerable communities where lack of adequate primary health care is a cause for concern. The aim of this work was to determine the impact of CT and HPV infections in women belonging to an isolated aboriginal population (Pilaga community) from a poor region in Northern Argentina (province of Formosa). For this purpose, a cross-sectional study was performed in all sexually active Pilaga women, who attended a local community-based gynecological health screening project. The polymerase chain reaction (PCR) method on a cervical brush specimen was used to detect both agents. RESULTS: A total of 227 women (20% of the total female population of the Pilaga community) were studied and the overall prevalence was 26.4% for CT, 46.7% for HPV and 16.3% for concurrent infection. CT infection was higher in HPV DNA positive (34.2%) than in HPV DNA negative women (19%; OR: 2.22/95% CI = 1.16-4.28 / p = 0.009) and the most prevalent HPV types were HPV-16 (19.4%), 6 and 18 (5.3%), 58 (3.5%) and 33 (3.1%). CONCLUSIONS: The prevalence of CT and HPV observed in Pilaga women are among the worst registered in Latin America. Also, data collected suggest that chlamydial infection may play an important role in the natural history of HPV infection. On this respect, we propose that the association between these two agents seems to be more related to a mutual potentiation than to the fact that they share a common route of transmission.

Immunological's host profile for HPV and Chlamydia trachomatis, a cervical cancer cofactor.

Over 100 different genotypes of human papillomavirus (HPV) have been isolated to date, while Chlamydia trachomatis is the most common bacterial sexually-transmitted pathogen. This review considers evidence that C. trachomatis infection became a cofactor for HPV establishment and the development of cervical intraepithelial neoplasia.

Molecular diagnosis of human papillomavirus in the development of cervical cancer.

Cervical cancer (CC) is a major public health problem in developing countries and its most significant etiological risk factor is infection by the human papillomavirus (HPV). The main approach to date for the prevention of CC has been through screening programs, using the cervical smear (PAP test) to detect precursory lesions. The sensitivity and specificity of the PAP smear depend on the skills of the observer to recognize and classify a variety of cellular abnormalities. The development of early diagnoses to detect HPV infection has been a problem as cytology and colposcopy identify the lesion at an advanced stage. Therefore, molecular approaches have become more successful for early CC diagnosis. These molecular techniques recognize HPV DNA sequences by DNA hybridization, PCR-RFLP, hybrid capture and reverse line blot systems. Unfortunately, these systems cannot determine whether the HPV infection is active, latent or persistent. Thus, immunological techniques such as Western blot and ELISA have been designed to follow the immune response against the virus, and they can also be used to identify the stage of the infection. Several companies have developed, manufactured and merchandised gene-based testing systems for the screening, monitoring and diagnosis of HPV. Our review and comments focus on the critical analysis of existing products and their use in clinical practice as well as on immunological systems used mainly in research, but that may be applied in large population screening programs.