Although Human Papillomavirus (HPV) is a necessary cause of cervical cancer, it is not a sufficient cause, so, others cofactors like co-infection with microbial pathogens could increase that risk. There is an association between the prevalence of high risk HPV genital infection and cervical cancer in adult women.
We studied 1067 patients mean age 37.2±9.9 (range: 17-76 years old) from multicenter hospitals for HPV detection and a sub-sample of these patients (n=172) for HPV and microorganism detection of the Gynecology/Oncology ambulatory of Santiago Hospital. The cervical samples were obtained for cytology, HPV, Ureaplasma parvum, Ureaplasma Urealyticum, Mycoplasma Genitalium and Mycoplasma Hominis detection. The method used for HPV detection and genotyping determination was Polymerase Chain Reaction followed by hybridization. The statistical methods used were Chi-square, ANOVA and binary logistic regression (SPSS v.22). Significance was attributed if P<0.05.
From 1067 patients, 314 (29.4%) had HPV DNA positive among women with normal and abnormal cytology. The incidence of HPV DNA positive was highest in women aged 20-40 years old (n=196, 62.4%). We identified 33 HPV types, which HPV 16 was the most predominated (n=60 (14.6%) followed by HPV types 31 (n=39, 9.5%), 51 (n=38, 9.2%), 52 (n=36, 8.8%), 53 (n=35, 8.5%), and 66 (n=27, 6.6%). The HPV genotypes were classified in low-risk (LR) (n=39, 12.4%), high-risk (HR) (n=286, 91.1%), 2 or more HPV types (n=97, 30.9%). For molecular diagnostic tests, we found that the majority of women with HPV DNA positive presented normal cytology (n=176, 56.1%), followed by atypical squamous cells of undetermined significance (n=100, 31.8%), 35 (11.1%) with low-grade squamous intraepithelial lesions and 3 (1.0%) with high-grade squamous intraepithelial lesions. In a sub-sample (n=172), we found that the presence of genital microorganisms was increased 3.0 times with HPV infection (OR=3.0, 95%CI [1.2-7.9], P=0.019). Furthermore, 2 or more HPV types increased this risk for 3.2 times (OR=3.2, 95%CI [1.3-8.1], P=0.015). Ureaplasma parvum was the microorganism more prevalent (71.4%); being 23.3% HPV positive and 24.1% with 2 or HR of detected HPV.
The presence of genital microorganisms was increased with HPV infection, being the presence of Ureaplasma parvum associated to HPV positive. We propose that the screen for the presence of different microorganisms could be important in prevention of severe dysplasias.