An association of cervical inflammation with high-grade cervical neoplasiain women infected with oncogenic human papillomavirus (HPV)

Previous reports of genital conditions, such as nonspecific genital infecti on/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 eit her genital tract inflammation or changes in bacteria flora consistent with bacterial vaginosis (BV) and cervical cancer. To test whether changes in v aginal bacterial flora or the degree of cervical inflammation are associate d with women having a human papillomavirus (HPV) infection or with women in fected with oncogenic HPV having high-grade cervical lesions (high-grade sq uamous intraepithelial lesions or cancer), we conducted a case-control stud y 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 as sociated with HPV DNA positivity, Analysis 1 was restricted to women with n o or mild (low-grade or equivocal) cytological abnormalities, and the degre e of inflammation and Nugent score (a measure of BV) were compared between women infected (it = 220) and not infected (it = 130) with HPV. To test whe ther BV and inflammation were associated with high-grade lesions, Analysis 2 was restricted to women infected with oncogenic HPV, and the degree of in flammation and Nugent score were compared between women with (it = 95) and without (re = 158) high-grade cervical lesions. In Analysis 1, BV and cervi cal 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 w ith high-grade lesions in oncogenic HPV-infected Women, (P-trend = 0.05). O vert cervicitis was associated with a 1.9-fold increase in risk of high-gra de lesions (95% confidence interval, 0.90-4.1). The results of this study s uggest that cervical inflammation may be associated with high-grade lesions and may be a cofactor for high-grade cervical lesions in women infected wi th oncogenic HPV.