Prevalence of co-infection between high-risk human papillomavirus and common sexually transmitted infections in cervical specimens

Objectives Evidence suggests that co-infection with sexually transmitted infection (STI) pathogens may support HPV infection persistence and cervical disease progression and neoplasia. We examined the prevalence of HPV and co-infection with other common STI pathogens in liquid-based cytology (LBC) cervical specimens, and their association with cervical disease by cytology. Methods In this retrospective, cross-sectional study, 149 randomly selected remnant cervical specimens, collected in LBC as part of routine cervical cancer screening in a large urban academic healthcare system, were tested on the Alinity m HR HPV assay and Alinity m STI assay. All specimens were processed for cytology and graded as negative for intraepithelial lesions or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US) or having any atypical cytology beyond ASC-US (≥LSIL). Results 62.4% (n=93/149) of specimens had abnormal (≥ASC-US) cytology and the remaining 37.6% (n=56/149) had NILM cytology. HR HPV was detected in 62.4% (93/149) of specimens and a single STI pathogen was detected in 11.4% (17/149) of specimens. Most specimens with a positive HPV result (73.1%; n=68/93) or positive STI result (94.1%; n=16/17) had ≥ASC-US cytology. Compared to HPV infection alone, co-infection with HPV and STI was associated with an increased prevalence of ASC-US (39.8% vs. 50.0%) and ≥LSIL cytology (33.3% vs. 41.7%). Having ≥LSIL cytology (OR= 4.1667; 95%CI: 1.6110;10.7763) or a positive STI result (OR= 1.5111; 95%CI: 0.5027;4.5420) were predictive of a positive Alinity m HR HPV assay result. Conclusions Our study confirmed an association between co-infection with HPV and STI pathogens and abnormal cytology in cervical specimens. HPV and STI co-testing may provide granular analyses of the risk of cervical disease associated with co-infections by specific HPV genotypes and STI pathogens. KEY MESSAGES What is already known on this topic Recent studies have suggested a possible link between HPV and STI co-infection, HPV persistence in the reproductive tract, and cervical neoplasia. What this study adds Compared to cervical specimens positive for HPV infection alone, specimens with HPV/STI co-infection had a higher prevalence of abnormal cytology. Having abnormal cytology or a positive Alinity m STI assay result were predictive of a positive Alinity m HR HPV assay result. How this study might affect research, practice, or policy Molecular testing for high-risk HPV and common STI pathogens may reveal additional insight for predictors of cervical disease.