Co-Infection with Chlamydia and HPV: The double whammy effect

Introduction

HPV (Human Papillomavirus) infection remains the most common STD. Almost all sexually active individuals will invariably be exposed to HPV during their course of life. Chronic infection with high-risk HPV subtypes is now known to be responsible for the transformation of normal cervical cells to pre-cancerous and cancer stages.

Chlamydia trachomatis is a pathogenic bacterium that is notoriously transmitted through sexual intercourse. While some with Chlamydia infection can present with lower genitalia abnormal symptoms such as lower pelvic or scrotal pain, abnormal discharge, itching, and pain, most infected people are asymptomatic. Chlamydia infection brings its wake potential long-term health comorbidities such as pelvic inflammatory disease, scarring, and infertility.

Both cervical cancer and chlamydia infection remain important global public health concerns. Cervical cancer is now the 4^th most common cancer in women in the world and 10^th most common cancer in women in Singapore. According to the World Health Organization, there are approximately 128.5million global cases of Chlamydial infection in reproductive adults around the age 15-49 in 2020. 

Simultaneous infection of both HPV and Chlamydia trachomatis is commonly seen in sexually active individuals. Both infections have high prevalence rates globally with the same transmission method. Furthermore, both conditions tend to affect individuals with similar risk factors, including being sexually active, a history of multiple partners, early age of starting to be sexually active. Control of Chlamydia and HPV infection remains a challenge for public health globally due to the high transmission rate and general asymptomatic nature of the diseases.

We want to increase awareness among readers on both conditions and promote sexually active individuals to proactively screen and treat for both conditions.

What are the synergistic deleterious effects of having both Chlamydia and HPV infections?

As a bacterial pathogen, Chlamydia trachomatis impairs the innate mucosal protective barrier in the lower genitalia (the vagina and cervix), diminishing local immune response, facilitating entrance and infection of HPV. 

Chlamydia trachomatis infection allows HPV to evade a person's immune response, weakening the immune system to spontaneously eradicate HPV. This prevents and hampers the clearance of HPV infection, leading to chronic persistent HPV infection and inflammation of the affected reproductive organ.

What are the potential health repercussions of having both Chlamydia and HPV infections?

Untreated Chlamydia increases susceptibility to acquiring HPV infection and prevents the clearance of HPV.

Untreated Chlamydia infection encourages the persistence of high-risk HPV infection, accelerates progression of normal cervical cells to precancerous/ cancerous cervical cells, and increases the risk of developing cervical cancer. 

Co-infection of HPV and Chlamydia infection increase risk of irreversible inflammation of the genitals, resulting in pelvic inflammatory disease and infertility.

How can we screen for Chlamydia and HPV infections? Is it necessarily required to test for both together?

• In view of the fact that one is invariably exposed to HPV during their lifetime if they are sexually active, sexually active females are advised to undergo regular Pap smears and HPV tests.
• While it may not necessarily mean everyone with HPV infections will have chlamydia infection, vice versa; depending on the history of exposure and personal risk factors, one with high-risk HPV infection may benefit from bacterial STD screening including chlamydia testing. Due to possible long-term health complications (discussed above) if there is the presence of untreated co-infections, it is worth considering further bacterial STD testing.

Chlamydia/ other bacterial STD tests can be done via NAAT (PCR) testing following obtaining vaginal/ urine/ rectal/ throat samples. 

HPV test and Pap smear test can be done via obtaining a sample with a cervical swab.

If you are uncertain what tests to consider, or how extensive one is supposed to be tested for, contact us to schedule a confidential consultation. Our doctor can recommend the most appropriate tests based on your symptoms, risk factors, and concerns.

Are HPV and Chlamydia infection treatable?

HPV

• HPV related cervical abnormalities such as precancerous stages are treatable, hence the importance of picking up the infection and abnormalities early during pap smear and HPV testing. Treatment options such as cryotherapy, laser therapy, LEEP, and cone procedure are useful in clearing off affected cervical cells and preventing them from turning into cancer. 
• HPV vaccination has a proven beneficial role in prevention and reduces the risk of acquiring high-risk HPV infection. HPV high-covalent 9 vaccination (Gardasil 9) is currently recommended for a person from the age 9 to 45 years old. 
• By the end of the day, HPV is a viral infection; maintaining a person's wellbeing and immune system, healthy living, avoid smoking are pivotal factors in long-term management of HPV

Chlamydia

Chlamydia trachomatis infection is a curable disease. It can be successfully eradicated following treatment with the right type and dose of antibiotics. Although chlamydia infection is fully treatable, delaying treatment can potentially result in health complications such as chronic inflammation and scarring of the reproductive organs, resulting in pelvic inflammatory disease in women and orchitis/ prostatitis in men, and infertility in both sexes. 

Take Charge of Your Sexual Health

Chlamydia and HPV are two of the most common sexually transmitted infections, and because both can be present without causing noticeable symptoms, regular screening plays an important role in protecting your long-term health. Early detection and timely treatment can help reduce the risk of complications, including persistent HPV infection, pelvic inflammatory disease, infertility, and cervical cancer.

If you are sexually active or have concerns about your risk of STIs, seeking medical advice can help you understand which screening tests or preventive measures are appropriate for your individual circumstances.

At Dr Ben Medical, we provide confidential STI screening, HPV testing, chlamydia testing, vaccination, and personalised sexual health advice to help you make informed decisions about your health. Contact us to schedule a consultation.

What have I learnt today?

• HPV infection and Chlamydia trachomatis are both common STDs seen in sexually active individuals.
• One can have mild to no symptoms when having HPV and Chlamydia infections.
• Persistent inflammation from high-risk HPV infections is responsible for the development of cervical cancer.
• Presence of untreated Chlamydia infection can result in delayed clearance of HPV infection, leading to chronic inflammation, which facilitates the transformation of cervical cells into precancerous and cancerous stages.
• Proactive STD screenings are beneficial in picking up both HPV and Chlamydia infection, especially in those without symptoms.
• Chlamydia infection is a treatable condition.
• HPV vaccination has been clinically proven to prevent and reduce the risk of acquiring HPV infection.

References:

1. Lu Y, Wu Q, Wang L, Ji L. Chlamydia trachomatis enhances HPV persistence through immune modulation. BMC Infect Dis. 2024 Feb 20;24(1):229.
2. M, Inchingolo F, Nguyen KCD, Santacroce L, Mosca A, Del Prete R. Alterations of Vaginal Microbiota and Chlamydia trachomatis as Crucial Co-Causative Factors in Cervical Cancer Genesis Procured by HPV. Microorganisms. 2023 Mar 6;11(3):662.
3. Ribeiro AA, Saddi VA, Carneiro MA, Figueiredo-Alves RR, da Silva Barros NK, de Almeida Carvalho KP, do Nascimento Tavares SB, de Araújo Teles S, D'Alessandro WB, Rabelo-Santos SH. Human papillomavirus and Chlamydia trachomatis infections in adolescents and young women: Prevalence and risk factors. Diagn Cytopathol. 2020 Aug;48(8):736-744.