aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2025-17-4-22-33aids-1096Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESИзучение рисков канцерогенеза при различных вариантах коинфекции вируса папилломы человека и других возбудителей инфекций, передаваемых половым путемStudy of carcinogenesis risks in different variants of coinfection with human papilloma virus and other sexually transmitted infection agentshttps://orcid.org/0000-0003-0029-7150КасаткинЕ. В.KasatkinE. V.

Касаткин Евгений Владимирович - кандидат медицинских наук, научный сотрудник; главный врач

197101, Санкт-Петербург, ул. Мира, д. 14

195112, Санкт-Петербург, Новочеркасский пр., д. 29/10

Kasatkin Evgenii Vladimirovich

St. Petersburg

kasatkine@gmail.comhttps://orcid.org/0000-0001-9921-3505ЛялинаЛ. В.LyalinaL. V.

Лялина Людмила Владимировна - доктор медицинских наук, профессор, заведующая лабораторией эпидемиологии инфекционных и неинфекционных заболеваний; профессор кафедры эпидемиологии, паразитологии и дезинфектологии

197101, Санкт-Петербург, ул. Мира, д. 14

St. Petersburg

lvlyalina777@yandex.ruСанкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии имени Пастера; Кожно-венерологический диспансер № 8РоссияSt. Petersburg Pasteur Institute; Skin and venereological dispensary No. 8Russian FederationСанкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии имени Пастера; Северо-Западный государственный медицинский университет имени И. И. МечниковаРоссияSt. Petersburg Pasteur Institute; North-Western State Medical University named after I. I. MechnikovRussian Federation2025010320261742233Copyright © Касаткин Е.В., Лялина Л.В., 20262026Касаткин Е.В., Лялина Л.В.Kasatkin E.V., Lyalina L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/1096

Инфекции, передаваемые половым путем (ИППП), распространены во всем мире и являются значительной проблемой национальных систем здравоохранения. Вирус папилломы человека (ВПЧ) ежегодно становится причиной более 600 000 случаев заболевания и 350 000 смертей от рака шейки матки (РШМ). Коинфекции ВПЧ и других ИППП нередко потенцируют возникновение диспластических процессов и РШМ. Значение коинфекции возбудителей ИППП и ВПЧ в канцерогенезе, влияние множественных инфекций ВПЧ на развитие РШМ изучено недостаточно.Цель исследования: оценка распространенности и рисков канцерогенеза при различных вариантах коинфекции вируса папилломы человека и других возбудителей инфекций, передаваемых половым путем.Материалы и методы. Обследовано 9310 ВПЧ-позитивных женщин c ИППП и/или другими заболеваниями. Выявление 14 генотипов ВПЧ проводили методом ПЦР. Диагноз цервикальной интраэпителиальной неоплазии (CIN) устанавливали на основе расширенной кольпоскопии и цитологического исследования. Методы: ПЦР, клинический, эпидемиологический, методы статистики.Результаты и их обсуждение. При коинфекции с ИППП распространенность ВПЧ 16, 18 и 45 генотипов имела статистически значимые различия (32,0%, 9,7% и 11,4% соответственно, p<0,001). Распространенность ВПЧ 16 типа характеризовалась несимметричным распределением между ИППП, демонстрируя максимальные значения при урогенитальном кандидозе, аногенитальных бородавках и хламидийной инфекции (40,7–36,8%) и более низкие при аногенитальном герпесе и цитомегаловирусной инфекции (28,3–26,8%, p=0,02). Распространенность CIN в группе больных ИППП (11,8%) значительно превышала показатель у всех обследованных (5,0%, p<0,001). Сочетание ИППП с одним типом ВПЧ являлось самым частым вариантом коинфекции (92%). Наличие множественной ВПЧ-инфекции при коинфекции с ИППП у больных исследуемой группы не являлось фактором, повышающим риск возникновения или степень тяжести CIN (p>0,05).Заключение. Распространенность ВПЧ среди больных ИППП (30,7%) оказалась достоверно выше, чем в группе сравнения (p<0,001). При коинфекции ВПЧ и ИППП обнаружена высокая распространенность ВПЧ 16 типа (25–40,7%) и CIN различной степени тяжести (3,7–16,7%). Не исключается потенциально высокий риск канцерогенеза в случаях коинфекции ВПЧ и микоуреаплазмозов, аногенитальной герпетической инфекции в связи со значительной распространенностью CIN (12,1–14,1%), сопоставимой с уровнем распространенности CIN при хламидийной инфекции (16,7%, p>0,05). Полученные результаты согласуются с опубликованными данными о негативном влиянии ассоциации ВПЧ и хламидийной инфекции на риск развития неоплазий и дополняют существующую базу знаний с позиций оценки влияния коинфекции ВПЧ и микоуреаплазмозов, аногенитального герпеса, аногенитальных бородавок, а также множественной ВПЧ-инфекции на риск канцерогенеза.

Sexually transmitted infections (STIs) are prevalent worldwide and pose a significant challenge to national healthcare systems. Human papillomavirus (HPV) annually causes over 600,000 cases and 350,000 deaths from cervical cancer (CC). Coinfections with HPV and other STIs often potentiate the development of dysplastic processes and CC. The role of STI and HPV coinfection in carcinogenesis and the impact of multiple HPV infections on the development of CC have been poorly studied.Aim of the study: to assess the prevalence and risks of carcinogenesis in various variants of coinfection with human papillomavirus and other sexually transmitted infection agents. Materials and methods. A total of 9,310 HPV-positive women with STIs and/or other diseases were examined. Detection of 14 HPV genotypes was performed using PCR. The diagnosis of cervical intraepithelial neoplasia (CIN) was established based on extended colposcopy and cytological examination. Methods: PCR, clinical, epidemiological, and statistical methods.Results and discussion. In case of coinfection with STIs, the prevalence of HPV genotypes 16, 18, and 45 had statistically significant differences (32.0%, 9.7%, and 11.4%, respectively, p<0.001). The prevalence of HPV type 16 was characterized by an asymmetric distribution between STIs, demonstrating maximum values for urogenital candidiasis, anogenital warts, and chlamydial infection (40.7–36.8%) and lower values for anogenital herpes and cytomegalovirus infection (28.3–26.8%, p=0.02). The prevalence of CIN in the group of patients with STIs (11.8%) significantly exceeded the indicator in all examined patients (5.0%, p<0.001). The combination of STIs with a single HPV type was the most common coinfection (92%). The presence of multiple HPV infections during coinfection with STIs in patients in the study group did not increase the risk or severity of CIN (p>0.05).Conclusion. The prevalence of HPV among patients with STIs (30.7%) was significantly higher than in the comparison group (p<0.001). In HPV and STI coinfections, a high prevalence of HPV type 16 (25–40.7%) and CIN of varying severity (3.7–16.7%) was observed. A potentially high risk of carcinogenesis cannot be excluded in cases of HPV coinfections with mycoureaplasmosis and anogenital herpes infection due to the significant prevalence of CIN (12.1–14.1%), comparable to the prevalence of CIN in chlamydial infection (16.7%, p>0.05). The obtained results are consistent with existing data on the negative impact of the association of HPV and chlamydial infection on the risk of neoplasia development and complement the existing knowledge base in terms of assessing the impact of HPV coinfections with mycoureaplasmosis, anogenital herpes, anogenital warts, as well as multiple HPV infections on the risk of carcinogenesis.

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The authors declare that there are no conflicts of interest present.