Is there a role for Chlamydia trachomatis in the development of cervical cancer?

It has been clearly shown that human papillomaviruses (HPV) are the cause of cervical cancer. Moreover, there is also speculation that HPV infection may initiate but not necessarily progress to carcinoma and that oncogenic influences by other factors, or cofactors, are necessary to fully establish HPV-induced malignancy. Such a cofactor is Chlamydia trachomatis infection, which is associated with squamous cell carcinoma of the cervix but not with other cervical carcinomas. More recent clinical studies using newer methods to detect C. trachomatis and HPV generally support the association, although controversy remains. Further clinical studies would be welcomed if a number of factors are considered, including carefully chosen methodology to determine C. trachomatis, as well as HPV status, an appropriate clinical end-point of invasive cervical cancer and sufficient study numbers to warrant appropriate statistical analysis. It would perhaps be even more helpful if future research focused on how C. trachomatis can promote cancer formation and, currently, there are several avenues to pursue how C. trachomatis may interact with HPV. Although exciting HPV vaccines are now available, increasing rates of C. trachomatis infection in the UK raise concern over the value of such a vaccine programme if C. trachomatis was proven to be a cofactor in HPV carcinogenesis. This would almost certainly give more emphasis to the ongoing UK chlamydia screening programme and would provide a helpful public health initiative.