The Influence Of HPV Latent Infection During The Third Trimester Of Pregnancy On Vaginitis And Pregnancy Outcome

ObjectiveThe aim of this study was to determine the prevalence of bacterial vaginosis(BV), Candida sp,trichomonas vaginalis and HPV in pregnant women;to explore alterations in the vaginal flora and PH of pregnant women in association with the presence of cervical HPV infection;to study the factors predisposing towards the acquisition of this infection; to make sure if HPV latent infection could increase the risk of adverse to outcome of pregnancy,and the necessity of treatment.MethodsWe evaluated 312 voluntary pregnancy women whose gestational weeks were from 28 to 30 regularly checking body in the sixth hospital of shanghai about predisposing factors of HPV by questionnaire face to face between January 2008 and June 2008.Vaginal and cervical secretions were tested for cleaning degree,Candida sp,TV,BV,HPV and vaginal pH.We test HPV DNA by Real-time PCR.Women with HPV DNA positive were in the case group;women with HPV DNA negative were in the control group.Pregnancy outcomes were followed up.Result1.There were 142 pregnant women with HPV latent infection(45.51%),23.08%(72 cases) presented high- risk(type 16\18k31\33\45\52\56\58) HPV,16.67%(52 cases) presented low-risk HPV(type 6\11 ) and 5.8%(18 cases) presented an association of low- and high- risk HPV;The prevalence of Candida sp was 15.06%(47 cases);The prevalence of Trichomonas vaginalis was 1.3%(4 cases);The prevalence of BV was 27.56%(86 cases).2.The vaginal pH was higher in the HPV-positive group than in the HPV-negative group (p＜0.01).The prevalence of BV was statistically significant between pregnant women with HPV infection compared to pregnant women without HPV infection(P=0.002); Candida sp(P=0.118) and Trichomonas vaginalis(P=0.492) were all not statistically significant between pregnant women with HPV latent infection compared to pregnant women without HPV infection.3.HPV latent infection had correlations with educational background,smoking and the number of sexual partners(P＜0.05).4.There was no statistically difference in the mode of delivery between the case group and the control group(P=0.636).5.The prevalence of PROM was significantly higher(34.5%) in the HPV-positive group than in the HPV-negative group(18.2%),P=0.001.The prevalence of puerperal infection was significantly higher(4.9%) in the HPV-positive group than in the HPV-negative group(0.6%),P=0.04.We did not found any difference in premature labor,postpartum hemorrhage,asphyxia neonatorium and so on.6.Logistic regression analyses show that the latent HPV infection can increase the risk of PROM(P=0.007,OR:2.080,95%CI:1.220-3.548);and BV can increase the risk of acquiring PROM(P=0.002,OR:2.404,95%CI:1.395-4.142),puerperal infection (P=0.008,OR:17.744,95%CI:2.151-146.373),preterm birth(P=0.018,OR:7.851, 95%CI:1.433-43.022).Candida sp can increase the risk of preterm birth(P=0.015,OR: 6.985,95%CI:1.448-33.686).7.There was significantly association between BV and chorioamnionitis.ConclusionHPV latent infection rate was very high during pregnancy.HPV latent infection was association with variations in vaginal PH,and could increase the risk of acquiring BV.No difference was found between the case group and the control group in the prevalence of Candida sp and TV.Significantly,genital tract infections(cervix uteri HPV infection included) during gestation affected the pregnancy outcome.Additionly,HPV latent infection had correlations with educational background,smoking and the number of sexual partners.Prenatal care should be enforced and genital tract infection should be treated actively.