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To the Editor: Dr Anttila and colleagues¹ presented data linking Chlamydia trachomatis with cervical squamous cell carcinoma (SCC). However, because the serologic methods they used to measure human papillomavirus (HPV) infection are of limited sensitivity and narrow spectrum,² the apparent increased risk of SCC associated with C trachomatis infections may be due to residual confounding caused by misclassification of the primary confounding variable, HPV. To assess C trachomatis as an independent cofactor in this study population, we suggest the analysis be restricted only to those women who are seropositive for HPV.

To date, only cigarette smoking and multiparity have emerged as risk factors for SCC after adequate adjustment for HPV status.³ Other genital infections have not been associated with a consistently increased risk for SCC after adjustment for HPV status. However, we agree that C trachomatis infection may act as a cofactor in HPV-induced tumorigenesis via an inflammatory pathway. It . . . [Full Text of this Article]

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