Burden of HPV-Associated High-Grade Cervical Lesions, Chlamydia, and Gonorrhea—Connecticut, 2011

Background: Chlamydia and gonorrhea are the first and second most common reportable diseases in the US.  Human papillomavirus (HPV) is estimated to infect three times the number of adolescents and young adults as chlamydia, but many infections are transient and HPV infections are not nationally notifiable.  Surveillance for high-grade cervical lesions (HGCL) caused by HPV that are important precursors to cancer can provide a way to assess the burden of disease.

Methods:  Reporting of HGCL is mandatory in Connecticut (CT) in part to support the Centers for Disease Control and Prevention HPV-IMPACT project.  Rates of HGCL (cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ) were compared to rates of chlamydia and gonorrhea in the US and CT obtained from surveillance for 2011.  Comparisons were age-specific (15–19, 20–24, 25–29, 30–34, and 35–39 years), and rate ratios (RR) were used for comparison with HGCL rates in the numerator.

Results:  HGCL rates in CT were lower than chlamydia in US and CT for all age groups with RRs  ≤ 0.89 except for women ages 35–39 years in which rates were comparable to the US (RR=0.99) and higher than CT (RR=1.26).  Conversely, HGCL rates in CT were comparable to or higher than gonorrhea in US and CT in all age groups between 20–39 years with RRs ranging from 1.03–5.02.

Conclusions: HGCLs are more common than gonorrhea among women ages 20–39 years.  These data reveal a high burden of HGCL that may go unrecognized because few population-based surveillance efforts exist. Additional surveillance efforts may be warranted to expand our understanding of disease burden as well as monitor HPV vaccine impact.  Though the current high rate of HGCL is troubling, it also signals the tremendous impact that vaccines might have if uptake rates can be improved.