Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk: Results from the EPIC cohort

Int J Cancer. 2020 Oct 15;147(8):2042-2052. doi: 10.1002/ijc.32999. Epub 2020 Apr 24.


A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead-based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22-4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60-1) was associated with higher risk of EOC overall (1.36 [1.13-1.64]) and with the serous subtype (1.44 [1.12-1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV-2 was associated with higher risk of endometrioid EOC (2.35 [1.24-4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV-2 might promote the development of endometrioid disease.

Keywords: Chlamydia trachomatis; Mycoplasma genitalium; herpes simplex virus; human papillomavirus; ovarian cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Carcinoma, Ovarian Epithelial / blood
  • Carcinoma, Ovarian Epithelial / etiology
  • Carcinoma, Ovarian Epithelial / virology
  • Case-Control Studies
  • Chlamydia Infections / blood*
  • Chlamydia Infections / complications*
  • Chlamydia Infections / genetics
  • Chlamydia Infections / virology
  • Chlamydia trachomatis / pathogenicity*
  • Female
  • Human papillomavirus 16 / pathogenicity
  • Humans
  • Middle Aged
  • Mycoplasma genitalium / pathogenicity
  • Ovarian Neoplasms / blood*
  • Ovarian Neoplasms / etiology*
  • Ovarian Neoplasms / virology
  • Papillomavirus Infections / blood
  • Papillomavirus Infections / genetics
  • Papillomavirus Infections / virology
  • Prospective Studies
  • Risk
  • Risk Factors
  • Sexually Transmitted Diseases / blood
  • Sexually Transmitted Diseases / etiology*
  • Sexually Transmitted Diseases / virology*


  • Biomarkers