A Mixed Methods Study of STI Co-Infections and Cervical Immune Microenvironment (

EPIC-STI项目3（GRAVITT）：STI合并感染和宫颈免疫的混合方法研究 微环境 总结 需要获得关于性传播感染负担的更好的基本流行病学数据， 共同感染，并在人群中进行转化研究， 生殖道粘膜免疫是专家小组确定的几个关键研究空白之一 会议旨在确定有效预防和控制性传播感染及其疾病后遗症的障碍。使用 混合设计方法，性病流行病学预防跨学科中心项目3（EPIC-STI） 将在以下具体目标中解决这两个研究差距。目标1将利用新的数据， 生物标本资源，新墨西哥州HPV Pap登记处（NMHPVPR），进行基于人群的调查 四种常见性传播感染的年龄特异性患病率--沙眼衣原体（CT），淋病奈瑟菌（NG）， 阴道毛滴虫（TV）和生殖支原体（MG）。该项目目标1的结果和 EPIC-STI项目4中得出的人乳头瘤病毒（HPV）患病率估计值将被合并， 提供一个全面的评估年龄特定的流行病的共同感染与最常见的 在不同种族和地理环境的人群中，病毒、细菌和原虫性传播感染 新墨西哥州，在美国衣原体感染率排名第八。与项目4目标2协同 将研究CT、NG、TV和MG合并感染与高危（HR）-HPV之间的关系， 高度宫颈上皮内瘤变（CIN 2+）的发展。通过将目标1中的STI测试与 NMHPVPR，我们将改进以前的研究，评估CT感染的作用与发展， 通过将个体基础上的合并感染与NMHPVPR可报告疾病联系起来，研究CIN 2+和宫颈癌 结果，使一个独特的机会，研究长期后果的STI和HR-HPV的共同， 感染.最后，将在目标3中进行一项前瞻性队列研究，以描述免疫学 CT感染妇女和CT未感染妇女对照组的微环境，通过测量一组 60种可溶性免疫标志物（细胞因子、趋化因子、生长因子、抗体）， 阿奇霉素治疗前后的宫颈分泌物样本。通过广泛收集STI合作， 感染和行为流行病学数据，这一目标也将提供机会，以评估差异， （1）CT阳性有症状和无症状女性，（2）抗生素治疗前后的免疫特征 （3）治疗时感染持续与消退的女性，以及（4）有和无感染的女性 1年内再次感染。目标3将为EPIC的项目1和2提供关键数据和生物材料- STI，在动物和人类研究之间建立必要的桥梁，旨在更好地了解 CT感染免疫应答和有效疫苗开发。

EPIC-STI PROJECT 3 (GRAVITT): A Mixed Methods Study of STI Co-infections and Cervical Immune Microenvironment SUMMARY The need to obtain better basic epidemiologic data on the burden of sexually transmitted infections (STIs) and co-infections and to conduct translational studies in human populations to expand the knowledge base on mucosal immunity in the genital tract were among several critical research gaps identified by expert panels convened to identify barriers to effective prevention and control of STIs and their disease sequelae. Using a mixed design approach, Project 3 of the Epidemiology Prevention Interdisciplinary center for STIs (EPIC-STI) will address these two research gaps in the following specific aims. Aim 1 will utilize a novel data and biospecimen resource, the New Mexico HPV Pap Registry (NMHPVPR), to conduct a population-based survey of age-specific prevalence of four common STIs - Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG). The results from Aim 1 of this project and the human papillomavirus (HPV) prevalence estimates derived in Project 4 of the EPIC-STI will be combined to provide a comprehensive evaluation of the age-specific prevalence of co-infections with the most common viral, bacterial, and protozoal sexually transmitted infections in an ethnic and geographically diverse population in New Mexico, which ranks 8th in Chlamydia infection in the United States. In synergy with Project 4, Aim 2 will investigate the association between CT, NG, TV, and MG co-infections with high risk (HR)-HPV on the development of high grade cervical intraepithelial neoplasia (CIN2+). By linking the STI testing in Aim 1 with the NMHPVPR, we will improve on previous studies evaluating the role of CT infection with the development of CIN2+ and cervical cancer by linking co-infections on an individual basis to the NMHPVPR reportable disease outcomes, enabling a unique opportunity to study the long term consequence of STI and HR-HPV co- infections. Finally, a prospective cohort study will be conducted in Aim 3 to describe the immunological microenvironment in CT-infected women and a control group of CT uninfected women by measuring a panel of 60 soluble immune markers (cytokines, chemokines, growth factors, antibodies) from sequentially collected cervical secretion samples before and after azithromycin treatment. Through extensive collection of STI co- infection and behavioral epidemiologic data, this aim will also provide the opportunity to evaluate differences in immune profiles in (1) CT positive symptomatic and asymptomatic women, (2) before and after antibiotic treatment, (3) women with persistent vs. resolved infection at treatment, and (4) women with and without reinfection within 1 year. Aim 3 will provide critical data and biological material to Projects 1 and 2 of the EPIC- STI, creating a necessary bridge between animal and human studies targeting a better understanding of the immune response to CT infection and effective vaccine development.