Chlamydia trachomatis and human papillomavirus (HPV) are the most common pathogens found in sexually transmitted infections (STIs), and both are known to increase the risk of cervical cancer (CC) and infertility. HPV is extremely common worldwide, and scientists use it to distinguish between low-risk and high-risk genotypes. In addition, HPV transmission can occur via simple contact in the genital area. From 50 to 80% of sexually active individuals become infected with both C. trachomatis and HPV viruses during their lifetime, and up to 50% become infected with an HPV oncogenic genotype. The natural history of this coinfection is strongly conditioned by the balance between the host microbiome and immune condition and the infecting agent. Though the infection often regresses, it tends to persist throughout adult life asymptomatically and silently. The partnership between HPV and C. trachomatis is basically due to their similarities: common transmission routes, reciprocal advantages, and the same risk factors. C. trachomatis is a Gram-negative bacteria, similar to HPV, and an intracellular bacterium, which shows a unique biphasic development that helps the latter continue its steady progression into the host throughout the entire life. Indeed, depending on the individual’s immune condition, the C. trachomatis infection tends to migrate toward the upper genital tract and spread to the uterus, and the fallopian tubes open up a pathway to HPV invasion. In addition, most HPV and C. trachomatis infections related to the female genital tract are facilitated by the decay of the first line of defense in the vaginal environment, which is constituted by a healthy vaginal microbiome that is characterized by a net equilibrium of all its components. Thus, the aim of this paper was to highlight the complexity and fragility of the vaginal microenvironment and accentuate the fundamental role of all elements and systems involved, including the Lactobacillus strains (Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus crispatus) and the immune–endocrine system, in preserving it from oncogenic mutation. Therefore, age, diet, and genetic predisposition together with an unspecific, persistent low-grade inflammatory state were found to be implicated in a high frequency and severity grade of disease, potentially resulting in pre-cancerous and cancerous cervical lesions.

Background: An interim guidance document by the WHO (World Health Organization) suggests the use of rapid diagnostic tests based on antigen detection as an alternative to the real-time PCR test for the diagnosis of SARS-CoV2 infection, when the molecular RT-PCR test is not available, or the turnaround time is excessive, precluding its clinical and/or public health usefulness. Rapid antigenic tests are recommended when a minimum of 80% sensitivity and 97% specificity are ensured. Methods: Here we employ a new assay for screening applications based on lateral-flow immunofluorescence assay, with microfluidic technology (Boditech AFIAS COVID-19/Flu Ag Combo) on a point-of-care analyzer AFIAS-6 (BoditechMed. Inc.) and compare it with a reference molecular method and an alternative screening immunochromatographic method (Boditech AFIAS COVID-19 Ag). Our study was carried out on stored UTM (at -20°C) samples of patients admitted to Di Venere Hospital of Bari that were already tested with molecular methods. Results: The new AFIAS COVID-19 Flu/Ag Combo test reached a clinical sensitivity of 92% on positive samples with Ct< 30, and a clinical specificity of 97.9% on negative samples. Sensitivity is higher than the reference immunochromatographic test AFIAS COVID-19/Ag (92.0% vs 88.0%) while specificity remains unchanged (97.9% vs 98.0%). In addition the new AFIAS Combo test confirm the same negative predictive value (NPV, 95.9%) of the rapid reference test (AFIAS COVID 19-Ag) and an agreement with the molecular test of 95.9% (Cohen's k = 0.908). Conclusions: Considering its qualitative improvement, rapidity and ease of use we suggests AFIAS Combo test as a valid alternative to the reference lateral flow test (AFIAS COVID-19 Ag) and an adequate screening test. Keywords: SARS-CoV2; COVID-19; POCT; diagnosis; screening; immunoassay; rapid antigen test