We studied prevalence, risk factors and concordance of vaginal and anal HPV infection and L1 seropositivity among female sex workers (FSW) in Amsterdam.
Methods
In 2016, FSW aged ≥18 years having a sexually transmitted infections (STI) consultation were invited to participate. Participation entailed taking vaginal and anal self-swabs. Demographics and sexual behaviour data were collected. HPV DNA was analysed using the SPF10-PCR-DEIA-LiPA25-system-v1. Serum was tested for HPV L1 antibodies using multiplex serology assays. Determinants of vaginal and anal high risk HPV (hrHPV) infection and L1 seropositivity were assessed with logistic regression analyses.
Results
We included 304 FSW; median age was 29 years (IQR 25–37). Vaginal and anal hrHPV prevalence were 46% and 55%, respectively. HrHPV L1 seropositivity was 37%. Vaginal-anal hrHPV concordance was strong, but no significant association between vaginal or anal hrHPV infection and seropositivity was found. Having had anal sexual contact was not associated with anal hrHPV infection (P = 0.119).
Discussion
Vaginal and anal hrHPV prevalence is high among FSW in Amsterdam, the Netherlands. Promotion of HPV vaccination, preferably at the beginning of the sex (work) career, may be a useful prevention method against hrHPV infection and disease. 相似文献
Initial success rates for fibrin glue ablation of cryptoglandular transsphincteric fistulas have been disappointing. We examined long-term outcomes after initially successful fibrin glue ablation of cryptoglandular transsphincteric fistulas.
Methods
Retrospective review identified 36 adult patients with cryptoglandular transsphincteric fistula Tisseel VH® fibrin glue ablation that was performed from May 2000 to March 2005. Fibrin glue ablations were performed under supervision of fellowship-trained colorectal surgeons. Follow-up interval was based on time until recurrence of fistula or time of last fistula-free evaluation.
Results
Twenty-four men and 12 women patients had a mean age of 50 (range, 27–85) years. Twenty patients responded to initial fibrin glue ablation treatment. Two additional patients healed with secondary fibrin glue ablation. Sixty-six percent (22/33 patients) of cryptoglandular transsphincteric fistulas were closed at three months. Eleven patients failed fibrin glue ablation at a mean of 33 (range, 6–41) days. Seventeen of 22 short-term success patients (3 months) were available for long-term follow-up. Ninety-four percent (16/17 patients) remained healed at final long-term follow-up. The remaining patient recurred just before the six-month follow-up.
Conclusions
Despite the suboptimal early success rate of fibrin glue ablation for cryptoglandular transsphincteric fistulas, when a fistula does close for at least six months this appears to be a durable closure. A single patient recurred after appearing healed at the three-month check.
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results of the first patients treated with this novel approach applying two techniques of sacral spinal nerve stimulator implantation. METHODS: Six patients underwent either of two techniques for electrode placement: one closed (electrodes placed through the sacral foramen) and one open (cuff electrodes placed after sacral laminectomy). Follow-up evaluation of their continence status ranged from 5 to 66 months. RESULTS: Incontinence improved in all patients. The percentage of incontinent bowel movements decreased during chronic stimulation from a mean of 40.2 percent to 2.8 percent, and the Wexner score decreased from a mean of 17 to 2. The function of the striated anal sphincter improved during chronic stimulation: maximum squeeze pressure increased from a mean of 48.5 mmHg to 92.7 mmHg, and median squeeze pressure increased from a mean of 37.3 mmHg to 72.5 mmHg. No complications were encountered perioperatively or postoperatively. Two devices had to be removed because of intractable pain, in one patient at the site of the electrode after five months and in the other at the site of the impulse generator after 45 months. CONCLUSION: Long-term sacral spinal nerve stimulation persistently improves continence and increases striated anal sphincter function in patients with fecal incontinence owing to functional deficits, but in whom the striated anal sphincter is morphologically intact. Two different operative approaches can be applied effectively.Supported by grants from Bayerischen Chirurgen e.V., Munich, Germany; Wilhelm Sander Stiftung, Neustadt, Germany; and Bakken Research Center, Medtronic, Maastricht, the Netherlands.A preliminary report of this study was presented as a poster at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998. 相似文献
PURPOSE: A prospective study was made of the prevalence and associations of pudendal neuropathy in 96 patients with fecal incontinence (72 females and 24 males). METHODS: Clinical exploration, perineal level measurement, anorectal manometry, and electrophysiologic evaluations (pudendal nerve terminal motor latency (PNTML) and external sphincter fiber density (FD)) were performed. RESULTS: Pudendal neuropathy (defined as PNTML>2.2 ms or FD>1.65) was found in 67 patients (69.8 percent) and was more common in females (75 percent) than in males (50 percent;P= 0.05). Pudendal neuropathy was also more frequent in patients with pathologic perineal descent (85 percentvs.55 percent;P<0.01) or exhibiting risk factors such as difficult labor or excessive defecatory straining (P<0.01). Perineal level at straining correlated inversely with both PNTML and FD (P<0.01). Manometric findings suggested greater external anal sphincter damage in patients with pudendal neuropathy than in those suffering fecal incontinence but no neuropathy (P<0.05). Pressure caused by the striated anal sphincter was also inversely correlated to PNTML. Pudendal neuropathy was encountered in 37 of 63 (58.7 percent) patients with sphincter injuryvs.in 31 of 33 (93.9 percent) patients with idiopathic fecal incontinence (P< 0.01). CONCLUSIONS: Pudendal neuropathy is an etiologic or associated factor often present in patients with fecal incontinence. In this sense, clinical, perineometric, and manometric findings correlate with pudendal neuropathy, though such explorations do not suffice to detect it.Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994. 相似文献
Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR.
Methods: Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent uncomplicated vaginal delivery or caesarean section.
Results: There were 93?437 vaginal deliveries. ASR occurred in 5.5% (n?=?2851) of the nulliparous and 1.5% (n?=?608) of the multiparous women. Recurrent ASR occurred in 8% (n?=?49) of whom 50% reported symptoms of AI. We found no difference in the occurrence of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p?=?0.37; OR?=?2.0) or by caesarean section (p?=?0.77; OR?=?1.3).
Conclusion: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies are required to confirm our findings. 相似文献
Anal endosonography is a new technique that is useful in the preoperative assessment of patients with anal fistulas. Endosonographic images are created by the reflection of sound waves from the interfaces between tissues of varying densities. In order to accentuate tissue interface layers at the level of the fistula tract, we introduced hydrogen peroxide into the fistula tract through the external opening during anal ultrasonography in two patients with recurrent anal fistula. Hydrogen peroxide injection resulted in hyperechoic imaging of the preinjection hypoechoic horseshoe fistula tract. Endosonographic findings were confirmed at the time of surgery in both patients. We conclude that hydrogen peroxide enhancement of the fistula tract is a simple, effective, and safe method of improving the accuracy of endoanal ultrasound assessment of recurrent anal fistula.Dr. Cheong is a visiting clinician from the Department of Surgery, Tan Tock Seng Hospital, Moulmein Road, Singapore 1130. 相似文献
Objective This study aims to evaluate the diagnostic precision of endoanal magnetic resonance imaging in identifying anal sphincter
injury and/or atrophy when compared with either endoanal ultrasound or surgical diagnosis.
Materials and methods Quantitative meta-analysis was performed on nine studies, comparing endoanal MRI with endoanal ultrasound or surgical diagnosis
in 157 patients. Sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver operating
characteristic curves (SROC) and subgroup analysis were undertaken.
Results The overall sensitivity and specificity of endoanal MRI for external sphincter injury was 0.78 (95%CI: 0.66–0.84) and 0.66
(95%CI: 0.51–0.79), respectively. For internal sphincter injury detection, this was 0.63 (95%CI: 0.50–0.74) and 0.71 (95%CI:
0.60–0.81), respectively. For detection of atrophy, this was 0.86 (95%CI: 0.71–0.95) and 0.82 (95%CI: 0.65–0.93), respectively.
The area under the SROC curve and diagnostic odds ratio were 0.84 (SE = 0.07) and 6.14 (95%CI: 2.17–17.4) for external sphincter
injury, 0.79 (SE = 0.07) and 4.60 (95%CI: 1.75–12.15) for internal sphincter injury, and 0.92 (SE = 0.08) and 21.49 (95%CI:
2.87–160.64) for sphincter atrophy.
Conclusion Endoanal MRI was sensitive and specific for the detection of external sphincter injury and especially sphincter atrophy. It
may be useful as an alternative to endoanal ultrasound in patients presenting with fecal incontinence, although further clinical
studies are needed to identify its best application in clinical practice. 相似文献
Anal warts (condylomata acuminata) from seven homosexual men revealed intraepithelial carcinoma (carcinomain situ) within the condylomatous tissue or in adjacent anal mucosa. All lesions displayed morphologic evidence of papillomavirus
infection and two of the seven revealed histologic changes characteristic of herpes simplex infection. This association of
viral infection with malignant transformation indicates that persistent or recurrent anal warts should be excised and thoroughly
examined by histologic techniques. Since four of the seven patients had histories suspicious for or diagnostic of the acquired
immunodeficiency syndrome (AIDS), we further suggest that homosexual men with persistent or recurrent perianal lesons be evaluated
for the presence of the syndrome. 相似文献
Anal dilatation is used as a simple method of treatment and has been used for both anal fissure and haemorrhoids. This study
examined longer-term results among a cohort of 162 patients, 132 of whom responded to a detailed questionnaire, an 82% response
(66 patients were male; age range 17–75 years, median 42 years). Follow-up ranged from 16 months to 36 months (median 27 months)
after anal dilatation (68 patients for fissure, 32 for haemorrhoids, and 32 for both). In the early months after dilatation,
83% had symptomatic improvement and 76% remained improved. Five (7%) patients with fissure and 11 with haemorrhoids (17%)
required further hospital treatment, while 10% and 17%, respectively, had received further treatment from their general practitioners
(GPs). Seventy-one percent said they would have a further anal dilation if symptoms recurred. There was no difference in results
obtained by surgeons of different seniority. Complications – bleeding (29%) and difficulty controlling flatus (15%) or faeces
(8%) – resolved in all cases. The results of anal dilatation for fissure are generally satisfactory in the longer term, with
a trend toward better symptom relief in patients with fissure compared with those with haemorrhoids. We do not recommend anal
dilatation as the sole treatment of patients with haemorrhoids, but it may be a useful adjunct to other treatments such as
banding or sclerotherapy. Morbidity was generally acceptable and the majority of our patients would be prepared to have this
procedure again if their symptoms were to return.
Accepted: 14 September 1998 相似文献