Chlamydia trachomatis and Human papillomavirus infections in cervical disease in Argentine women

OBJECTIVES: To examine the prevalence of Human papillomavirus and Chlamydia trachomatis DNA in cervical samples among women with normal and abnormal cervical cytology from La Plata, Argentina. METHODS: Two hundred and seventy-nine women (200 with cervical neoplasia or ICC and 79 women with normal cytology) provided cervical samples for the detection of HPV and C. trachomatis DNA by PCR-based assays. RESULTS: HPV DNA increased with the cervical lesion severity, ranging from 30% among women with normal cytology to 99-100% among women with HSIL or ICC. C. trachomatis DNA prevalence increased from low levels in women with normal cytology (11%) to 47% in those with HSIL, but was uncommon among ICC patients (20%). Among women with normal cytology, C. trachomatis prevalence was higher in HPV DNA positive (12.5%) than HPV DNA negative women (10.9%), but this difference was not significant. CONCLUSIONS: HPV prevalence in the general population is slightly higher than those reported for other developing countries. C. trachomatis DNA positivity was associated with a higher risk of both LSIL and HSIL lesions, but not with ICC.     

Herpes simplex virus infection in women with previous spontaneous abortion

We have carried out a retrospective clinical investigation of 45 women in the first and second trimester of pregnancy aiming to demonstrate the role of genital HSV infection in the genesis of spontaneous abortion (miscarriage). Latent HSV infection was diagnosed using the microneutralization test; asymptomatic HSV vaginal or cervical shedding was diagnosed with indirect immunofluorescence and cytological-Papanicolau staining. The results showed that the highest incidence of latent HSV type 2 infection (64%) occurred in women who had one or more spontaneous abortions, whereas this type of infection was found in only 5% of pregnant women of the control group. The incidence of asymptomatic cervical HSV type 2 infection was also considerably higher in patients with a history of spontaneous abortions. Our results indicate a possible aetiological connection between HSV and spontaneous abortion.     

Human papillomavirus infection and cervical disease in human immunodeficiency virus-1-infected women

OBJECTIVE: To report on the natural history of high-risk human papillomavirus (HPV) infection and cervical disease in human immunodeficiency virus (HIV)-1-infected women living in Cape Town, South Africa. METHODS: This was a prospective study of 400 untreated, HIV-1-infected women who underwent high-risk HPV DNA testing, cytology, colposcopy, histology, and CD4 count testing every 6 months for 36 months. Human immunodeficiency virus viral loads and HPV type distribution were determined at entry and after 18 months. RESULTS: Sixty-eight percent of the women were high-risk HPV DNA positive at entry, 35% had a cytologic diagnosis of low-grade squamous intraepithelial lesion (LSIL), and 13% had high-grade squamous intraepithelial lesion (HSIL). There were no cancers. Abnormal cytology and high-risk HPV positivity were strongly correlated with low CD4 counts and high HIV viral loads. The most prevalent types of HPV were HPV-16, -52, -53, -35, and -18. Incident high-risk HPV infection occurred in 22%, and of those infected with high-risk HPV, 94% of infections persisted over an 18-month period, and 6% cleared their infections. Cytologic progression to SIL from normal/atypical squamous cells of undetermined significance cytology occurred in 17% of cases, but only 4% of cases of LSIL progressed to HSIL. CONCLUSION: There is a high level of high-risk HPV infection in HIV-1 infected women, but progression to HSIL over 36 months occurred in the minority of cases. We recommend an initial colposcopy for an abnormal test, and if no high-grade lesion is identified, triennial screening would be appropriate. Human papillomavirus type 16 was the commonest, and HPV-18 was the fifth commonest, suggesting that vaccination against these two types would have a significant effect. LEVEL OF EVIDENCE: II.     

High risk of human papillomavirus infection and cervical squamous intraepithelial lesions among women with symptomatic human immunodeficiency virus infection.

We investigated the relationship of human papillomavirus (by cervicovaginal lavage and Southern blot), human immunodeficiency virus, and squamous intraepithelial lesions in 96 high-risk women in the Bronx, New York. Antibodies for human immunodeficiency virus were detected in 51 (53%) women. Of the 33 women with symptomatic human immunodeficiency virus infection, 23 (70%) had human papillomavirus infection compared with 4 of 18 (22%) asymptomatic women who were human immunodeficiency virus seropositive and 10 of 45 (22%) uninfected women (p less than 0.0001). The rate of squamous intraepithelial lesions was 52% (14 of 27) for women with both viruses detected, 18% (6 of 34) for women with either virus detected, and 9% (3 of 35) for uninfected women. Among symptomatic human immunodeficiency virus-infected women, a strong association between human papillomavirus infection and squamous intraepithelial lesions was demonstrated (odds ratio, 12; 95% confidence interval, 1.3 to 108). Risk was highest for younger women from ethnic or racial minority groups. Advanced human immunodeficiency virus-related disease, with its associated immunosuppression, seems to exacerbate human papillomavirus-mediated cervical cytologic abnormalities. Public health measures are needed to provide Papanicolaou smear screening and appropriate clinical follow-up and treatment for women at high risk for human immunodeficiency virus infection.     

Herpes simplex virus infection in the newborn

Herpes simplex virus (HSV) infection is a rare disease, but with serious sequelae in the newborn. Despite active treatment with high dose Acyclovir, prognosis on psychomotor development remains unfavorable. A short review of the recent literature about clinical forms, diagnosis, treatment, and disease prophylaxis is presented.     

The significance of human papillomavirus infection detected by cervical cytology among women infected with the human immunodeficiency virus.

Human immunodeficiency virus (HIV) infection is a risk factor for both human papillomavirus infection (HPV) and cervical squamous intraepithelial lesions (SIL). This study was undertaken to determine the prevalence of underlying SIL among women with a cytological diagnosis of HPV infection alone. Of 160 women, the overall prevalence of HIV infection and SIL was 41.9% and 36.9%, respectively. Biopsy which confirmed SIL of any grade was demonstrated in 49.3% and 28% of HIV-infected and HIV-non-infected women. However, for individual grade of SIL, there was no statistical significant difference among the HIV-infected and HIV-non-infected groups. Although the finding of a cytological diagnosis of HPV among HIV-non-infected women is usually managed conservatively, the finding of a high rate of underlying SIL among HIV-infected women may argue against such a conservative approach.     

Herpes simplex virus infections.

This review discusses current reports on herpes simplex virus infections as they relate to the use of laboratory testing, infections in the neonate, herpes simplex virus association with human immunodeficiency virus infection, and updating the current therapy and management of genital herpes. Findings over the past year are important in the clinical management of patients with genital herpes. All health care workers who manage patients with genital herpes need to know the limitations of serologic testing. Current information suggests that serologic commercial testing that is most commonly available cannot discriminate between infections caused by herpes simplex virus type 1 and type 2. Laboratory methods still rely on culturing herpes simplex virus in living cells in vitro. However, the availability of monoclonal antibodies allows for rapid assays for the confirmation of cultured herpes simplex virus. In addition, assays have been developed and tested, suggesting that perhaps antigen-detection systems may be available that could replace culturing the virus in living cells. New information on neonatal herpes points out the predictors of morbidity and mortality in newborns who contract herpes within the first few weeks of life. Information concerning asymptomatic shedding in labor will provide the clinician with a better understanding of this disease entity in the pregnant woman. Several studies have confirmed that herpes simplex virus infection is a risk factor for developing human immunodeficiency virus infection. A new study clearly shows that treatment using daily acyclovir therapy over a prolonged period of time can control and may modify herpesvirus infection.     

Herpes simplex virus infection in pregnancy and transmission to neonatal

Herpes simplex virus (HSV) infection is the most common sexually transmitted viral disease. According epidemiological studies almost one quarter of the adult population in Bulgaria is seropositive for HSV-2. High prevalence of infection, asymptomatic course and limited diagnostic resources increased risk of neonatal acquisition of HSV from pregnant women. The etiology, epidemiology, clinical presentation, diagnostic methods and factors influencing neonatal transmission of HSV are presented.     

Herpes simplex virus

Genital herpes simplex infection remains an infectious disease having widespread consequences for both adult and neonatal populations. Physicians must understand that the psychologic impact of genital HSV infections frequently is more disabling than the physical manifestations. Sensitivity, compassion, and support are necessary from members of the medical community, and psychologic counseling may help patients cope with HSV and all its implications. Similarly, physicians must downplay the hysteria that has been associated with herpesvirus infections, emerging as a result of intense media coverage in the 1970s and 1980s. Minimizing the number of cases of neonatal herpes through identification of infected women during parturition continues to be important. Recent guidelines suggest a rationale for the management of women at risk for genital HSV. Nevertheless, until newer immunologic and serologic techniques become clinically reliable and allow a correct and rapid diagnosis of herpes simplex infection, identification of the infected woman in labor must be made using detailed clinical history, physical examination, and viral culture.     

Sexually transmitted and other genital infections in women with cervical human papillomavirus infection

Objective: We investigated possible correlations between latent cervical human papillomavirus infection (CHPI) and other sexually transmitted diseases (STDs).Methods: Of 972 randomly selected women attending 2 family planning clinics and a youth clinic who had agreed to participate in a study concerning STDs, 66 (6.8%) had latent CHPI.Results: An association was found between latent CHPI on one hand and a history of genital chlamydial infection, gonorrhea, recurrent vaginal candidiasis, cervicitis, or pelvic inflammatory disease (PID) on the other, while no correlation between latent CHPI and coexistent STDs was found. No correlation of latent CHPI to either current or past genital warts was noted. In multifactorial analyses, which included the lifetime number of sexual partners and age at first intercourse, we found that all significant associations except a history of gonorrhea vanished.Conclusions: In this study population, screening for other current STDs in women with latent CHPI would be of limited value.     

Prevalence of human papillomavirus infection and correlation with cervical lesions in Japanese women

PURPOSE: To investigate the prevalence of human papillomavirus (HPV) infection in patients attending a gynecologic outpatient department, and to correlate the infection status with the presence or absence of uterine cervical lesions and the grades assessed by cytological or histological examinations. METHODS: Five hundred and seventy-two subjects were studied. In all subjects, HPV detection by the hybrid capture method and a cervical cytological examination were performed RESULTS: The HPV-positive rate in subjects with normal cytology was 12.3%. The detection rate was high (21.7%) in subjects aged in the twenties and low in the forties, and HPV was not detected in subjects aged in the sixties and seventies. When HPV-positive rates were examined according to cytological or histological grades, the rates were higher in subjects with abnormal cytology (P < 0.01) or cervical intraepithelial neoplasia (CIN) or squamous cell carcinoma compared with those with normal cytology. CONCLUSION: Diagnosis of HPV infection is also important for the prediction of progression to CIN and cervical cancer.     

The relationship between human papillomavirus infection and cervical intraepithelial neoplasia in Turkish women

To compare the prevalence of cervical human papillomavirus (HPV) infection in Turkish women with normal Papanicolaou (Pap) smear and cervical intraepithelial neoplasia (CIN). In between March 2002 and November 2005, the study was designed as case-control study. Cytologic abnormalities in Pap smears were classified according to the Bethesda System (2001). Identification of the presence of HPV was carried out by the Hybrid Capture II test for all patients. To compare the groups, Chi-square test was used. A total of 1353 reproductive aged women were screened. Of them, 1344 (99.3%) had normal or class I Pap smear. Remaining nine cases (0.7%) had CIN at several degrees (five CIN I, three CIN II, and one carcinoma in situ). While all these nine cases with cervical pathologies had HPV, only 20 cases from the other group (1.5%) had HPV (chi(2) 466.1; P = 0.0001). This is the first study of the evaluation of the association between HPV and preinvasive cervical lesions in Turkish population. In spite of low general frequency (2.1%) of cervical HPV colonization in this population, a strong correlation was found between HPV and CIN.     

Herpes simplex virus. An expanding relationship to human cancer

Herpes simplex virus (HSV) causes a wide spectrum of infectious disease in humans. During the past 15 years, evidence has accumulated indicating that, in addition, HSV may be a cause of human cancer, particularly cervical cancer. The research on HSV has taken five directions. First is detection of previous infection with HSV 2. This was the earliest approach and was performed largely with serologic assays. Studies showed a higher incidence of infection with HSV-2 in cervical cancer patients as compared with matched controls. Second is searching for evidence of HSV markers in premalignant and malignant lesions. Viral antigens and nucleic acids have now been demonstrated directly in transformed cells. Antibodies to viral proteins suggestive of abortive infection have been shown to be present in high percentages of cervical cancer patients. Third is searching for in vivo evidence of HSV oncogenic potential. HSV has been shown to be capable of transforming cells in culture. Attempts are being made to determine the fragment of viral DNA responsible for transformation. Fourth is development of animal models for virus-induced cervical cancer. A mouse model is showing promise. Fifth is studying the expanding relationship of HSV to other human cancers. Cancer of the vulva has recently been associated with genital HSV infection.     

The association of Herpes simplex virus and cervical cancer: a review.

Authors using diverse experimental techniques have presented evidence to suggest that there may be an etiologic relationship between HSV-2 and squamous cell carcinoma of the cervix. A score of separate studies from different parts of the world have demonstrated that women with cancer or its precursors are more likely to have antibody activity directed against the virus than are controls. Follow-up data from patients with confirmed Herpes infection indicate that these women develop serious anaplastic changes at a higher rate than the general population. Other data have linked Herpes infection to animal and other human tumors, and experimental work has resulted in the isolation of a virus specific protein antigen reactive with high specificity against antisera from carcinoma patients. The isolation of Herpes DNA and RNA in a human tumor is further suggestive that the virus may have been responsible for the induction of neoplasia.     

Prevalence of different types of human papillomavirus in cervical infection of north Italian women.

We investigated the prevalences of human papillomavirus (HPV) of type 6, 11, 16, 18, 31, 33, 35 and 42 in 276 cervical tissue samples biopsied from a group of North-Italian women in which a HPV infection of the cervix had been suspected. The specimens were evaluated by conventional histological examination and by HPV typing, using Southern blot hybridization on the extracted DNA. We related different degrees of squamous cervical dysplasia, showing or not viral cytopathic effects, with the HPV types harboured in the lesions. Significant rising of HPV 16 prevalences was observed proceeding from mild to moderate and to severe dysplasias both in presence (r = 0.9623, P less than 0.01) and in absence (r = 0.879, P less than 0.05) of koilocytosis, while an opposite trend was detected for HPV 6 and 11. In our sampling we did not find HPV 35 DNA sequences; in all occasions HPV 31 was associated with mild dysplasias. The absolute prevalences of types 18, 33 and 42 were generally low (from 2 to 3%); they did not show any association with specific histological damage of the cervix or with significant patterns related with the progression of cervical dysplasia.     

Adeno-associated virus and human papillomavirus types in cervical samples of pregnant and non-pregnant women

Objective

To investigate the prevalence of AAV and HPV DNA and their types in cervical secretion from pregnant and non-pregnant women.

Study design

The samples were obtained from 40 pregnant and 62 non-pregnant women who were attended at the outpatient clinic of the Federal University Hospital of Espírito Santo, Southeastern Brazil. AAV and HPV were investigated by PCR and typed by PCR and/or RFLP.

Results

The occurrence of AAV in all samples was 25.5% (26/102): 81% (21/26) and 19% (5/26) for AAV2/3 and AAV5 species, respectively. AAV were observed in 35% (14/40) and 19% (12/62) of pregnant and non-pregnant women, respectively. HPV occurred in 22% of all samples; 25% (10/40) in pregnant and 20% (12/60) in non-pregnant women. HPV types were determined for 72.7% of the strains, most of which classified as high-risk. AAV–HPV co-infection was observed in 15.4% (4/26), mostly in pregnant women.

Conclusions

There was a greater prevalence of AAV and HPV in pregnant than in non-pregnant women, which suggests that the gestational state may play a role in reactivating the viruses.     

Herpes simplex virus infection in the first weeks of life

Most neonatal Herpes-simplex-virus infections are the result of virus acquisition during passage through the birth canal. Transplacental transmission of HSV is seldom. The infection is mostly localized at the skin, eyes and central nervous system. The disseminated HSV-infection represents as the most severe clinical picture. It is reported about meningoencephalitis caused by HSV in 3 infants in the first weeks of life. The therapeutic success of antiviral chemotherapeutics depends very much on their application at an early stage of the disease, which can be recognized by cerebral sonography and detection of IgM-antibodies against HSV.