Abnormalities of the uterine cervix in women with vulval warts. A preliminary communication.

Fifty women attending a clinic for sexually transmitted diseases with vulval condylomata acuminata were examined by cervical cytology and colposcopy for cervical infection by human papillomavirus (HPV) or epithelial abnormality indicating cervical intraepithelial neoplasia (CIN) or both. Collated results showed a high prevalence of both conditions in these 50 women; 25 (50%) had evidence of cervical infection by HPV and 18 (36%) epithelial abnormalities consistent with CIN 1 or 2.     

The association between sexually transmitted pathogens and cervical intra-epithelial neoplasia in a developing community.

OBJECTIVE--To determine the association of sexually transmitted pathogens in women with cervical intra-epithelial neoplasia (CIN). SETTING--An urban tertiary referral hospital serving a large indigent developing community. PARTICIPANTS--48 women attending a colposcopy clinic and 49 women attending a family planning clinic. METHODS--Vaginal, endocervical, rectal swab specimens and sera were collected for the detection of sexually transmitted pathogens. Cervical cytology was performed on all patients. Women attending the colposcopy clinic had confirmation of abnormal cervical cytology by colposcopic directed biopsy. RESULTS--The mean age of women with CIN (33 years) was significantly greater than that of the women without CIN (28 years) and that of the family planning group (26 years). There was a high prevalence of sexually transmitted pathogens in all women. A significantly higher prevalence of bacterial vaginosis was found in women with CIN compared to those without (50% vs 20%; p = 0.034). The human papilloma virus (HPV) was detected in 46% of women with CIN and 65% of those without CIN. Chlamydia trachomatis (21%) and Trichomonas vaginalis (39%) were detected frequently in women with CIN. C. trachomatis (14%-21%) was detected more frequently than Neisseria gonorrhoeae (3-5%) in all asymptomatic women studied. CONCLUSION--This study demonstrates a high prevalence of sexually transmitted pathogens in women with and without CIN as well as family planning clinic attenders. Bacterial vaginosis was a significant finding in women with CIN. C. trachomatis was detected in a high proportion of all women studied and found more commonly than N. gonorrhoeae. We therefore recommend that all women attending gynaecological services in a developing community be investigated and treated for sexually transmitted diseases.     

Abnormalities of the uterine cervix in women with vulval warts. A preliminary communication

Fifty women attending a clinic for sexually transmitted diseases with vulval condylomata acuminata were examined by cervical cytology and colposcopy for cervical infection by human papillomavirus (HPV) or epithelial abnormality indicating cervical intraepithelial neoplasia (CIN) or both. Collated results showed a high prevalence of both conditions in these 50 women; 25 (50%) had evidence of cervical infection by HPV and 18 (36%) epithelial abnormalities consistent with CIN 1 or 2.     

Managing women with human papillomavirus changes in cervical cytology.

Of 86 women with cervical cytological evidence of human papillomavirus (HPV) infection who underwent colposcopy, 55 yielded histological confirmation of HPV infection and 17 of them had cervical intraepithelial neoplasia (CIN). Of 51 women followed up six months after cryotherapy of their cervical lesions, 46 showed no evidence of HPV infection in their cervices. Of the patients with CIN lesions, only one out of the 16 followed up had persistent CIN II six months after treatment, which gave a clearance rate of 94% for early CIN lesions treated by this method. Of 62 sexual partners examined, 48 had sexually transmitted infections, 38 of them genital warts. The use of colposcopy with directed punch biopsy is a practical way of managing patients whose cervical smears suggest HPV infection. Cryotherapy is effective in treating histologically confirmed cervical HPV and associated minor CIN lesions. Contact tracing and screening for other sexually transmitted diseases is an integral part of managing genital warts.     

Coexistent chlamydial infections related to natural history of human papillomavirus lesions in uterine cervix.

To assess the role of Chlamydia trachomatis in the development of cervical intraepithelial neoplasia (CIN) and to evaluate possible synergism between chlamydiae and human papillomavirus (HPV) in this process, 418 women who had been prospectively followed up for cervical HPV infections at our clinic since 1981 were tested for chlamydiae. At each visit the patients were examined by colposcopy, and other investigations, such as Papanicolaou (Pap) smears, punch biopsies, urethral, and cervical swabs, were undertaken as indicated. In biopsy specimens the cytopathic changes of HPV, concomitant CIN, and the local immunocompetent cell infiltrates were analysed. The latter were measured and further identified using an alpha naphthyl acetate esterase (ANAE) technique to define B cells, macrophages, and T cells and using monoclonal antibodies to define T cell subsets, NK (natural killer cells), and Langerhans cells. Chlamydial isolation (4.1% in the cervix, and 3.6% in the urethra) did not positively correlate with the degree of cytological atypia in PAP smears or with the degree of CIN lesions associated with HPV. Chlamydial cervicitis did not affect the ANAE definable cell composition of the immunocompetent cell infiltrates in HPV lesions, or that of the immunocompetent cell subsets, including the ratios of T helper to T suppressor cells and the numbers of NK cells. Chlamydial infection did not alter the natural history of HPV lesions, of which 30% regressed, 53% persisted, and 17% progressed during follow up. The present results do not provide evidence to substantiate the hypothesis that chlamydiae and HPV might act synergistically in cervical carcinogenesis, or the view that C trachomatis may be a major aetiological agent of CIN lesions. Chlamydiae and HPV are covariables of sexual behaviour, and their concomitant appearance in sexually promiscuous women is best explained by this fact. As we do not have more direct evidence for the oncogenic potential of C trachomatis (as we have of HPV), it seems reasonable to consider that this agent is not a major cause of CIN, but rather a sexually transmitted agent commonly found in women with CIN because of their promiscuous sexual behaviour.     

Screening for cervical dysplasia in department of genitourinary medicine.

In 632 patients attending a sexually transmitted disease (STD) clinic who were colposcoped because they were in certain high risk groups for cervical neoplasia, and irrespective of cytological findings, 13 out of 51 biopsied had false negative cytology results. Human papilloma virus (HPV) was the most important sexually transmitted agent associated with cervical intraepithelial neoplasia (CIN), but HPV was also present in most patients with false negative (11/13) and false positive (11/14) cytology results. Screening by colposcopy, as well as cervical cytology, is therefore mandatory and must be available for certain STD clinic patients.     

Do condoms prevent genital HPV infection,external genital warts,or cervical neoplasia? A meta-analysis

BACKGROUND: Although condoms most likely prevent HIV infection, evidence of their effectiveness against other sexually transmitted diseases is mixed. GOAL: The goal of the study was to determine whether condom use prevents genital human papillomavirus (HPV) infection and HPV-related conditions. STUDY DESIGN: We conducted a literature review and meta-analysis of the effect of condom use on the prevention of genital warts, subclinical HPV infection, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer (ICC). RESULTS: Among 27 estimates from 20 studies, there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive. However, risk for genital warts, CIN of grade II or III (CIN II or III), and ICC was somewhat reduced. CONCLUSIONS: Available data are too inconsistent to provide precise estimates. However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts, CIN II or III, and ICC.     

Prevalence and determinants of Chlamydia trachomatis infections in women from Bogota, Colombia

OBJECTIVES: Chlamydia trachomatis infection in the cervix and uterus has been hypothesised to be a co-factor for cervical cancer. We performed a cross sectional study in Bogota, Colombia, where cervical cancer rates are high, to determine the prevalence and determinants of C trachomatis infection, and in particular its association with human papillomavirus (HPV). METHODS: 1829 low income sexually active women were interviewed and tested for C trachomatis, using an endogenous plasmid PCR-EIA, and for 37 HPV types, using a general primer GP5+/6+ mediated PCR-EIA. RESULTS: The overall prevalence of C trachomatis was 5.0%, and it did not differ substantially between women with normal (5.0%) and those with abnormal (5.2%) cervical cytology. Women infected with any HPV type (15.1%) had a slightly increased risk of being simultaneously infected with C trachomatis (adjusted OR 1.3, 95% CI: 0.8 to 2.4). This association was stronger when multiple HPV infections (adjusted OR 2.5, 95% CI: 1.1 to 5.9) were present. No other lifestyle or reproductive characteristics were clearly associated with risk of C trachomatis infection. CONCLUSIONS: HPV infected women, particularly women with multiple HPV infections, are at increased risk of being infected with C trachomatis.     

Prognostic factors in cervical human papillomavirus infections.

A prospective follow-up study, without further treatment, of a series of 528 women with cervical human papillomavirus (HPV) infections was conducted from 1981 to the present, with a mean follow-up time of 60.3 months (standard deviation 25.1 months). The women visited the Outpatient Department of Gynecology, Kuopio University Hospital, Kuopio, Finland at six-month intervals. At each visit, a thorough gynecologic examination, PAP-smear, and colposcopy with or without punch biopsy were performed. Epidemiologic data were collected by questionnaire, and complete follow-up data were available for 480 of the 528 women. Of these 480 cases of HPV infection, 58.3% regressed spontaneously, and clinical progression was detected in 14.8%. To establish the prognostic factors associated with the clinical course of cervical HPV infections, the Cox proportional hazards regression model was applied. In the analysis, five variables were included: age, PAP-smear class, grade of cervical intraepithelial neoplasia (CIN), HPV type, and colposcopic appearance at the first visit. In general, patient age at the time of diagnosis was inversely related to the probability of spontaneous regression (P less than 0.01). CIN II, CIN III and HPV type 16 were the most significant independent prognostic factors for progression of cervical HPV infections (P less than 0.001, P less than 0.0001, and P less than 0.001, respectively). We conclude that whenever HPV 16 DNA is found in the cervical biopsy with any grade of CIN, the lesion should be treated. Similarly, the presence of CIN II and CIN III indicates treatment whether HPV DNA are detected or not.(ABSTRACT TRUNCATED AT 250 WORDS)     

The silent suffering women--a population based study on the association between reported symptoms and past and present infections of the lower genital tract.

OBJECTIVES--To assess the prevalence of lower genital tract symptoms and the association between reported symptoms and past and present signs of sexually transmitted diseases (STD) in young women. DESIGN--All women belonging to the 19-, 21-, 23- and 25-year age cohorts and living in the catchment area of the community health centre, were invited by mail to take part in a population-based study. The participants answered a structured questionnaire and a gynaecologic examination was performed. Samples for wet smear, cervical Pap smear, HPV DNA determination and Chlamydia trachomatis culture were taken at the gynaecologic examination. The presence of genital warts was noted. A blood sample was analysed for antibodies against C trachomatis and HSV-2. SETTING--The community health care centre was located in Umeå, a city in Northern Sweden. RESULTS--Of the 886 women who were eligible, 611 (70%) participated in the investigation. One out of four women reported symptoms from the lower genital tract. The most commonly reported symptoms were itching, followed by discharge, and soreness. The most commonly reported STD was C trachomatis (15%). The most prevalent present STD was HPV infection (20%) whereas C trachomatis infection could be isolated from 2.7% of the women. Antibodies against C trachomatis and HSV-2 were present among 22% and 6% of the women, respectively. There was a significant correlation between the women's complaint of vaginal discharge and previous C trachomatis infection, lack of lactobacilli and presence of leucocytosis in wet smear. CONCLUSIONS--We have in a population-based study of young healthy women found that one out of four women had some kind of lower genital tract complaint. Itching was the most commonly reported symptom and was associated with pseudohyphae and acetowhite patches. Reported vaginal discharge and soreness were associated with the history of a past C trachomatis infection and signs of a disturbed vaginal flora.     

Human immunodeficiency virus, human papillomavirus, and cervical intraepithelial neoplasia in Nairobi prostitutes.

To evaluate the impact of human immunodeficiency virus (HIV) on human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN), a study was conducted of 147 HIV-seropositive and 51 HIV-seronegative prostitutes in Nairobi, Kenya. Among the women infected with HIV, 10 (7%) had signs or symptoms of significant HIV-related disease, and the remaining 93% were asymptomatic. The prevalence of cervical HPV DNA was 37% among HIV-seropositive women and 24% in HIV-seronegative women (odds ratio [OR] 1.7, 95% confidence intervals [CI] 0.8, 3.6, after adjusting for potential confounding factors). Genital warts, cervical HPV DNA, and cytologic findings consistent with CIN were all significantly associated with younger age and fewer years of prostitution, but were unrelated or weakly related to number of sexual partners per week or frequency of condom use. In a subset of 63 women with evaluable Papanicolaou smears, CIN was found in 50% of the women with HPV but only in 8% of those without HPV (adjusted OR 7.2, 95% CI 1.6, 32.1, P = 0.006). However, CIN was unrelated to HIV seropositivity (prevalence of 26% among HIV-seropositive women and 24% in HIV-seronegative women). Among women with cervical HPV DNA, HIV infection was not associated with an increased prevalence of CIN (47% prevalence among women with HIV versus 57% prevalence among women without HIV). Thus, in this population of HIV-seropositive women, most of whom had CDC Stage II or III infection, there was no demonstration of an adverse impact of HIV on CIN.     

Value of colposcopy in sexually transmitted diseases clinic based on first year''s experience.

Two hundred and thirty two patients underwent cervical colposcopy within the first year of establishing a colposcopy service in the sexually transmitted diseases clinic at St Mary's Hospital, London. Their mean age was 27 years. Cervical intraepithelial neoplasia (CIN) was identified in 68 of 81 (84%) patients whose smears showed dyskaryosis and who underwent biopsy. CIN was also detected in 14 of 41 (34%) patients who underwent biopsy and whose repeat smears were reported as giving normal results. The value of assessing two consecutive smears was evident, however, because none of the 99 patients with CIN had two normal smear results consecutively. Patients requiring treatment underwent laser ablation, which was provided in the department of gynaecology. These results show that colposcopy plays a vital part in managing patients with abnormal smears and indicate that genitourinary physicians need to give priority to developing colposcopy services in their specialty.     

宫颈上皮内瘤变患者HPV感染情况及转阴率的相关因素分析

目的:研究宫颈上皮内瘤变(CIN)患者人乳头瘤病毒(HPV)感染情况及转阴率的相关影响因素。方法:选取我院2012年1月至2016年1月173例宫颈上皮内瘤患者为研究对象,进行HPV检测。所有患者均在我院接受宫颈上皮内瘤变手术治疗,对术后6个月HPV转阴的患者进行相关影响因素分析。结果:正常组(60例)、CINⅠ级组(68例)、CINⅡ级组(59例)、CINⅢ级组(46例)的HPV感染率分别为18.3%、63.2%、81.4%、95.7%。年龄、病毒负荷量、病理切缘、避孕方式、性伴侣个数、配偶性伴侣个数等6项影响HPV转阴率的相关因素差异具有统计学意义(P0.05)。结论:HPV感染率随宫颈上皮内瘤变病变程度增加而上升,严密检测HPV有利于预警病情发展,提高宫颈癌诊断准确率。年龄、病毒负荷量、病理切缘、避孕方式、性伴侣个数、配偶性伴侣是HPV转阴率的相关影响因素,控制相关影响因素对宫颈上皮内瘤变的预后有重要意义。     

Herpes simplex virus seroprevalence and risk factors in 2 Canadian sexually transmitted disease clinics

OBJECTIVES: The objectives of this study were to determine the seroprevalence and risk factors for herpes simplex virus (HSV) types 1 and 2 in patients attending 2 Canadian sexually transmitted disease (STD) clinics. STUDY: Stored sera were tested for the presence of IgG class antibodies to HSV-1 and HSV-2 and results linked to that obtained from a risk behavior questionnaire. RESULTS: Overall prevalences for HSV-1 and -2 were 56% and 19%, respectively. HSV-1 and -2 seropositivity was associated with increasing age, female gender, nonwhite ethnicity, and a history of STD. HSV-2 seropositivity was also associated with a history of genital herpes, presence of genital sores, and coinfection with either human immunodeficiency virus (HIV) or hepatitis C (HCV). CONCLUSIONS: Herpes simplex infection is common in this high-risk Canadian population. Our finding that HCV seropositivity was a significant predictor for HSV-2 seropositivity emphasizes the overlap between pathogens that are primarily thought to be bloodborne pathogens and sexually transmitted infections and the need to target prevention in these areas concurrently.     

No association of anti-Chlamydia trachomatis antibodies and severity of cervical neoplasia

OBJECTIVE: To explore whether the presence of Chlamydia trachomatis antibodies is associated with the severity of neoplastic lesions in women with cervical dyskaryosis. METHODS: In a cross sectional study in two groups of women referred for an abnormal Papanicolaou smear (group A: 296, group B: 331 women) blood samples were analysed for antichlamydial antibodies by enzyme immunoassay. Cervical neoplasia was graded histologically. RESULTS: In group A no association was found between increasing grade of CIN and the presence of antichlamydial antibodies. The proportion (93%) of women with antichlamydial antibodies was higher in 14 women with (micro)invasive carcinoma than in women with CIN (35%). As the high prevalence of antichlamydial antibodies in women with cervical carcinoma is not consistent with prevalences reported in recent literature, we analysed a second group of women in which indeed the high prevalence was not confirmed CONCLUSION: Our results suggest that the presence of circulating antichlamydial antibodies is not associated with the severity of neoplastic lesions and it seems unlikely that C trachomatis has a role in the progression of cervical neoplasia.     

35245例宫颈癌筛查结果分析

目的:了解沈阳市苏家屯区农村已婚妇女子宫颈癌的发病率,争取对农村宫颈癌妇女做到早发现、早治疗,降低死亡率.探索更适于农村妇女的宫颈癌检查方式.方法:从2009 ～2011年连续3年对苏家屯区已婚农村妇女共35245人,进行宫颈脱落细胞学检查,妇科检查和脱落细胞学异常者行阴道镜检查和组织病理学检查.结果:通过3年的检查,2009年检出101例宫颈癌前病变和4例宫颈癌,发病率分别为14.43‰和57.2/10万.2010年检出101例宫颈癌前病变和10例宫颈癌,发病率分别为7.15‰和70.8/10万.2011年检出67例宫颈癌前病变和5例宫颈癌,发病率分别为4.74％和35.4/10万.宫颈癌前病变和宫颈癌的发病率均在40 ～ 59年龄段最高;19例宫颈癌中,2例为年轻宫颈癌患者,15例在40 ～59年龄段.结论:我区属宫颈癌高发地区,宫颈癌的发病趋于年轻化.宫颈癌发病率呈现出从上升到下降的变化,这也证实了宫颈癌筛查是早期发现和早期治疗宫颈癌的重要措施.     

Attack rates of human papillomavirus type 16 and cervical neoplasia in primiparous women and field trial designs for HPV16 vaccination

BACKGROUND: Identification of human papillomavirus type 16 (HPV16) as the major risk factor for cervical neoplasia, and mass production of DNA free HPV capsids have paved the way to preventive vaccination trials. Design of such trials requires reliable attack rate data. OBJECTIVE: Determination of (1) HPV16 and (2) cervical neoplasia attack rates in primiparous women. Estimation of actuarial sample sizes for HPV16 vaccination phase IV trials. DESIGN: A longitudinal cohort study. METHODS: Population based Finnish Maternity Cohort (FMC) and Finnish Cancer Registry (FCR) were linked for the identification of two cohorts of primiparous women: (1) a random subsample of the FMC: 1656 women with two pregnancies between 1983-9 or 1990-6 and living in the Helsinki metropolitan area, and (2) all 72,791 primiparous women living in the same area during 1983-94. Attack rate for persistent HPV16 infection (1) was estimated in 1279 seronegative women by proportion of seroconversions between the first and the second pregnancy. Comparable 10 year cumulative incidence rate (CR) of cervical intraepithelial neoplasia grade III and cervical cancer (CIN III+) (2) was estimated based on cases registered at the FCR during 1991-4. RESULTS: The HPV16 attack rates were 13.8% (< 18 years), 7.0% (18-19 years), 2.3% (21 years), 2.4% (23 years), and 4.5% (< 25 years). Number of vaccinees required for a 5 year efficacy trial with persistent HPV16 infection as the end point ranged between 1000 and 3900, assuming 80% power, 90%-70% vaccine efficacy (VE), and misclassification. The CRs of CIN III+ were 0.33% (< 18 years), 0.44% (18-19 years), 0.21% (20-24 years), and 0.28% (< 25 years). Number of vaccinees required for a 10 year efficacy trial with HPV16 positive CIN III+ as the end point was 15,000 assuming 80% power, 90% VE, and 75% aetiological fraction of CIN III+ for HPV16. CONCLUSIONS: The attack rates of HPV16 and CIN III+ identify primiparous women under 25 years of age among target populations for postnatal HPV vaccination at phase II/III trials.     

Prevalence of high risk human papillomavirus types among Nicaraguan women with histological proved pre-neoplastic and neoplastic lesions of the cervix

OBJECTIVES: To determine the prevalence of high risk human papillomavirus (HPV) types in Nicaraguan women with histological proved pre-neoplastic and neoplastic cervical lesions, and to assess its potential impact on preventive strategies. METHODS: 206 women with histopathological confirmed cervical lesions (CIN I or worse) were screened for HPV DNA on a liquid based cytology sample, using an HPV short fragment polymerase chain reaction based assay. HPV positive samples were genotyped with a reverse hybridisation line probe assay (Lipa). HPV negative samples were re-analysed using type specific real time polymerase chain reaction. RESULTS: Of all lesions CIN II or worse, 12% tested negative. Prevalence of high risk HPV increased from 48.1% in cervical intraepithelial neoplasia I (CIN I) to 94.7% in invasive squamous cervical carcinoma (SCC). The most prevalent high risk HPV types were, in order of prevalence rate, HPV 16, 58, 31 and 52. HPV 16 and/or HPV 31 were present in 63.2% of SCC cases. CONCLUSION: Targeting HPV 16 and 31 with prophylactic vaccines could possibly have an important impact on the incidence of invasive cervical carcinoma in Nicaragua. Further research is needed to define the oncogenic potential of other high prevalent HPV genotypes. Meanwhile, primary prevention and cervical cancer screening programmes should be optimised.     

Detection of human papillomavirus genotypes among high-risk women: a comparison of hybrid capture and linear array tests

OBJECTIVES: To assess the concordance and performance of 2 different assays in detection of human papillomavirus (HPV) genotypes among women with abnormal Pap smear. STUDY DESIGN: A series of 575 women referred for colposcopy due to an abnormal Pap smear were analyzed with the Linear Array HPV Genotyping test detecting 37 HPV types and compared with Hybrid Capture II (HCII) assay for detection of carcinogenic HPV. Histologic outcomes of cervical intraepithelial neoplasia grade 2 (CIN2) or worse (CIN2+) and CIN3+ were the primary endpoints. Clinical performance, including receiver operating characteristics, was determined for both tests. RESULTS: HCII and linear array (LA) were concordant in 88.1% (433/491; 95% CI 85.3%-91.0%), having a substantial agreement with regular kappa (kappa = 0.70, 95% CI 0.62-0.77) and almost perfect agreement with weighted kappa (ICC = 0.82, 95% CI 0.7-0.85). In detecting CIN2+ and CIN3+, LA is 5% and 6% more sensitive but 9.5% and 8.7% less specific than HCII (area under ROC curve; P = 0.317 and P = 0.875, respectively). CONCLUSIONS: Performance of HCII and LA does not significantly differ in detecting CIN2+ or CIN3+.     

Increased prevalence of herpes viruses in high grade CIN and carcinoma of the cervix: the potential for synergistic effect⋆

Objective To assess the prevalence of human papillomavirus (HPV) type 16 and 18, herpes simplex virus (HSV) and human cytomegalovirus (HCMV) in cervical biopsies in order to evaluate their relationship in cervical intraepithelial neoplasia (CIN) and cancer. Setting Colposcopy clinic; Service de Gynécologic-Obstétrique I, Hôpital de Hautepierre. Hôpitaux Universities de Strasbourg and Laboratoire Commun ULP/Synthélabo et U74 INSERM. Institut de Virologie dc la Faculté de Medecine de Strasbourg, France. Subjects Forty-two women with low grade and high grade CIN, twenty women with cervical squamous cancer and twenty-two women with normal cervix assessed by cytological, colposcopical and histological analysis. Methods Viral DNA was detected by PCR technique in colposcopically directed biopsies. Results The prevalence of HPV16 and/or HPV18 with HSV and/or HCMV was significantly higher in cancers (25%) or high grade CIN (29%) than in normal cervices (0%). On the contrary, when only HPV DNA was found, there was no significant difference between cancers (3O%). high grade CIN (29%) and normal cervices (9%). Conclusions The results support the hypothesis of a role of herpes viruses (HSV and HCMV) as cofactors in cervical carcinogenesis.