Perinatal transmission of human papillomavirus from gravidas with latent infections

OBJECTIVE: To evaluate the risk of perinatal human papillomavirus (HPV) transmission from mothers with latent infections to the oropharyngeal mucosae of their infants. METHODS: Seven hundred eleven mother-newborn pairs were tested. Polymerase chain reaction was done with MY09/MY11 consensus primers to identify HPV DNA in maternal cervicovaginal lavages and newborn nasopharyngeal aspirates. Positive cases were further amplified with type-specific primers for HPVs 6, 11, 16, 18, and 33. All infants born to HPV-positive mothers were observed to 18 months for appearance of HPV in oropharyngeal mucosae. RESULTS: Human papillomavirus DNA was detected in 11 neonates born vaginally to HPV-positive women, a vertical transmission rate was 30% (95% confidence interval [CI] 15.9, 47). Nasopharyngeal aspirates were HPV-negative in all 11 cases in which rupture of membranes occurred less than 2 hours before delivery. When rupture preceeded delivery by 2-4 hours, and when it occurred after more than 4 hours, the respective rates for HPV positivity were seven of 21 and four of five (chi2 for trend = 10.7, P = .001). At follow-up, virus was cleared from the oropharyngeal samples as early as the 5th week. CONCLUSION: Pregnant women with latent HPV infections have low potential of transmitting the virus to the oropharyngeal mucosae of their infants. The time between rupture of the amnion and delivery seems to be a critical factor in predicting transmission. Human papillomavirus-positive infants should be considered contaminated rather than infected since virus is cleared over several months after birth.     

Leukotrienes in human umbilical plasma at birth

Summary. The aim of this study was to see whether leukotrienes are present in human umbilical plasma at birth either before or after labour. Plasma concentrations of LTB₄ (6·02 ng/ml) and LTD₄ (6·11 ng/ml) were significantly higher ( P <0·01) after spontaneous vaginal delivery than during elective caesarean section before labour (LTB₄= 1·96 ng/ml, LTD₄= 0·18 ng/ml). A possible involvement of leukotrienes in the biochemical and metabolic events of human labour is sugges     

Leukotrienes in human umbilical plasma at birth

The aim of this study was to see whether leukotrienes are present in human umbilical plasma at birth either before or after labour. Plasma concentrations of LTB4 (6.02 ng/ml) and LTD4 (6.11 ng/ml) were significantly higher (P less than 0.01) after spontaneous vaginal delivery than during elective caesarean section before labour (LTB4 = 1.96 ng/ml, LTD4 = 0.18 ng/ml). A possible involvement of leukotrienes in the biochemical and metabolic events of human labour is suggested.     

亚临床型人乳头瘤病毒感染垂直传播途径的研究

目的　探讨亚临床型人乳头瘤病毒 (humanpapillomavirus ,HPV)感染的垂直传播途径。 方法　华中科技大学同济医学院附属同济医院于 1999年 10月至 2 0 0 1年 4月间应用共有引物多聚酶链反应 (CP PCR)结合限制性片段长度多态 (RFLP)分析技术 ,对 183例孕妇亚临床型HPV感染垂直传播进行研究。结果　孕妇宫颈分泌物、外周血及羊水HPVDNA检出率分别为 35 5 1%、5 1 11%和 2 5 0 0 % ;经产道、胎盘的垂直传播率分别为4 0 74 %和 5 2 17%。结论　亚临床型HPV感染的垂直传播途径除经产道、羊水外 ,尚有血行性经胎盘传播的可能。     

Prostaglandins in the human umbilical circulation at birth

Prostaglandin E (PGE), prostaglandin F (PGF) and 13, 14-dihydro-15-keto-prostaglandin F (PGFM) have been measured in umbilical cord plasma obtained immediately after delivery of the baby before clampiing of the cord. In general the prostaglandin levels followed the pattern PGFM greater than PGE greater than PGF. A significant arterio-venous difference was demonstrated only for PGE with raised venous levels (P less than 0.01). In cord blood samples obtained from infants whose mothers had received epidural anaesthesia, no arterio-venous difference for PGE could be demonstrated although the mean levels were not significantly different from controls. The concentrations of prostaglandins in umbilical cord plasma proximal to the placenta were found to rise continuously from the time of delivery of the baby with no significant changes after cord clamping or placental delivery. The possible physiological significance of these findings is discussed.     

Primary screening for human papillomavirus infection

As human papillomavirus infection is now known to be a necessary risk factor for at least 95% of cervical cancers, the medical community has a responsibility to assess and evaluate how this knowledge should best be used for the prevention of cervical cancer. Organized screening strategies combining cytological screening with human papillomavirus testing in older age groups could theoretically be more sensitive than current screening programmes in reducing the incidence of cervical cancer. If it is possible safely to extend the screening interval in human papillomavirus-negative women, such programmes could also both be more effective and more cost-efficient. Although some modelling studies have indicated that this could indeed be the case, evidence from clinical trials evaluating the long-term protective effect of primary human papillomavirus screening is still lacking. The key issues on the research agenda for primary human papillomavirus screening are reviewed.     

Anal human papillomavirus DNA in women at a colposcopy clinic

Objectives

To describe the type-specific prevalence of anal and cervical human papillomavirus (HPV) infections and the cytology in HIV-negative women without a history of cervical cancer, attending a colposcopy clinic. To examine if an HPV positive anal smear is related to anal pathology and consequently indicative for further examinations (high resolution anoscopy, anal biopsy).

Study design

From 149 consecutive women an anal swab and a cervical swab were taken, using the Cervex-Brush^®. The presence of 18 different HPV genotypes was determined using TaqMan-based real-time quantitative PCR targeting type-specific sequences of viral genes. From the fluid containing the cellular material, a liquid-based cytology sample was prepared of both collections with the robotic BD PrepStain™ Slide Processor. All slides were pre-screened by BD FocalPoint™ system and categorized from quintiles 1 to 5 and afterwards screened using targeted microscopic interpretation of selected suspicious fields using FocalPoint^® guided screening review stations. The 2001 Bethesda System Terminology was used for the anal slides.

Results

Ninety-six anal samples and all 149 cervical samples were adequate. Overall presence of HPV in the anus was 56.3% and in the cervix 53.7%. Overall, cytological abnormalities were found in 10.8% of anal smears and in 32.8% of cervical smears. HPV genotypes were identified in 47 samples on both sites: partial or complete concordance was found in 85.1%. HPV types 6, 16 and 18 were found in 27.9% and in 26.6% of the anal and cervical samples, respectively. The top three HPV types in the anus were 16, 51 and 39; in the cervix 16, 39, 51 and 56 (a shared 3^rd place). HPV type 11 was not found.

Conclusions

The presence of HPV genotypes is clearly multifocal in this study population of women attending a colposcopy clinic, with high concordance of genotypes. The number of anal HPV infections is high. Although cytological abnormalities are rare, the presence of HPV may lead to anal lesions later in life. From this perspective, complementary medical history and clinical examination of the anal region are advised.     

Education about human papillomavirus and human papillomavirus vaccines in adolescents

PURPOSE OF REVIEW: The purpose of this article is to review recent literature that may help guide the development of effective, evidence-based strategies to educate adolescents about human papillomavirus (HPV) and HPV vaccines. Educational strategies are essential, given several new and highly effective technologies to prevent HPV and related diseases such as cervical cancer. RECENT FINDINGS: Although little has been published regarding adolescent knowledge about HPV and HPV vaccines, studies conducted primarily in adult women demonstrate that knowledge generally is poor. Studies of adolescent attitudes about HPV vaccines have identified several modifiable factors associated with intention and confidence in one's ability to receive the vaccine, including higher perceived severity of cervical cancer and fewer barriers to vaccination. Studies of clinician attitudes about HPV vaccines have demonstrated that although clinicians generally support vaccination, some report concerns; for example, adolescents may practice riskier sexual behaviors after vaccination. Studies also show that clinicians believe that educational materials developed specifically for adolescents are essential. SUMMARY: The recent literature on adolescent knowledge about HPV and attitudes about HPV vaccines supports the importance of designing developmentally appropriate educational materials for adolescents about HPV and HPV vaccines, and provides guidance for the development of key educational messages.     

Distribution of maternal and infant human papillomavirus: risk factors associated with vertical transmission

Objective

To evaluate the rate of human papillomavirus (HPV) infection in pregnant women and their neonates, and the risk factors associated with vertical transmission of HPV infection from mothers to neonates.

Study design

Cervical HPV testing was undertaken in pregnant women over 36 weeks of gestation, and mouth secretions and oral mucosa of neonates were tested for HPV immediately after delivery. HPV-positive neonates were rechecked 2 months postpartum to identify the persistence of HPV infection. In HPV-positive mothers, the placenta, cord blood and maternal peripheral blood were also analysed for HPV to confirm whether transplacental HPV infection occurred.

Results

HPV was detected in 72 of 469 pregnant women (15.4%) and in 15 neonates (3.2%). Maternal HPV positivity was associated with primiparity and abnormal cervical cytology. The rate of vertical transmission was 20.8%, and all HPV-positive neonates were born from HPV-positive mothers. Vertical transmission was associated with vaginal delivery and multiple HPV types in the mother. Neonates with HPV showed a tendency for higher maternal total HPV copy number than neonates without HPV, but this difference was not significant (p = 0.081). No cases of HPV infection were found in the infants at 2 months postpartum, and no HPV was detected in placenta, cord blood or maternal blood.

Conclusions

Vertical transmission of HPV is associated with vaginal delivery and multiple HPV types in the mother; however, neonatal HPV infection through vertical transmission is thought to be a transient.     

Current methods of testing for human papillomavirus

Human papillomavirus DNA testing is gaining wider acceptance, yet the majority of testing is still undertaken in the research setting using protocols that are unsuitable for clinical diagnostic laboratories. Large-scale clinical human papillomavirus DNA testing is likely to be introduced as an adjunct to cervical cytology, so the cytology laboratory is an appropriate place for it to be undertaken. This poses a challenge for any human papillomavirus DNA test since it will be performed by technicians not specifically trained in virology or molecular biology, and will need to produce consistently reliable results in this setting. This is only realistically possible with a standardized and quality-controlled, commercially produced human papillomavirus DNA test. There is currently only one such commercially available assay, although there are a number of research-based tests that could logically lead to additional commercial products. The technological basis of these assays, together with available performance data, is reviewed in this chapter and the clinical utility of the tests is evaluated.     

Conization for CIN associated with human papillomavirus infection

Summary We report results of follow-up by PAP smears and colposcopy in 116 women treated since 1981 by conization for cervical intraepithelial neoplasia with human papillomavirus infection (HPV-CIN). The mean follow-up time was 31.9 (SD 19) months. Preoperative diagnosis was HPV-CIN II (with extension into the endocervix) in 11 cases and HPV-CIN III in 103 cases; two diagnostic conizations were performed. The histological examination of the cone biopsies showed complete excision of CIN in 109 cases (94%). Three patients underwent hysterectomy after conization; one had microinvasion in the cone biopsy, one had suspicion of microinvasion and one had non-radical conization. Three patients (2.6%) were lost to follow-up. After excluding these six patients the primary cure rate of HPV lesions (normal cytological and colposcopical finding after conization) was 82.7%. Four patients (4.6%) had residual CIN after conization. During the follow-up 15 patients had recurrence of HPV infection, only one had HPV-CIN I. HPV 16 was the most common HPV type (56/116, 48.2%) in the conization group and also in the recurrent cases (9/15, 60%). The results support the role of HPV 16 in cervical carcinogenesis.     

Cervical dysplasia and human papillomavirus

Evidence suggests a link between human papillomavirus infections and cervical dysplasia-carcinoma. This has led to the recommendation that when human papillomavirus infections are identified on the cervix, especially in association with dysplasia, these patients should have colposcopic assessment and treatment. The natural history of cervical human papillomavirus infections, particularly when associated with mild or moderate dysplasia, is not clear. To assess this question, 235 women with mild to moderate cervical dysplasia associated with a human papillomavirus infection were prospectively evaluated at 6-month intervals by the Colposcopy Clinic. This review suggests that mild to moderate cervical dysplasia associated with human papillomavirus infection eventually spontaneously disappears or, at worse, lingers on over many months in a mild to moderate form. These observations do not support the current popular practice of treating all mild to moderate cervical dysplasias associated with human papillomavirus infection or cervical human papillomavirus infection not associated with dysplastic lesions.