Change in knowledge of women about cervix cancer,human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines

Objectives

Test knowledge of HPV, cervix cancer awareness and acceptance of HPV vaccination of women now and a year ago.

Study design

Questionnaires were filled out by 305 women visiting four gynaecologists of the Regional Hospital Heilig Hart, Tienen, Belgium during two subsequent weeks. Fisher T or Chi² were used as statistical methods to compare the data with the survey of 381 women exactly one year before.

Results

Knowledge about HPV as a cause of cervix cancer and the presence of a vaccine rose from roughly 50% in 2007 to over 80% in 2008 (p < 0.0001). Level of education and having daughters, sons or no children no longer influenced the level of knowledge or willingness to accept the vaccine. Most parents favor the age group 12–16 years as an ideal time for vaccination. In contrast with the 2007 survey, women below 26 years had now acquired almost equivalent knowledge to older women about the virus, cervix cancer and the vaccine, but they were far less likely to accept the vaccine due to its cost, unless it would be reimbursed (OR 4.2 (1.6–11) p = 0.0055).

Conclusion

One year after introduction of the first two HPV vaccines, over 75% of women attending an ambulatory gynaecology clinic know HPV causes cervix cancer and that you can get vaccinated against it. Compared with a year earlier, young and lower educated women had dramatically improved their knowledge. However, women below 26 years are less prepared to pay the cost for vaccination if it is not reimbursed.     

Impact of HPV16/18 vaccination on quality of life: A pilot study

Abstract

Objectives Genital human papillomavirus (HPV) infections and associated precancerous lesions adversely affect health-related quality of life (HRQoL). HPV vaccines provide effective protection against these conditions. We therefore investigated the impact of HPV vaccination on HRQoL in young women five years after participation in a phase III HPV vaccination trial.

Methods A total of 4808 originally 16- to 17-year-old Finnish girls had participated in the PATRICIA trial and received either bivalent HPV 16/18 vaccine or hepatitis A-virus (HAV) vaccine in 2004 to 2005. Unvaccinated girls (n = 9602), from adjacent birth cohorts, had participated in the control cohort in 2005. From 2009 to 2011, at 22 to 23 years of age, all participants received a questionnaire consisting of two generic HRQoL instruments (RAND36 and EQ VAS) and a disease-specific questionnaire (CECA10).

Results We analysed responses of 1143 HPV 16/18-vaccinated, 980 HAV-vaccinated, and 3753 unvaccinated young women. The unadjusted mean outcome measures of the different HRQoL estimates were similar in the three different responder cohorts.

Conclusions Five years after vaccination the health-related quality of life of HPV 16/ 18- vaccinated young women did not differ from those of HAV-vaccinated or unvaccinated controls representing the general population.     

Pap Smear Knowledge Among Young Women Following the Introduction of the HPV Vaccine

Study ObjectiveInvestigate sexually active young women's knowledge of the term Pap smear since development of the HPV vaccine.DesignCross-sectional study conducted January–May 2007.SettingUniversity health services clinic at a university in southern United States.ParticipantsSexually active women, age 18–24, presenting for a Pap smear or STD testing (N = 145).Main Outcome MeasuresPap smear knowledge was assessed by participants' written definition of the term Pap smear and by multiple choice responses indicating Pap smear as a test for cervical cancer/ HPV and not a pelvic exam, STD test, or pregnancy test.Results9.7% provided accurate definitions; 12.4% checked appropriate Pap smear synonyms. 68.5% incorrectly responded that Pap smear was the same as “pelvic exam”; 42.5% indicated “STD test”; 11.7% indicated “pregnancy test.” Indicators of HPV risk (age of sexual debut, previous abnormal Pap smear, previous STD diagnosis) were not associated with knowledge. Never using condoms, increasing age, and lower depression scores predicted accurate Pap smear definition rating (R² = 0.08). Never using condoms, Caucasian race, and decreased lifetime number of sex partners predicted accurate identification of Pap smear synonyms (R² = 0.15).ResultsFew participants understood the meaning of the term Pap smear; there does not appear to be improvement in women's knowledge after development of the HPV vaccine. Poor Pap smear knowledge may affect young women's understanding of their overall sexual health.     

HPV genotyping in neuroendocrine carcinoma of the uterine cervix in northern Thailand

Objective

To determine the distribution of HPV genotypes in cervical neuroendocrine carcinoma (NECA) in northern Thailand, and evaluate the correlation between HPV genotype and clinicopathologic features.

Methods

Samples from 111 women treated for cervical NECA at Chiang Mai University Hospital between 1992 and 2009 were tested for HPV genotype. Samples were formaldehyde-fixed, paraffin-embedded, and tested via nested PCR and dot blot hybridization.

Results

Ninety-seven of the 111 samples were adequate for DNA analysis. HPV DNA was detected in 93 samples, of which 76 (81.7%) were single, 14 (15.1%) were multiple, and 3 (3.2%) were untyped infections. HPV18 was the most common subtype (70 cases, 75.3%), followed by HPV16 (28 cases, 30.1%). Other genotypes included HPV58 (3.2%), HPV52 (2.1%), and HPV33 (1.1%). Collectively, HPV16 and/or HPV18 were found in 83 cases (89.3%). Women with HPV18 infection were significantly younger (42.0 years) than those with non-HPV18 infections (54.1 years) (P = 0.003). Associated adenocarcinoma in situ was more frequently seen among women with HPV18 infection (P = 0.034).

Conclusions

HPV18 infection was predominant in cervical NECA. Variations in HPV genotype may be related to the clinicopathologic features and pathogenetic pathways of NECA. Vaccination against HPV16 and HPV18 might provide protection against cervical NECA in almost 90% of cases.     

A National Survey of Canadian Adults on HPV: Knowledge,Attitudes, and Barriers to the HPV Vaccine

ObjectiveIdentifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public.MethodsAn online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women.ResultsThe majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants.ConclusionCanadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.     

Knowledge of Human Papillomavirus and Acceptability to Vaccinate in Adolescents and Young Adults of the Moroccan Population

Study ObjectiveHuman papillomavirus (HPV) infection is estimated to play an etiologic role in 99.7% of cervical cancer. Vaccines can prevent up to 70% of the cervical cancer caused by HPV 16 and 18. The present study was designed to define the knowledge of HPV and HPV vaccine acceptability among Moroccan youth.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA nationwide anonymous questionnaire with a sample of 688 adolescents (12-17 years) and 356 young adults (18-30 years) was organized, that asked about HPV, origin of cervical cancer, Papanicolaou (Pap) test, and acceptability of HPV vaccine. Data were analyzed using univariate and multivariate logistic regression methods.ResultsOverall, a low frequency (213/1044 = 20%) of HPV knowledge was observed among the studied population. A multivariate model analysis showed that age, educational level, and knowledge of the Pap test remained significantly associated factors with HPV knowledge. Additionally, only 27% (282/1044) of participants were willing to accept HPV vaccination. Highest acceptability was observed among young adults compared with adolescents (166/356 = 46.6% vs 116/688 = 16.9%). Sixty-two percent (103/165) of male participants accepted the HPV vaccine compared with only 20.4% (179/879) of female participants. Educational level, type of school, and knowledge of the Pap test were associated factors with HPV vaccine acceptability in a multivariate model analysis.ConclusionThe present study showed a low level of HPV knowledge and HPV vaccine acceptability among Moroccan youth. Promotion of activities and sensitization are required to maximize public awareness in the future. This objective can be achieved with the use of media, active efforts by health care providers, and introduction of sexual education in school programs.     

Morphological and immunohistochemical evidence of human papilloma virus (HPV) involvement in the dysplastic lesions of the uterine cervix

A series of 110 biopsies of the uterine cervix containing dysplastic and/or in situ changes were assessed morphologiccally with reference to presence or absence of the coexistent condylomatous lesions, and using the immunoperoxidase-PAP technique to disclose the HPV (human papilloma virus) antigens in the cells.Morphologically, 79 biopsies contained condylomatous (CO) lesions (63 flat, 12 inverted and 4 papillomatous ones), and 31 were non-condylomatous (NCO) dysplasias/ in situ carcinomas. The mean age of the CO group was more than 10 years less than that of NCO women (P < 0.0001). Of the papillomatous COs, 75% were associated with mild or moderate dysplasia only, whereas 42% of the inverted ones contained an associated in situ carcinoma. Most of the flat lesions were found in very young women (10–39 years of age).HPV antigens were demonstrated in all papillomatous lesions (100%), in 83% of the inverted ones, and in 67% of the flat COs. In generally, the frequency of the HPV-positive cases decreased when epithelial atypia increased. None of the NCO lesions showed HPV positive cells.The results support earlier morphological findings on the frequent association of cervical condylomas and epithelial dysplasias, as well as those on the HPV as the etiologic agent of the former. The role of HPV as a possible etiologic agent of the cervical squamous cell neoplasia deserves further attention.     

Short-term type-specific HPV persistence and its predictors in an asymptomatic general female population in Zhejiang, China

Objective

To study short-term type-specific human papillomavirus (HPV) persistence and associated predictors in an asymptomatic general female population in Zhejiang, China.

Methods

Persistence was evaluated in women who were HPV positive at enrollment and who returned within 6–14 months. Liquid-based cytology screening was encouraged for returning women.

Results

Persistence was evaluated in 548 women. Overall persistence was 49.1%, and established high-risk HPV persistence was 54.5%. The types associated with the highest level of persistence were HPV-52, HPV-58, HPV-56, and HPV-16—most of which belong to α9 species. In total, 252 women refused cytology screening. No differences were found regarding HPV persistence and other variables among women who returned for follow-up, women who accepted cytology screening, and women who refused cytology screening. Among women aged 35 years or older, there were no differences between those with normal cytology and those with abnormal cytology in the short-term persistence of HPV types, except for HPV-58 (P < 0.01) and HPV-81 (P = 0.04). Established high-risk HPV persistence increased with age, low income, and early sexual experience.

Conclusion

The data support close surveillance of older women with established high-risk HPV infections, and conservative management of women with non-α9 HPV and no risk factors.     

Racial and Ethnic Differences in HPV Knowledge,Attitudes, and Vaccination Rates among Low-income African-American,Haitian, Latina,and Caucasian Young Adult Women

ObjectiveTo examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years.DesignUsing semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake.ParticipantsWe enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012.Main Outcome MeasuresIntent to vaccinate and actual vaccination rates.ResultsOf 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians.ConclusionDesire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.     

Human Papillomavirus Vaccination and Sexual Behavior in Young Women

Study ObjectiveTo compare sexual attitudes and behaviors of young women who have received or declined the HPV vaccine.DesignCross-sectional survey.SettingObstetrics and gynecology and pediatrics clinics at a large, Midwestern, academic health center.Participants223 young women (ages 13-24): 153 who had received HPV vaccination and 70 with no prior HPV vaccination.Main Outcome MeasuresSexual behaviors; attitudes toward sexual activity.ResultsVaccinated young women were slightly but significantly younger than unvaccinated (mean age 19.2 vs 20.0). Both groups showed a large percentage of participants engaging in high-risk sexual behavior (75% vs 77%). The mean age at sexual debut was not significantly different between the groups (16.8 vs 17.0) nor was the average number of sexual partners (6.6 for both). Unvaccinated participants were more likely to have been pregnant (20% vs 8.6%, P = .016), although this difference was not significant in multivariate analysis CI [0.902-5.177]. Specific questions regarding high-risk sexual behaviors and attitudes revealed no significant differences between the groups.ConclusionWe found that sexual behaviors, including high-risk behaviors, were similar between young women who had and had not received HPV vaccination. Our findings provide no support for suggestions that the vaccine is associated with increased sexual activity. Importantly, we found that young women in our population are sexually active at a young age and are engaged in high-risk behaviors, affirming the importance of early vaccination.     

Ethnically diverse female university students’ knowledge and attitudes toward human papillomavirus (HPV), HPV vaccination and cervical cancer

Objective

Cervical HPV is the most common sexually transmitted disease among college-age women. This study aimed to assess knowledge and attitudes towards HPV infection, HPV vaccination and cervical cancer among female university students, to provide insight into development of HPV educational information.

Study design

A cross-sectional survey using a convenience sample. A total of 1083 ethnically diverse female students attending a public university were approached and 650 were interviewed.

Results

Knowledge regarding HPV, HPV vaccination, cervical screening and cervical cancer risk factors was remarkably poor. Across the sample, the mean total knowledge score (14-item) was only 3.25 (S.D. ±2.41; 95% CI 3.07–3.44). Only 10.3% had heard of the newly released HPV vaccine. Approximately 48% of participants indicated an intention to receive an HPV vaccine. Intention to receive an HPV vaccine was significantly associated with knowledge of HPV and genital warts (OR 1.53; 95% CI 1.25–1.88), and knowledge of cervical screening and cervical cancer risk factors (OR 1.21; 95% CI 1.11–1.33). Of those who refused HPV vaccination, 50.9% doubted the safety and efficacy of the new vaccine, and 41.5% perceived themselves as not at risk of HPV infection.

Conclusion

The findings suggest that providing education about the etiology of cervical cancer and the HPV link is an essential component to enhance HPV vaccine uptake.     

Young Women's Beliefs Regarding Human Papillomavirus

ObjectiveTo describe young women's perceptions of human papillomavirus (HPV) using the Common Sense Model and examine whether perceptions differ based on history of HPV diagnosis or sexually transmitted disease (STD) testing.DesignCross‐sectional, survey data.SettingFour women's health clinics and one university classroom.ParticipantsThree hundred and two women ages 18–24.MethodsYoung women's beliefs regarding HPV were measured using the HPV Representations of Sexually Transmitted Diseases (RoSTD) survey.ResultsMost survey respondents believed HPV diagnosis was likely to result in cancer and death. Negative beliefs about the psychosocial consequences of HPV diagnosis were common. Compared to those who had not been diagnosed with HPV (or had never received STD testing), young women with a history of HPV diagnosis or STD testing had less serious and more accurate beliefs about HPV.ConclusionYoung women tend to have misconceptions about HPV in addition to noteworthy concerns about the psychosocial consequences of HPV diagnosis. Clinical attention to young women's beliefs about HPV may provide direction for improving the delivery of patient‐centered education and counseling about this exceedingly common illness.     

河北丰宁地区妇女人乳头瘤病毒感染及疫苗认知状况调查

目的调查河北省丰宁满族自治县妇女人乳头瘤病毒（HPV）感染及对宫颈癌、HPV和HPV疫苗的认知情况,并探讨宣教对其认知度的影响。方法对河北丰宁地区717例18~45岁妇女进行HPV相关知识的问卷调查及宣教,对其中647例妇女留取宫颈脱落细胞进行高危型HPV DNA检测。结果高危型HPV总检出率为16.07%（104/647）;14.78%（106/717）的妇女曾听说过HPV,HPV知晓率与年龄、婚姻情况、户口类型及教育程度有关（P〈0.05）;84.38%（605/717）的妇女从未行宫颈癌筛查,在112例行宫颈癌筛查的妇女中,末次筛查为巴氏涂片、宫颈液基细胞学和HPV检测者分别为16.07%（18/112）、39.29%（44/112）和8.04%（9/112）;宣教后HPV知晓率显著提高（P〈0.05）;15.76%（113/717）的妇女既往听说过HPV疫苗,75.59%（542/717）的妇女倾向于接种医疗机构提供的疫苗,24.41%（175/717）的妇女倾向于接种政府或医药公司提供的疫苗。结论河北丰宁地区妇女HPV现患率较高,对HPV及宫颈癌的认知率偏低,宣教后人群认知程度显著提高,因此公众教育可以显著提高人群对HPV疫苗相关知识的认知水平。     

HPV Unvaccinated Status and HPV Sexual Risk Behaviour are Common among Canadian Young Adult Women and Men

Objective

The current research focuses on sexual risk behaviour among young adult Canadians who have not been vaccinated against HPV.

Young multiethnic women's attitudes toward the HPV vaccine and HPV vaccination

Objective

To investigate the acceptability of the HPV vaccine among a multiethnic sample of young women in Malaysia.

Methods

A qualitative study of 40 young women aged between 13 and 27 years recruited into 7 focus groups to discuss their knowledge of HPV infection, and their attitudes toward and acceptance of the HPV vaccine. The women were divided into Malay, Chinese, and Indian groups to allow for comparison among ethnicities.

Results

Poor knowledge about HPV did not influence the HPV vaccine's acceptability. Although participants were in favor of the vaccine, the majority preferred to delay vaccination because it is newly introduced, they did not perceive themselves to be at risk of HPV infection, or because of cost factors. Concerns were raised regarding the vaccine's safety, the potential to be perceived as promiscuous and sexually active, and whether the vaccine was halal.

Conclusion

Promotion of the HPV vaccine should take account of social and cultural acceptability. The findings will help develop strategies for effective vaccination initiatives in a multiethnic and multireligious Asian society.     

Culture of Non-Genital Sites Increases the Detection of Gonorrhea in Women

Study ObjectivesAlthough gonorrhea may infect the cervix, rectum, or pharynx of women, culturing non-cervical sites is rare outside of sexually transmitted disease (STD) clinics. This study aims to compare rectal and pharyngeal gonorrhea prevalence in adolescent and adult women and to calculate the percentage of cases that would be missed with cervical culture alone.DesignRetrospective review of two laboratory databases.SettingSTD clinic (2006–2007) and urban children's hospital (2003–2007).ParticipantsAdolescent women (age 14–21, n = 16,039) in the hospital database; adolescent (n=525) and adult (age >21) women (n = 1424) in the STD database.Main Outcome MeasuresPrevalence of gonorrhea by group and culture source.ResultsCervical plus additional culture was performed in 76% of adult STD, 52% of adolescent STD, and 2% of adolescent hospital samples. Pharyngeal gonorrhea prevalence in the adolescent hospital (3.5%) was similar to adolescent STD (6.8%, P = 0.1) and adult STD (2.5%, P = 0.4) samples. Rectal gonorrhea prevalence in adolescent hospital (2.9%) was lower than adolescent STD (13.4%, P = 0.01) but not adult STD (5.2%, P = 0.6) samples. Pharyngeal gonorrhea occurred in 0.6–3.4% and rectal gonorrhea in 0–2.7% of women with a negative cervical culture. Culturing only the cervix missed 20–40% of adult STD, 14–26% of adolescent STD, and 11% of adolescent hospital infected cases.ConclusionsPharyngeal gonorrhea is as high in adolescent women from a children's hospital as in adult women from an STD clinic. Without pharyngeal culture, 11–26% of infected adolescent women would be missed. Increased pharyngeal testing may impact the gonorrhea epidemic among adolescent women.     

22234例子宫颈高危型HPV感染及亚型分布研究

目的:分析17种型别的高危型人乳头瘤病毒(HPV)在22234例子宫颈癌筛查中的感染率及亚型分布特点。方法:回顾性分析2018年1月1日至2019年1月1日22234例于华中科技大学同济医学院附属协和医院行子宫颈癌筛查患者高危型HPV感染率及感染亚型。结果:22234例接受子宫颈癌筛查患者中,一种或以上高危型HPV阳性者3574例(16.1%),其中HPV16或(和)HPV18阳性者703例(3.2%)。在3574例高危型HPV阳性女性中,最常见的高危HPV感染是HPV52(24.4%),其次为HPV58(16.5%)、HPV16(14.0%)、HPV53(12.6%)和HPV39(8.6%)。与HPV16阴性患者相比,在HPV16阳性的患者中,除HPV31、HPV35、HPV45、HPV26和HPV82以外的12种高危型HPV的感染风险均显著降低约2~5倍(OR 0.169~0.530,P<0.05);与HPV18阴性患者相比,HPV18阳性的患者中HPV16、HPV33、HPV39、HPV51、HPV52、HPV58和HPV53的感染风险均显著下降(P<0.05)。结论:女性高危型HPV感染率较高,最常见的高危型HPV是HPV52和HPV58感染,并且HPV16、18感染对多个其他型别高危型HPV感染有保护作用。     

A National Survey of Canadian Physicians on HPV: Knowledge,Barriers, and Preventive Practices

Objective

Physicians are the sole prescribers of the human papillomavirus (HPV) vaccine for adults in Canada. This survey of Canadian physicians aimed to explore knowledge, barriers, and preventive practices regarding HPV vaccination.

Human Papillomavirus Awareness in Haiti: Preparing for a National HPV Vaccination Program

Study Objective

Cervical cancer morbidity and mortality are pressing public health issues that affect women in Haiti. To inform efforts to develop a human papillomavirus (HPV) vaccination program in Haiti, we sought to understand HPV awareness and willingness to get HPV vaccination in Haiti.