宫颈上皮内瘤变治疗后人乳头瘤病毒的清除及随访

人乳头瘤病毒(HPV)是宫颈癌前病变与宫颈癌的主要致病因素,持续高危型HPV感染是宫颈癌前病变的危险信号。该文介绍了HPV在宫颈病变治疗后的清除及其影响因素,在宫颈病变治疗后的随访中高危型HPV检测对预测宫颈病变的疗效及预后有意义。持续高危型HPV阳性是宫颈上皮内瘤变持续和复发的高危因素。     

正确认识人乳头状瘤病毒感染和疫苗的应用

人乳头状瘤病毒(HPV)感染是患病率最高的女性生殖道病毒感染,但大多数HPV都能被感染者的自身免疫系统清除,只有少数会发展为持续性HPV感染,极少数可能进展为官颈癌前病变或宫颈癌.     

围生期人乳头瘤病毒感染对母儿的影响

目前已明确人乳头瘤病毒(human papilloma virus,HPV)感染与宫颈癌的关系,即HPV感染是宫颈癌发生的必要条件,而生殖道感染高危型HPV是宫颈癌前病变即宫颈上皮内瘤变(cervical intraepithelian neoplasia,CIN)、宫颈癌发生的主要危险因素,低危型HPV感染常引起下生殖道湿疣等良性病变包括CINⅠ的发生。女性生殖道HPV感染多见于生育期妇女,     

女性生殖道人乳头瘤病毒感染的流行病学

女性生殖道人乳头瘤病毒 (humanpapillomavirus,HPV)感染是目前世界范围内最常见的性传播疾病之一 ,其中涉及 10 0余种HPV亚型。已有诸多的流行病学及分子生物学研究资料表明HPV感染除与女性生殖道疣有关外 ,与宫颈癌及癌前病变关系密切 ,高危型HPV感染是导致宫颈癌的主要病因 ,近年来对HPV的研究正成为一个新的热点。了解女性生殖道HPV感染的流行病学特征 ,对预防及处理HPV感染均有重要意义。1　女性生殖道HPV感染率　　资料显示至少有 80 %性活跃的成年人在某一时期感染过一种或一种以上的生殖道HPV亚型 ,多数病例HPV感染是暂…     

DNA甲基化技术在HPV相关下生殖道病变的临床应用

<正>女性下生殖道病变大多与人乳头瘤病毒(HPV)感染密切相关,子宫颈癌及癌前病变最为常见,外阴、阴道癌前病变和癌比较少见。子宫颈细胞学和高危型HPV(HR-HPV)联合检测是目前主流的子宫颈癌筛查方法,是预防子宫颈癌的重要手段。然而,由于HR-HPV感染率高以及HPV检测的低特异性使得阴道镜检查的转诊率较高,往往导致过度治疗。细胞学检查对病理医生要求高且敏感性低,时常造成漏诊。因此,亟需新的检测手段来弥补现有筛查方法的不足。研究显示,     

人乳头瘤病毒感染与妊娠

正人乳头瘤病毒(human papillomavirus,HPV)是一种双链环状DNA病毒,可引起宫颈、阴道、外阴、肛门、阴茎、口咽等部位癌和癌前病变。HPV有200多种型别,其中约40种可引起女性下生殖道病变。高危型HPV持续感染是子宫颈癌的主要病因,低危型HPV主要引起生殖道湿疣。妊娠期HPV感染很常见,影响母儿健康。     

生殖道人乳头瘤病毒感染的治疗现状

人乳头瘤病毒(HPV)是引起女性生殖道感染,尤其是宫颈病变和肿瘤的主要原因,因此,生殖道HPV感染的治疗成为人们关注的焦点。目前,对于生殖道HPV感染,一些包括物理的、手术的、生物的、化学的、中药在内的治疗手段虽已显示出较好的效果,但都不确切和特效。近年相关药物和技术的开发应用,拓展了生殖道HPV感染治疗的研究领域,为最终清除HPV奠定了基础。     

沙眼衣原体感染与生殖道人乳头瘤病毒感染的关系及其与宫颈病变发生的相关性研究

目的研究女性生殖道人乳头瘤病毒(human papilloma virus,HPV)感染与沙眼衣原体(Chlamydia trachomatis,CT)感染的关系,及其与宫颈癌前病变和宫颈癌发生的相关性。方法以妇产科门诊患者540例为研究对象,所有患者均行HPV、CT和宫颈细胞学检查。对疑似宫颈病变的患者进一步行宫颈活检。根据HPV检测结果,将HPV检测阳性的患者140例设为观察组,HPV检测阴性的患者400例设为对照组,分析生殖道HPV感染与CT感染的相关性,以及其与宫颈病变发生的相关性。结果观察组宫颈病变发生率(21.4%)显著高于对照组(1.3%,P0.000 1)。按照HPV感染分型,进一步将观察组分为高危组(78例)、低危组(32例)和混合感染组(30例)。高危组(25.6%)和混合感染组(26.7%)宫颈病变发生率均显著高于低危组(6.3%,P=0.009;P=0.019)。同时,观察组CT感染率(27.1%)显著高于对照组(3.3%,P0.000 1)。HPV感染患者中,高危组(33.3%)和混合感染组(36.7%)的CT感染率均显著高于低危组(3.1%,P=0.021;P=0.019)。依据是否存在C T感染将观察组患者分为H P V单纯感染组和C T混合感染组。结果显示后者宫颈病变率(57.8%)显著高于前者(25.5%,P=0.046)。且CT混合感染组,高危HPV和混合HPV感染患者宫颈病变的发生率分别为39.3%和50.0%,均明显高于HPV单纯感染组中高危HPV和混合HPV感染患者,其发生率分别为16.0%和15.4%,差异均具有统计学意义(P=0.026和P=0.017)。Logistic回归分析显示高危型HPV感染(OR=2.180,P=0.018)、HPV和CT混合感染(OR=6.690,P=0.012)是宫颈病变发生的风险因素。结论女性生殖道CT感染与HPV感染密切相关,HPV和CT混合感染是宫颈癌前病变和癌变的独立风险因素。通过早期筛查女性生殖道HPV感染和CT感染,及时有效地治疗微生物混合感染,对进一步降低宫颈癌前病变和宫颈癌的发病率,提高临床治疗效果具有重要意义。     

阴道鳞状上皮内瘤变的诊治进展

<正>人乳头瘤病毒(HPV)感染可引起下生殖道的癌前病变，包括子宫颈、阴道、外阴及肛周。相比于子宫颈，临床医生对阴道病变的关注往往不足。阴道上皮内瘤变(VaIN)2/3[阴道高级别鳞状上皮内瘤变(HSIL)]是阴道癌的癌前病变，需积极治疗。既往流行病学调查认为VaIN是一种比较少见的疾病，其发生率为(0.2～0.3)/10万，为子宫颈上皮内瘤变(CIN)的1.0%。我国HPV疫苗接种率低，     

子宫颈高级别上皮内病变治疗后HPV疫苗预防复发的研究进展

由于各种原因,宫颈高级别鳞状上皮内病变(HSIL)锥切治疗后病变持续/复发率仍较高,且进展为宫颈癌的风险明显高于普通人群。除治疗后严密随访外,如何减少宫颈HSIL治疗后的复发,成为一个临床关注的问题。预防性HPV疫苗对其相关型生殖道癌前病变和癌均有很好的预防效果,已广泛应用于适龄女性。最近的研究显示,宫颈HSIL治疗后患者接种预防性HPV疫苗也可显著降低病变的持续/复发率,提示治疗后接种HPV疫苗仍可获益,从而减少再次治疗相关的并发症,这一观点可能影响宫颈HSIL治疗后的管理,扩大预防性HPV疫苗的应用范围。因此,本文对宫颈HSIL治疗后接种HPV疫苗对病变复发影响的相关临床研究进展进行综述。     

HPV infection and cervical disease: a review

Cervical cancer remains a significant problem worldwide particularly in underdeveloped countries. The disease and its financial impact are significant. Infection with the human papilloma virus (HPV) is necessary for the development of cervical cancer and its precursors. HPV also causes precancer and cancer elsewhere in the lower genital tract in women and men, as well as cancers of the aerodigestive tract. Whilst non-sexual transmission has been reported, the usual method of transmission is by sexual intercourse with the virus deposited on the basement membrane of the cervical epithelium. It is then taken up by the basal cells, and viral amplification occurs with the maturation of the squamous epithelium. During this process, it remains hidden from the host immune system, thus not mounting an immune response in many instances. About half of the women infected with HPV do not develop clinically detected serum antibody levels and are thus at risk of re-infection with the same HPV type. HPV vaccination produces sustained levels of serum-neutralising antibodies and has been shown to be effective in reducing disease caused by the vaccine-associated HPV types. Vaccination is considered well tolerated and safe with syncope and venous thromboembolism reported more frequently that would be expected. Vaccination will not protect against pre-existing HPV infection and hence may not provide complete protection in all women, and as the duration of protection is not known, for the time being routine Pap testing screening according to the Australian guidelines should continue.     

Evaluation of urinary cytology of male sexual partners of women with cervical intraepithelial neoplasia and human papilloma virus infection

Condylomas of the genital tract can be found in 70% of patients who have cytologic evidence of human papilloma virus (HPV) infection or mild epithelial dysplasia (CIN I). Most male sexual partners of women with overt or subclinical HPV infections have no visible condylomas. Presently, there is no therapy for subclinically infected male partners. A screening test capable of detecting such HPV infections in males would be of value should effective therapy be discovered. Fifty-four men who were the current sexual partners of women with visible condylomata acuminata or with cytologic evidence of subclinical HPV infection or cervical neoplasia were asked to give a urine specimen for cytologic examination. The cytologist had no knowledge of the cytologic or histopathologic findings in the female partners. Of the 54 women, 39 (72%) had either visible genital condylomas or cytologic evidence of mild dysplasia or of HPV infection with or without mild dysplasia (CIN I). Twenty-five (63%) had histologic evidence of HPV infection with or without mild dysplasia. With one exception, urinary cytologic preparations from the study and from the control males were negative. No correlation could be found between cervical cytology and histology in the females and urinary cytologic findings in their current male partners. At the present time there is no screening test that can be utilized to detect male carriers with subclinical disease.     

Increased frequency of genital human papillomavirus infection in human immunodeficiency virus-seropositive Taiwanese women.

BACKGROUND AND PURPOSE: Human papillomavirus (HPV) infection is associated with increased incidence and severity of HPV-related cervical dysplasia and cervical cancer in women with human immunodeficiency virus (HIV) infection. This study examined the incidence of genital HPV infection in HIV-infected Taiwanese women and its relationship with cervical neoplasia. METHODS: This hospital-based, case-control study enrolled 31 consecutive HIV-seropositive women and 124 age-matched women who were free from HIV infection. Polymerase chain reaction (PCR) was used to distinguish high-risk (types 16, 18, 31, 33, 52 and 58) and low-risk HPV (types 6 and 11). The occurrence of genital HPV infection was compared between women with and without HIV infection. In addition, CD4 lymphocyte counts were determined by flow cytometry and Papanicolaou test was done in women with HIV infection. RESULTS: HPV and Papanicolaou test were done soon after the diagnosis of HIV infection. HIV seropositive women had a significantly greater high-risk HPV infection rate (48.4%; 15/31) than women without HIV infection (20.2%; 25/124; odds ratio, 3.71; p = 0.001). However, the prevalence of cervical intraepithelial neoplasia was similar between women with and without HIV infection. The CD4 lymphocyte counts in HIV-seropositive women were similar between those with and without genital HPV infection. CONCLUSIONS: The risk of genital HPV infection was significantly increased in HIV-infected women. Due to the association between high-risk HPV infection and the development of cervical dysplasia and cervical cancer, regular follow-up of Papanicolaou test is necessary in these women.     

Human papillomavirus in the oral mucosa of women with genital human papillomavirus lesions

OBJECTIVES: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases worldwide. We determined the frequency of HPV in the oral cavity of women with and without genital HPV lesions. MATERIAL AND METHODS: All patients were seen at the Department of Gynecology, Women's Health Center and the State University of Campinas, Sao Paulo, Brazil and submitted to a general physical and gynecological examination plus an evaluation of the oral cavity. Detailed histories investigated their sexual practices. HPV in the oral cavity was determined by polymerase chain reaction using consensus primers in 70 women presenting with histopathology-confirmed clinical HPV lesions in the genital region and 70 women negative by gynecological, colposcopic and cytological examination for clinical or subclinical HPV lesions. RESULTS: Oral HPV was detected in 29 (20.7%) of the subjects. Among the positive women, 26 (89.7%) were also positive for genital HPV as opposed to only 3 (2.7%) who were genital HPV-negative (p < 0.0001). The overall prevalence of HPV in the oral cavity of patients with and without genital HPV was 37.1 and 4.3%, respectively, (p < 0.0001). The presence of oral HPV was unrelated to the practice of fellatio (22% versus 19%). CONCLUSION: Patients with HPV genital infection have a greater frequency of HPV in their oral mucosa.     

Human papillomavirus infections: diagnosis, treatment, and hope for a vaccine

HPV infections are common, with millions of Americans infected. Common gynecologic manifestations of HPV infection include genital warts and cervical neoplasia. The CDC recently issued guidelines for the treatment of genital warts. Gynecologists should be familiar with these therapies and their potential short-comings. A recently reported clinical trial has raised hopes that HPV and its sequelae may be prevented by vaccination.     

Clinical findings among young women with genital human papillomavirus infection

OBJECTIVE: The purpose of this study was to identify clinical signs and symptoms associated with detection of human papillomavirus (HPV) DNA in the female genital tract. STUDY DESIGN: A total of 516 university students (18 to 24 years old) enrolled in a cohort study that included the collection of genital specimens for HPV DNA testing every 4 months for up to 4 years. Reported symptoms and objective clinical findings of women with and without HPV DNA were compared by multivariate analysis. RESULTS: Acute and persisting HPV infections were not associated with discharge, itching, burning, soreness, or fissures. Clinical evidence of genital warts was statistically associated only with HPV types 6 and 11. Detection of any HPV DNA was associated with bacterial vaginosis (BV). Furthermore, a time lag analysis suggests that HPV infection usually precedes detection of BV. CONCLUSION: Most women who acquire genital HPV infection are asymptomatic; some, however, are at increased risk for BV.     

Secretory immunoglobulin A in saliva of women with oral and genital HPV infection

Secretory IgA contributes towards the protection of mucosal surfaces against invading microorganisms. OBJECTIVES: Quantify secretory IgA titers in the saliva of women with HPV in the oropharynx and/or in the genital area. SUBJECTS AND METHODS: Seventy women with clinical genital HPV lesions and 70 women without HPV infection were tested for oral HPV DNA and the levels of total IgA in their saliva. One millilitre of saliva was collected, centrifuged and stored at -80 degrees C for the measurement of secretory IgA by nephelometry technique. A pool of oral pharyngeal cells was collected for HPV identification by polymerase chain reaction. RESULTS: Oral HPV PCR was positive in 29 (21%) women (26 women with genital HPV and only 3 women without genital HPV). Titers of secretory IgA were extremely lower in-patients with HPV DNA in the oropharynx when compared to HPV negative women (p<0.0001). Genital HPV and smoking were also associated to low levels of total sIgA in saliva (p<0.01). After multivariable analyses only the presence of HPV in the oral cavity and/or in genital area, but not smoking, was related to low levels of total secretory IgA. CONCLUSION: Women with low levels of total secretory IgA could be more susceptible to having their oral mucosa colonized by HPV.     

Genital papillomavirus infections: current knowledge and future prospects

Although much has been learned about the biology of HPV during the last decade, little progress has been made in the development of rational and effective patient management strategies. Without stronger evidence supporting a causal role for HPV in the development of genital tract and anal cancers, and without the availability of effective therapies, it is premature to recommend widespread screening for detection of HPV DNA or RNA with the molecular hybridization tests soon to be available commercially. Papanicolaou smear screening for detection of early precancerous changes of the cervix and referral for colposcopy and biopsy of areas of epithelium that are suspicious for intraepithelial neoplasia of the cervix, vagina, vulva, penis, or anus remain the cornerstones of genital tract and anal cancer prevention. The patient care implications of subclinical persistent HPV infection of the genital tract are not well understood. For this reason, and because none of the available therapies are curative, treatment of large areas of normal-appearing genital tract epithelium also cannot be recommended at this time. It is hoped that, with the growing research focus on therapies that have the potential for virologic cure, some day effective treatment for subclinical infection will be available. Until that time, patients with recalcitrant or recurring genital warts may benefit most by the sequential application of different treatment modalities.     

Human papillomavirus infection and cervical neoplasia: new perspectives

This review addresses several problems associated with human papillomavirus (HPV) infection of the cervix and lower female genital tract. These include the definition of HPV infection and its distinction from HPV-associated neoplasia, the distinction of HPV infection from reactive epithelial changes induced by other infections, and the transmission of HPV infection via the male partner. The available evidence indicates that there are two distinct intraepithelial processes in the cervix associated with HPV. One is the classical condyloma and its counterpart in immature epithelium, atypical immature metaplasia. The other is intraepithelial neoplasia, which, like classical infection, may be mature [cervical intraepithelial neoplasia (CIN) with koilocytosis] or immature (high grade CIN or carcinoma in situ). Molecular hybridization studies indicate that HPVs 6 and 11 are most commonly detected in the former, whereas HPVs 16 and 18 DNA are most common in the latter and in invasive cancer. From the clinical standpoint the most important distinction is between HPV-related disease (condyloma or CIN) and reactive changes associated with other pathogens, such as Chlamydia. The former should be removed from the cervix, whereas the latter should be treated medically or followed. It is stressed that therapy should not hinge upon the histological distinction of HPV infection from neoplasia and that all lesions should be removed, by conservative means if possible. This is underscored by the fact that a high proportion of CIN lesions contain areas identical to condyloma and that lesions with deep endocervical canal involvement, including those with features suggesting condyloma, should be treated by cone biopsy to exclude the presence of invasive cancer. Histological classifications for nonneoplastic, HPV-infected, and neoplastic epithelium are proposed. The management of the male partner is still unsettled. However, a large proportion of male partners of these patients have penile lesions and should be included in diagnostic and therapeutic protocols of women with genital HPV infections or neoplasms.     

妊娠合并下生殖道人乳头瘤病毒感染临床分析

目的:探讨妊娠期下生殖道人乳头瘤病毒(HPV)感染的特点、诊治以及HPV持续感染患者的妊娠时机。方法:对北京协和医院45例妊娠合并生殖道HPV感染患者进行回顾性分析。结果:26例(58%)表现为下生殖道疣,18例(38%)为亚临床感染,1例(4%)为潜伏感染。10例(22%)患者合并其他感染。16例(36%)患者接受药物、激光、冷冻或手术治疗。39例患者足月分娩,未发现呼吸道乳头瘤病新生儿。产后复查3例患者仍有下生殖道疣。13例患者复查宫颈薄层液基细胞学涂片,4例患者异常。5例患者复查HC2,2例阳性。结论:妊娠期下生殖道HPV感染发生新生儿呼吸道乳头瘤病率很低,但下生殖道HPV感染孕妇易合并其他下生殖道感染。持续HPV感染患者可在病毒负荷低时计划妊娠。