Natural Outcome of Genital Tract High-Risk Human Papillomavirus Infection and Associated Factors among 760 Women

Objective: To investigate the natural outcome of genital tract high risk human papillomavirus (HR-HPV) infection and associated factors among women in Xi'an region.

Methods: Totally 760 women with primary genital tract HR-HPV infection were enrolled and followed up by HPV-DNA genotyping technology. The cervical cytological techniques and/or colposcopy were used when necessary.

Results: Among these subjects, the natural clearance rate of HR-HPV infection was 71.58%, with the median time of 8.10 months. The rate of HPV persistent infection was 22.63%, with the median time of 17.23 months. The rate of progression to cervical intraepithelial neoplasia (CIN)/cervical cancer (CC) was 5.79%, with the median time of 29.34 months. The natural clearance rate (P=0.000), persistent infection rate (P=0.000) and progression rate (P=0.040) in women older than 50 years were statistically difference from other age groups. The persistent infection rate in multiple infections group was significantly lower than that in single infection group (P=0.010), with the median time statistically longer than that in single infection group (P=0.018). The most easily progressive genotypes were HPV-16, HPV-33, HPV-58,HPV-18,HPV-52,and HPV-68,among which HPV-16 was the most common genotype in CIN 3/CC cases, accounting for 85.00%.

Conclusions: Most of HR-HPV infections are naturally cleared within 2 years, and only a few cases progresses to CIN/CC. Women older than 50 years have a lower natural clearance rate and higher persistent and progressive rates. Multiple infections can affect the persistent infection. HPV-16 is the most common carcinogenic genotype in Xi'an region.

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By:  Zhang Q1, Cao D1, Ma Q1, Li N1, Cui XQ1, Yang XF1.

• 1Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xi'anJiaotong University,Xi'an 710061,China.

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Progression or Regression? – Strengths and Weaknesses of the New Munich Nomenclature III for Cervix Cytology

Since 01. 01. 2015 the new Munich nomenclature III for gynaecological diagnostics of the cervix has been in force. The changes have led to controversial scientific discussions. This study reports for the first time on the consequences.

The present data are based on smear screening results for the year 2014. The data of 63 134 patients were evaluated. 

2.27 % of all smears were remarkable. Group IIa was assigned to 0.91 %. Group II-p was somewhat more frequently recorded than group IIID1 (0.59 vs. 0.53 %). Groups IIID1 and IIID2 were found in 0.53 and 0.61 %, respectively, of the cases. Agreement with histology was found in 36.84 and 44.68 %, respectively. Glandular lesions represented the most frequent changes in group III. Histological clarification was obtained for 0.18 % of all remarkable findings. The relative incidence of high-grade precancerous conditions (CIN III) and invasive tumours amounted to 0.1 %. 

A close communication between gynaecologists and cytologists is mandatory for the correct usage of the new nomenclature. The future annual statistics of the health insurances can now be analysed in more detail. A statistical classification of glandular epithelial changes is now also possible for the first time. The heterogeneous group IIa constitutes an unnecessary uncertainty for patients and physicians. The splitting of the group IIID does not appear to have any advantage for the further clinical management. Further studies are needed to show whether or not the classification can stand up to international comparisons.

Below:  Histological clarification of 12 cases with unclear or equivocal findings according to the Munich nomenclature III (groups III-g [n = 11] and III-p [n = 1]). The cytological finding III-p correlates with the histological diagnosis of an invasive vaginal cancer.

Full article at:  http://goo.gl/oveUJM

By:  Z. Hilal, C. Tempfer, S. Schiermeier, J. Reinecke, C. Ruppenkamp, and Z. Hilal

¹ZYDOLAB – Institut für klinische Zytologie und Immunzytochemie, Dortmund

²Abteilung für Gynäkologie und Geburtshilfe, Ruhr Universität Bochum, Herne

³Abteilung für Gynäkologie und Geburtshilfe, Universität Witten/Herdecke, Witten

⁴Institut für Pathologie, Universitätsklinikum Düsseldorf, Düsseldorf

Correspondence Dr. med. Ziad Hilal ZYDOLAB – Institut für klinische Zytologie und Immunzytochemie, Markt 10, 44137 Dortmund, ; Email:ed.balodyz@lalih.z

 

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Female Sexual Dysfunction in Women with Non-Malignant Cervical Diseases: A Study from an Urban Chinese Sample

Non-malignant cervical diseases are common causes of disease among women worldwide. Although many studies have focused on sexual function in women with cervical cancer, little is known about the prevalence of female sexual dysfunction and its risk factors in women with non-malignant cervical diseases. 

The present study aims to assess sexual function in Chinese women with non-malignant cervical diseases and to identify potential risk factors for these diseases. A cross-sectional hospital-based survey was conducted in Nanjing, China. The Chinese version of the Female Sexual Function Index (CVFSFI) was used to evaluate sexual function. Three hundred three women who had been diagnosed with at least one non-malignant cervical disease and 293 healthy women were recruited from Nanjing Maternity and Child Health Hospital of Nanjing Medical University. 

We found that women with non-malignant cervical diseases had 

• a significantly higher prevalence of female sexual dysfunction (FSD) (51.8% vs. 34.8%), 
• low desire (43.2% vs. 26.3%), 
• arousal disorder (41.6% vs. 28.3%), and 
• lubrication disorder (51.2% vs. 36.9%) compared with the control group. 

Cervicitis and cervical intraepithelial neoplasia (CIN) were found to be independent risk factors for FSD. 

Our study indicates that women with cervicitis and CIN are at a high risk for FSD and deserve focused initial and follow-up management.

Full article at: http://goo.gl/g4n3HW

By:

Jiehua Ma, Lianjun Pan

State Key Laboratory of Reproductive Medicine, Department of Reproductive Health, Nanjing Maternity and Child Health Care Hospital affiliated with Nanjing Medical University, Nanjing, Jiangsu, China

Yanjing Kan, Yu Lei

State Key Laboratory of Reproductive Medicine, Department of Cervical Care, Nanjing Maternity and Child Health Care Hospital affiliated with Nanjing Medical University, Nanjing, Jiangsu, China

Aixia Zhang

State Key Laboratory of Reproductive Medicine, Department of Nursing, Nanjing Maternity and Child Health Care Hospital affiliated with Nanjing Medical University, Nanjing, Jiangsu, China

Bin Yang

Department of Reproductive genetic, The Fourth People's Hospital, Zhenjiang, 212001, China

Ping Li

State Key Laboratory of Reproductive Medicine, Department of Gynecological Endocrinology, Nanjing Maternity and Child Health Care Hospital affiliated with Nanjing Medical University, Nanjing, Jiangsu, China

   

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Monitoring Effect of Human Papillomavirus Vaccines in US Population, Emerging Infections Program, 2008–2012

Below:  Prevalence of human papillomavirus (HPV) types among women with a diagnosis of cervical intraepithelial neoplasia grade 2 or 3 or adenocarcinoma in situ, Emerging Infections Program HPV-IMPACT project, 2008–2012. HPV-16 and -18 are the most common oncogenic HPV types; HPV-6 and -11 are nononcogenic HPV types that cause genital warts and respiratory papillomatosis.

In 2007, five Emerging Infections Program (EIP) sites were funded to determine the feasibility of establishing a population-based surveillance system for monitoring the effect of human papillomavirus (HPV) vaccine on pre-invasive cervical lesions. The project involved active population-based surveillance of cervical intraepithelial neoplasia grades 2 and 3 and adenocarcinoma in situ as well as associated HPV types in women >18 years of age residing in defined catchment areas; collecting relevant clinical information and detailed HPV vaccination histories for women 18–39 years of age; and estimating the annual rate of cervical cancer screening among the catchment area population. The first few years of the project provided key information, including data on HPV type distribution, before expected effect of vaccine introduction. The project’s success exemplifies the flexibility of EIP’s network to expand core activities to include emerging surveillance needs beyond acute infectious diseases. Project results contribute key information regarding the impact of HPV vaccination in the United States.

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The Accuracy of p16/Ki-67 and HPV Test in the Detection of CIN2/3 in Women Diagnosed with ASC-US or LSIL

Below:  Examples of positive tests for Ki-67 (red) and p16 (brown)

Below:  hr-HPV test according to the colpo-histological diagnosis

The objective of this study was to compare the accuracies of double staining for p16/Ki-67 and the molecular test for high-risk HPV (hr-HPV) to identify high-grade cervical intraepithelial neoplasia (CIN2/CIN3) in women with cervical cytology of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Data were collected from 201 women who underwent cervical cytology screening in the Barretos Cancer Hospital and their results were categorized as ASC-US (n=96) or LSIL (n=105). All patients underwent colposcopy with or without cervical biopsy for diagnosis of CIN2/CIN3. The hr-HPV test (Cobas 4800 test) and immunocytochemistry were performed to detect biomarkers p16/Ki-67 (CINtec PLUS test). Two samples (1 ASC-US/1 LSIL) were excluded from the analysis due to inconclusive results of the histologic examination. There were 8 cases of CIN2/CIN3 among 95 women with ASC-US (8.4%), and 23 cases of CIN2/CIN3 among 104 women with LSIL (22.1%). In the group of women with ASC-US, the sensitivity and specificity in diagnosing CIN2/CIN3 were 87.5% and 79.5% for the HPV test and 62.5% and 93.1% for p16/Ki-67. Among women with LSIL, the sensitivity and specificity in the diagnosis of CIN2/CIN3 were 87% and 34.7% for the HPV test and 69.6% and 75.3% for immunocytochemistry. Superior performance was observed for p16/Ki-67 double staining, especially among women under 30 for whom the test had an area under the ROC curve of 0.762 (p<0.001). Both p16/Ki-67 double staining and the hr-HPV DNA test had similar performance in predicting high-grade cervical intraepithelial neoplasia among women with ASC-US. The best performance was observed in women aged >30 years. In younger women (≤30 years) with LSIL, p16/Ki-67 had greater accuracy in identifying precursor lesions. Among women >30 years diagnosed with LSIL, the two methods showed similar performance.

Via:   http://goo.gl/B6fkcg  HT @usponline