Journal of Lower Genital Tract Disease最新文献

Objectives: The aims of the study were to describe clinicopathologic features of vulvar biopsies diagnostic for vitiligo and assess the link between vitiligo and genital symptoms.

Methods: The pathology database identified vulvar biopsies showing vitiligo, defined as absent or rare melanocytes on HMB-45, Sox-10, or Melan-A stains. Inclusion criteria were age 18 or over and availability of slides and medical records. Clinical data included demographics, comorbid conditions, symptoms, examination, treatment, and response. Histopathologic review documented site, epidermal characteristics, dermal collagen change, and lymphocytic infiltrate. Cases were stratified by histologic evidence of lichenoid dermatosis.

Results: Vulvar biopsies demonstrated vitiligo in 36 women with a median age of 56 years. Simultaneous histologic diagnosis of lichen sclerosus (LS) or lichenoid dermatitis was present in 23 (64%). Seven (19%) showed otherwise normal skin, while 5 (14%) had lichen simplex chronicus and 1 (3%) had spongiotic dermatitis. Itch was more frequent in the lichenoid group [21/23 (91%) vs 6/13 (46%); p = .005], while asymptomatic status was more likely in the normal/dermatitis group [5/13 (38%) vs 2/23 (9%); p = .001]. Three of 7 (43%) women with isolated histologic vitiligo reported pain and/or itch; 2 of their clinicians provided topical steroid maintenance and follow-up for presumed LS. Of 19 women with histologic LS, 11 (58%) lacked basal layer degeneration, of whom 6 (54%) reported concurrent topical steroid or calcineurin inhibitor use.

Conclusions: Symptomatic women with biopsy-proven vulvar vitiligo usually have an additional dermatologic condition, but histopathologic diagnosis of overlapping conditions is complicated by basal layer assessment and nonsclerotic LS.

Objective: The aim of this study was to evaluate the clinical performance of 2 DNA-based assays (DNA-xGT, DNA-lGT) and 1 RNA-based assay (mRNA), using specimens from women with cervical carcinoma or high-grade cervical lesions (≥CIN3).

Methods: Liquid-based cytology samples collected from 154 patients with ≥CIN3 histology results were tested with DNA-xGT, DNA-lGT, and mRNA assays. The clinical sensitivities of the HPV testing for disease detection were evaluated. Genotype-specific agreement was also assessed between the assays.

Results: The clinical sensitivity of the DNA-xGT, DNA-lGT, and mRNA in detecting ≥CIN3 were 96.8%, 96.1%, and 91.6%, respectively. The overall high-risk HPV positive percent agreement ranged from 92.6% to 99.3% across different assay pairs analyzed. Composite comparator analysis demonstrated no significant difference between the DNA assays; however, a significant difference was observed between the RNA assay and the DNA assays.

Conclusions: While no statistically significant difference was observed between DNA-xGT and DNA-lGT assays in disease detection rate, the mRNA test showed a significantly lower detection rate when compared to the DNA-xGT assay. Most of the missed infections (8/13) were identified as HPV16 or HPV18.

Objective: Multicentric, human papillomavirus (HPV) associated lower genital tract disease includes preinvasive and invasive lesions at multiple anatomic sites and can be synchronous or metachronous. Identifying patients with multicentric disease is crucial because of associated high treatment failure and recurrence. This study evaluates clinicopathologic patterns in immunocompetent and immunocompromised patients with multicentric lower anogenital disease.

Methods: Two-hospital retrospective study of 36 patients with histologic diagnoses of multicentric anogenital HPV-associated dysplasia was identified over a 25-year period. Patients were classified based on immune status: immunocompetent without HIV, immunocompetent with HIV, and immunocompromised. Histologic diagnoses, p16 immunohistochemistry (IHC), and in situ hybridization (ISH) for high-risk (HR) and low-risk (LR) HPV were reviewed.

Results: The most common sites of dysplasia were the anus (25%) and vulva (25%), with high-grade squamous intraepithelial lesions (HSIL) being the most frequent diagnosis (50%). Positive p16 IHC and HR-HPV ISH staining occurred in 71% and 81% of specimens, respectively. One-third of patients revealed a variation in IHC/ISH expression in lesions at the same anatomic sites at different time points. A significantly higher frequency of variation occurred in individuals living with HIV and immunocompromised individuals when compared to immunocompetent individuals.

Conclusions: This study supports the theory that some multicentric disease may arise from repeated infections with various HPV genotypes. The findings highlight the need for further research into genetic predispositions and other factors influencing the development of multicentric HPV-associated lesions in both immunocompetent and immunocompromised individuals.

Objective: Cervical acetowhitening is a strong visual cue for lesion identification; however, clinician opinions are subjective and inconsistent. To provide objective evaluation, a machine learning model that enhances colposcopy by automating acetowhite lesion detection in cervical time-series images was developed.

Methods: A dataset of time-series images collected during 238 colposcopy examinations, where in each case, acetowhitening areas had been annotated by 5 expert colposcopists, was utilized. After preprocessing the images, which included aligning them and extracting the cervix by bounding-box detection, the time-series images were divided into discrete segments, and the transient visual changes were extracted as local statistical features. Using the local agreement levels of the reviewers' predictions for the presence of a lesion, a machine learning model was trained to classify the time-series data and generate synthetic annotations.

Results: The model-generated synthetic acetowhite lesion maps aligned well with the experts' annotations. In a subset of cases with localized histology results from punch biopsy, model predictions correlated well with histopathology, highlighting potential for clinical utility.

Conclusions: The proposed method was effective in mimicking expert colposcopists in identifying lesions based on classification of time-series images and outputs correlated with histology. Application of a machine learning model in the clinical setting may streamline lesion identification, support clinician decision-making for punch biopsy, and eventually improve accuracy in detecting precancerous lesions.

Objectives: The authors set out to evaluate the efficacy and safety of phosphodiesterase-4 inhibitor apremilast for moderate-to-severe genital erosive lichen planus (GELP) in women.

Methods: In this randomized, double-blinded, placebo-controlled trial, women with moderate-to-severe GELP received either 30-mg apremilast tablets twice daily, or placebo tablets, for 24 weeks. According to pretrial power calculations, the study needed 40 participants to demonstrate a meaningful clinical effect. Efficacy was evaluated using a clinical scoring tool (GELP score). The primary endpoint was GELP scores at week 24 assessed by an analysis of covariance model adjusted for baseline values. Secondary endpoints included Female Sexual Distress Scale-revised and Dermatology Life Quality Index scores.

Results: A total of 37 women with mean age 57.5 years and a mean GELP score of 14.2 were randomized to receive either apremilast ( n = 19) or placebo ( n = 18). In an intention-to-treat analysis at week 24, mean GELP score was 11.6 in the apremilast group and 11.6 in the placebo group with mean difference between the 2 groups being -0.4 (95% CI = -2.7 to 1.9; p = .71). No significant differences in the secondary endpoints, including Female Sexual Distress Scale-revised and Dermatology Life Quality Index scores, were observed. The per protocol analyses with 14 and 15 participants in each group revealed similar results. Adverse events were registered in 36 women, including serious adverse events in 2 women in the apremilast group.

Conclusions: Although having a small sample size, this randomized controlled trial did not reveal any signals indicating a clinical effect from apremilast treatment in women with moderate-to-severe GELP.

Objective: The aim of the study was to evaluate whether a teaching session and optional reminders improved frequency of performance of vulvar self-examination (VSE) in a population at increased risk of vulvar cancer.

Methods: Participants were recruited from Colposcopy and Vulvar Dermatology clinics at a publicly funded academic hospital in Ontario, Canada. Participants completed a questionnaire, were taught how to perform a VSE, and were given an information booklet. They had the option to receive phone or electronic health record reminders to complete a VSE over the course of the next 6 weeks. After 6 weeks, participants were contacted to survey their VSE behaviors. Data were analyzed using descriptive statistics.

Results: Two hundred nineteen participants completed the study. Prior to the study, 28 participants (13%) had heard of VSE, while 31 (14%) had never looked at their external genitalia before. At a 6-week follow-up, 181 out of 219 participants (83%) completed a VSE, compared to 16% who regularly performed VSEs prior to the intervention ( p < .001). There was a statistically significant improvement in self-reported ability to find the labia minora, labia majora and urethra after the intervention.

Conclusions: Despite low baseline levels of familiarity with VSE, a simple teaching session, with or without reminders was associated with high performance of VSE in a population at increased risk of vulvar cancer.

Objective: The study aimed to assess the use of boric acid and probiotics among patients treated at a tertiary care vulvovaginal health center.

Methods: The authors conducted a cross-sectional survey of 206 new patients from October 2024 and January 2025. Participants completed a questionnaire on demographics, vulvovaginal history, self-treatment practices, and a Vulvar Quality of Life Index. Descriptive statistics, bivariate analyses, multivariable logistic regression, and subgroup analyses were performed.

Results: Fifty percent of participants reported use of boric acid, and 61.2% used probiotics. Only 2.9% used boric acid for the CDC guideline-recommended duration of >21 days. Among those with vulvovaginal candidiasis or bacterial vaginosis, 62.3% and 55.9%, respectively, reported prior boric acid use. Patients learned about boric acid and probiotics from healthcare providers (63.4% and 55.8%, respectively), followed by social media (29.0% and 24.2%). Primary treatment goals included pH balance, symptom relief, and treating infections. Patients spent an annual average of $397 on their condition, with an average of $23 on boric acid and $9 on probiotics. Higher Vulvar Quality of Life Index scores ( p = .042) and being single ( p = .015) were independently associated with boric acid use.

Conclusion: Boric acid and probiotics are widely used among patients with vulvovaginal conditions requiring tertiary care, almost always with unsupported reasons. Although nearly half of the respondents received treatment recommendations from providers, few reported use aligned with clinical guidelines. Given the significant financial burden and extensive misinformed use, there is a critical need for improved patient education and evidence-based counseling to prevent reliance on ineffective or misleading therapies.

Objective: The aim of the study was to evaluate the risk for cervical intraepithelial neoplasia II (CIN 2) or worse associated with high-risk (HR) non-16/18 human papillomavirus (HPV) types among women with normal cytology in a screening context.

Methods: This population-based historical cohort study was conducted in a large state-mandate health provider. Human papillomavirus genotyping was performed on Pap tests collected in women that were positive for non-16/18 HPV types from 2019 to 2023. HPV detection was performed using COBAS (4800/6800) (Roche Diagnostics) test: a qualitative in vitro test for the detection of 14 HR HPV types. The women were followed for histopathologic outcomes until end of 2024. Cumulative incidence proportions of CIN 1, 2, and 3 or worse were calculated.

Results: Of 24,439 women tested positive for HPV during the study period, a total of 7,930 women tested positive for HR HPV non-16/18 with a normal cytology. Among these, 875 (11.1%) developed pathological findings in biopsy including CIN II ( n = 68, 0.9%) and CIN III ( n = 802, 10.1%) lesions, cervical squamous cell carcinoma and adenocarcinoma (4, 0.1%), as well as one case of adenocarcinoma in situ (0.01%).

Conclusions: Women with HR HPV non-16/18 and normal cytology represent a high-risk group requiring long-term follow-up. No malignancies were observed in the first year of follow-up, supporting the recommendation for retesting after 12 months and colposcopy referral if the infection persists.

Objective: Vulvar health conditions such as lichen sclerosus and vulvodynia are often misdiagnosed or delayed in diagnosis, leading to worsened clinical outcomes. A standardized intake questionnaire for the initial patient visit could improve early detection and management of these complex conditions. This study aimed to develop a consensus-based standardized intake questionnaire for vulvar health clinics using the eDelphi methodology.

Methods: An international eDelphi process was initiated. Specialists in vulvar health were recruited to participate in 2 rounds of online surveys to achieve consensus on key questions. The consensus was defined as 70% agreement among panelists for inclusion or exclusion of questions, with feedback incorporated between rounds.

Results: A total of 80 panelists from various specialties, including dermatology and gynecology, participated. In the first round, 136 items were reviewed, with 64 meeting consensus for inclusion. After the second round, an additional 20 items were added, leading to a final intake questionnaire consisting of 82 items that were condensed and reorganized to 52 questions and 2 validated surveys (the Vulvar Quality of Life Index and Patient Health Questionnaire 2).

Conclusions: This study successfully identified key questions for a standardized intake questionnaire for vulvar health clinics using the eDelphi methodology. The methodology may also be applicable to other health conditions requiring structured patient intake processes.

Objectives: Practice recommendations for the minimum steps to perform a colposcopy were published in 2017. The goals of this study are to assess whether adherence to these guidelines correlates with detection of cervical intraepithelial neoplasia and to analyze factors associated with rates of biopsy during colposcopy.

Methods: All colposcopies performed at 2 academic medical centers between 2018-2023 were identified by billing code. Patient demographics, cervical cancer screening, medical history, colposcopy details, and pathology were collected from retrospective medical record review. Adherence to guidelines was determined by the number of criteria met on colposcopy documentation. The outcomes assessed were grade of pathology and rate of biopsy.

Results: In univariable regression analysis, no association between adherence to guidelines and detection of cervical intraepithelial neoplasia 2+ was identified (odds ratio [OR] = 1.11, p = .12). When controlling for race, ethnicity, insurance type, Pap test cytology, and human papillomavirus vaccination status in multivariate analysis, there remained no statistically significant correlation (adj. OR = 1.11, p = .14). Black patients (OR = 0.66, p = .039), publicly insured patients (OR = 0.38, p < .001), and patients with HIV (OR = 0.39, p < .001) were each significantly less likely to have a biopsy taken during colposcopies compared to White, privately insured patients, or HIV-negative patients. In multivariate analysis, HIV and public insurance remained factors associated with lower rates of biopsy (adj. OR = 0.46, p < .001 and adj. OR = 0.63, p = .035, respectively).

Conclusions: The study found insufficient evidence to support current colposcopy guidelines. The analysis revealed disparities in the execution of biopsies during colposcopies, particularly in Black, publicly insured, and HIV-positive patients, underscoring the importance of standardization of colposcopic practices.