Journal of Lower Genital Tract Disease最新文献

Objectives: Human papillomavirus (HPV) vaccines prevent cervical cancer. The inpatient postpartum period presents a unique window for vaccination. The authors' study investigates HPV vaccine knowledge, barriers to vaccination, and willingness to get vaccinated during inpatient postpartum care.

Materials and methods: The authors conducted a cross-sectional survey of 147 participants, age 18 to 26, who delivered at the authors' institution between November 1, 2019, and April 30, 2020. Participants completed a questionnaire that included demographics, vaccine knowledge, hesitancies, and willingness to vaccinate. The authors used descriptive statistics and compared groups with chi-square or Wilcoxon rank sum for categorical variables and t -test for continuous variables.

Results: Of the 147 patients, 58 (39.46%) were fully vaccinated against HPV and 89 (60.54%) of participants were unvaccinated or partially vaccinated. There was a greater proportion of African American and Asian participants among unvaccinated women (28.1% vs 20.7% and 16.9% vs 1.7%, respectively). Most unvaccinated participants (52.9%) were willing to get vaccinated in the postpartum unit. Both vaccinated and unvaccinated groups were similarly aware that the HPV vaccine prevents cervical and oropharyngeal cancers and genital warts. The top barrier to future vaccination was forgetting to complete the vaccination series.

Conclusions: Most women were not fully vaccinated but were willing to receive their first dose while in the postpartum unit. African American women were less likely to be vaccinated and expressed more unwillingness to accept vaccination. The authors identified barriers to HPV vaccination that can be tackled with the initiation of inpatient postpartum vaccination.

Objectives: This investigation explored the prevalence of human papillomavirus (HPV) infection by subtypes in girls aged up to 12.

Methods: Four indexed databases, PubMed, EMBASE, Cochrane, and LILACS, were evaluated. Twenty-nine observational studies published between 1992 and 2018 were included.

Results: The prevalence of genital condyloma acuminatum or HPV-positive serology due to prior infection among girls with suspected/confirmed sexual abuse was 25%, and without a history or information about abuse, 8%. The analysis indicated that low-risk HPV types were the most prevalent among this group, corresponding to 86.6% of the identified types. Human papillomavirus 6 and 11 were the most prevalent types, followed by HPV 16 and 2. Moreover, the analysis identified limited epidemiological data on genital warts in children up to 12 years. Several studies focused on convenience sampling, sexually abused girls, or failed to separate data by gender.

Conclusion: Findings of the systematic review and prevalence meta-analysis indicate that the occurrence of HPV infection in girls aged 12 or younger is relatively rare, underscoring the significance of understanding the prevalence of HPV in the pediatric population. However, it is essential to be cautious when applying these results to the pediatric population, given cases of girls who are suspected of or have suffered sexual abuse. There is a pressing need for further research to fill the information gap on HPV infection in this vulnerable group.

Objectives: Evidence-based guidelines recommend against screening for cervical cancer (Pap testing) in average-risk adolescents <21 years old. Despite this, many still undergo unindicated screenings with subsequent detrimental reproductive health and economic consequences. The authors' aim was to reduce unindicated cervical cancer screening in individuals <21 years old in a large health care system by utilizing an electronic provider notification.

Methods: Starting in July 2020, a Best Practice Advisory (BPA) appeared in the electronic medical record (EMR) if providers ordered Pap testing on individuals <21 years old. This BPA reiterated that screening was not indicated for average-risk adolescents and prompted users to choose an indication if they wanted to proceed. A retrospective chart review, pre/post intervention study was performed comparing individuals <21 years old with Pap testing performed before and after intervention (January 2019-June 2020 and July 2020-June 2021, respectively). Patient characteristics were extracted from the EMR and analyzed using Fisher exact tests, Kruskal-Wallis tests, and logistic regression.

Results: There were 140 subjects included: 106 preintervention and 34 postintervention. There were no differences in baseline characteristics. Neither Pap nor human papillomavirus testing results differed between the groups. Preintervention, 6.6% of cytology tests were indicated compared to 20.6% postintervention ( p = .042). The proportion of indicated human papillomavirus testing did not differ preintervention and postintervention at 65% and 45%, respectively ( p = .295). The overall reduction in unindicated cervical cancer screening postintervention was 13.9% (95% CI = 4.0-23.7).

Conclusions: The authors demonstrated that incorporating a BPA to the EMR reduces unindicated cervical cancer screening.

Objective: Provoked vulvodynia (PV), characterized by vulvar pain upon touch or pressure, is the leading cause of pain during sexual intercourse. It causes a significant decline in overall quality of life, including sexual dysfunction and mental distress. Surgical interventions, such as perineoplasty and vestibulectomy, are considered a last resort for PV cases unresponsive to less invasive therapies. This systematic review evaluates the efficacy of surgery for PV and suggests areas for future research.

Materials and methods: The literature search encompassed PubMed, Scopus, Web of Science, and Cochrane Library, identifying relevant peer-reviewed studies up to August 21, 2023.

Results: Out of 1102 records retrieved, 29 met the eligibility criteria. Surgery was typically considered after failed conservative treatments. In 15 of the 29 studies defining surgical success as a significant reduction in dyspareunia, success rates ranged from 52% to 93%. Six studies using validated scales for pain assessment noted a significant reduction in vulvar pain following surgery ( p < .001). Two studies reported enhancements in sexual function ranging from 57% to 87%, while 3 studies found 89%-97% of women regained the ability to engage in sexual intercourse after surgery. Patient satisfaction rates ranged from 79% to 93%. Bartholin cysts occurred in up to 9% of cases, the most common complication reported.

Conclusion: Surgery seems to be an effective and safe PV treatment option with success rates ranging from 52% to 97%, depending on the variation of outcome measures. Randomized clinical trials with established outcome measures are needed to determine the best surgical approach with minimal operative risk and optimal long-term outcomes.

Objectives: The cohort of diethylstilbestrol (DES)-exposed people is aging, and a substantial fraction have already passed the age of 65, when unexposed average-risk people may exit cervical cancer screening provided they have had adequate prior screening. Current guidelines exclude individuals with a history of in utero exposure to DES. This clinical consensus includes a systematic review of relevant studies and provides updated guidance for surveillance of the aging DES-exposed cohort.

Methods: A literature search was performed to find all relevant DES and clear cell adenocarcinoma (CCA) papers that addressed key clinical questions. Study quality was assessed and recommendations were rated on strength (A-E) and quality of evidence (I-III) using the system described for previous American Society of Colposcopy and Cervical Pathology consensus guidelines.

Results: DES-exposed patients were 40 times more likely (standardized incidence ratio = 40.9; 95% CI, 13.1-126.2) to develop cervical and vaginal CCAs compared with unexposed individuals, with most cases diagnosed in individuals between the ages of 15 and 31. DES exposure in utero significantly increases the risk of CCA compared with nonexposed people, but the absolute risk of CCA is low. While CCA does seem to occur in older exposed patients, cases were rare and calculated incidence rates were extremely low, with the largest in any of the cohorts at 2.86 per million women-years.

Conclusions: The American Society of Colposcopy and Cervical Pathology recommends people with prenatal exposure to DES receive annual screening for CCA with cytology until the age of 65 and discontinue screening beyond the age of 65 provided they otherwise meet criteria for cessation of screening.

Objectives: This study was designed to evaluate the performance of a host gene methylation marker panel (ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671) in the triage of human papillomavirus (HPV)-positive women, its possible impact in a cervical cancer screening program, and the possible influence of the variation of the rate of HPV16/18 in its performance.

Materials and methods: Cohort study in which consecutive women referred for colposcopy in an organized cervical cancer screening program had repeated HPV testing, colposcopy, and biopsies. The women that remained HPV positive at the time of colposcopy were tested with the panel of DNA methylation markers. The performance of the test was evaluated and compared to standard practice.

Results: The study test had a sensitivity and specificity for cervical intraepithelial neoplasia (CIN) 2+ of 60.8% (49.1-71.6%) and 88.4% (83.2-92.5%), respectively. For CIN3+, it was of 78.0% (64.0-88.5%) and 86.0% (80.8-90.2%), respectively. The rate and level of methylation positively correlated with the severity of disease. The use of methylation reduces the referral for colposcopy to 25.5%, while detecting 78.0% of the CIN3+ cases. Referral of all HPV16/18-positive cases and triage of the other high-risk HPV-positive cases with methylation, detects 90.0% of the cases of CIN3+, while reducing the number of referrals to 43.2%. The variation in the rate of HPV16/18 does not relevantly affect the performance of the methylation panel.

Conclusions: The studied methylation panel has a high sensitivity and specificity for CIN3+ and reduces the rate of referrals for colposcopy, without relevant variation according to the rate of HPV16/18.

Abstract: Vulvar examination during procedures for cervical carcinoma screening (CCS) can be a valid chance for early diagnosis of vulvar diseases and precancerous lesions. With this aim an online questionnaire was sent to the members of the Italian Cervical Carcinoma Screening Group (GISCi) from either first level group (FLG, Pap/human papillomavirus test sampling) or second level group (SLG, colposcopy and treatments) to assess if and how vulvar examination was performed. 86% of FLG and 90.2% of SLG report performing vulvar examination prior to CCS procedures. 15% of SLG cannot manage basic vulvar diseases and they refer patients to specialized center. 54.3% underline lack of standardized protocol in case of vulvar disease detection. Despite most health care professionals report examining the vulva during CCS procedures, vulvar cancer early diagnosis is still challenging.

Objectives: Vulval lichen planus (VLP) is a chronic inflammatory dermatosis that is often refractory to treatment and results in poor quality of life. The management of recalcitrant disease is not well described in the current literature. Hydroxychloroquine (HCQ) has a role in treating oral and cutaneous lichen planus and may be used in VLP based on expert opinion. This review aimed at adding to the limited existing evidence on the role of HCQ for VLP.

Materials and methods: This is a case series of 23 people with VLP treated with HCQ. Outcomes were assessed based on physician global assessment.

Results: Twenty-three people with a mean age of 66 years were included. Ten patients (44%) had a much improved response to HCQ, 1 patient (4%) had a partial response, and 7 (30%) had minimal/no response to treatment. Five people (22%) experienced side effects that resulted in stopping HCQ.

Conclusions: This series demonstrated some efficacy of HCQ in treating VLP. We are limited by the small participant numbers due to the rarity of this condition and a lack of an objective assessment tool. Further controlled studies are needed to assess the effectiveness and tolerability of HCQ in treating this complex condition.