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Abstract
Safe and effective contraceptive choices are essential for women with HIV-1 infection and at risk for HIV-1 infection. Epidemiological and laboratory-based studies suggest that hormonal contraception may influence HIV-1 transmission. Several large studies in high-risk populations indicate that hormonal contraceptive use may modestly increase the risk of HIV-1 acquisition. In addition, HIV-1-infected users of hormonal contraceptives may be more infectious to their uninfected partners, although no studies have directly measured HIV-1 transmission risk from women to men. However, several studies failed to demonstrate a link between contraceptive use and HIV-1 acquisition or transmission, and interpretation of many studies limited by methodological considerations, such as infrequent measurements of contraceptive exposure and HIV-1 status. As a result, many questions remain, and high-quality studies remain needed. It is clear that hormonal contraceptives are not protective against HIV-1 infection and that dual protection with condoms should be the goal for women using hormonal contraception.
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Affiliation(s)
- Catherine A Blish
- Division of Human Biology, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
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Campaner AB, Eras AE, Paganini CBL, Galvão MAL. The effect of cigarette smoking on cell proliferation in normal uterine cervix epithelium. Arch Gynecol Obstet 2010; 284:119-23. [PMID: 20677025 DOI: 10.1007/s00404-010-1586-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 07/04/2010] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of smoking on cell proliferation in normal cervical epithelium. METHODS A total of 45 women undergoing hysterectomies due to uterine leiomyomata were investigated. Thirty were nonsmokers and 15 were current smokers. A segment of tissue was taken from cervix after removal of the uterus, and the identification of cell proliferation was performed by immunohistochemical analysis employing Ki-67 staining. The number of positive cells colored by Ki-67 staining was finally expressed as number of cells per square millimeter (mm²) of epithelium. RESULTS The comparison of the number of proliferating cells measured by ki-67 staining among smoking and nonsmoking women did not show significant difference. Among smoking women, there was no significant difference related to the number of cigarettes smoked per day or time of consumption and epithelial cell proliferation. However, the total amount of cigarettes smoked throughout presented significant association with Ki-67 staining (p < 0.001); the number of proliferating cells per mm² increased proportionally to the increase in consumption of cigarettes. CONCLUSIONS The results indicated that there was no significant difference between cell proliferation in smokers and nonsmokers; however, it was shown that in the smokers' group, amount of cigarettes smoked during throughout lifetime can increase cell proliferation in normal cervical epithelium.
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Affiliation(s)
- Adriana Bittencourt Campaner
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, América, São Paulo, SP, 05401-200, Brazil.
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53
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Morrison CS, Chen PL, Kwok C, Richardson BA, Chipato T, Mugerwa R, Byamugisha J, Padian N, Celentano DD, Salata RA. Hormonal contraception and HIV acquisition: reanalysis using marginal structural modeling. AIDS 2010; 24:1778-81. [PMID: 20588106 DOI: 10.1097/qad.0b013e32833a2537] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hormonal contraceptives are used widely worldwide; their effect on HIV acquisition remains unresolved. We reanalyzed data from the Hormonal Contraception and HIV Study using marginal structural modeling to reduce selection bias due to time-dependent confounding. Replicating our original analysis closely, we found that depo-medroxyprogesterone acetate (DMPA) but not combined oral contraceptive (COC) was associated with increased HIV acquisition. Also, young (18-24 years) but not older women who used DMPA and COCs were at increased HIV risk.
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54
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Sobel JD. Vaginitis, vulvitis, cervicitis and cutaneous vulval lesions. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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55
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Monroy OL, Aguilar C, Lizano M, Cruz-Talonia F, Cruz RM, Rocha-Zavaleta L. Prevalence of human papillomavirus genotypes, and mucosal IgA anti-viral responses in women with cervical ectopy. J Clin Virol 2009; 47:43-8. [PMID: 19906557 DOI: 10.1016/j.jcv.2009.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 09/29/2009] [Accepted: 10/07/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data on the prevalence of different human papillomavirus (HPV) genotypes and the associated mucosal immune response in women with cervical ectopy are scarce. OBJECTIVE To assess the prevalence of different HPV genotypes and the mucosal anti-viral immune response in cervical ectopy. STUDY DESIGN Detection and typing of HPV DNA was determined in 141 women with cervical ectopy, 272 cytologically normal controls and 98 low-grade squamous intraepithelial lesions (LSIL) by PCR and direct sequencing. Mucosal IgA antibodies to HPV16 and HPV18 were evaluated in cervical mucus by ELISA. RESULTS The prevalence of HPV in cervical ectopy was higher (73.7%) than that observed in control samples (30.5% in endocervix, and 1.8% in exocervix), but similar to the prevalence in LSIL (62.2%). Typing showed that the overall distribution frequency concerned 14 different genotypes, with HPV18 being the most prevalent in cervical ectopy (53.9%), whereas HPV16 predominated in LSIL (38.7%). High-risk HPV genotypes were 2.2 times more frequent in cervical ectopy than in the normal endocervix (p<0.0001). HPV infection in cervical ectopy patients was accompanied by a mucosal IgA-antibody response. Antibody reactivity to HPV18 was significantly higher than the response to HPV16. CONCLUSION Cervical ectopy is a risk factor for infection with high-risk HPV genotypes, in particular HPV18. Our results emphasize the need of further studies to clarify the oncogenic potential of this virus in cervical ectopy.
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Affiliation(s)
- Olga L Monroy
- Departamento de Biologia Molecular y Biotecnología, Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico, Circuito Escolar s/n, Ciudad Universitaria, Mexico DF, CP 04510, Mexico
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Hacialioğlu N, Nazik E, Kiliç M. A descriptive study of douching practices in Turkish women. Int J Nurs Pract 2009; 15:57-64. [PMID: 19335521 DOI: 10.1111/j.1440-172x.2009.01735.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vaginal douching is a common hygiene practice for many women all over the world. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the aim of this study is to evaluate the status of vaginal douching practices of women in the Erzurum province of Turkey. The present study was a descriptive and cross-sectional quality. All participants were 15-49 years of age and all were married. Data analysis included descriptive statistics and chi(2) test. The present study revealed that the frequency of douching was 51.4% among women and that the most common reason for their habit was feminine hygiene and the most popular material used was water. A statistically significant relationship was found between the habit of doing the vaginal douching and the educational level, age of marriage, number of births, case of genital infections within the last year and presence of complaints indicating vaginal infections for the last month. This study provides preliminary information about women's douching practices and attitudes. It might also provide information to health-care practitioners in their efforts to educate women on the adverse effects of vaginal douching.
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Affiliation(s)
- Nazli Hacialioğlu
- Department of Nursing, Erzurum Health School, Atatürk University, Erzurum, Turkey
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58
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Vessey M, Yeates D. Some minor female reproductive system disorders: findings in the Oxford-Family Planning Association contraceptive study. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2009; 35:105-10. [DOI: 10.1783/147118909787931988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Heikinheimo O, Lähteenmäki P. Contraception and HIV infection in women. Hum Reprod Update 2009; 15:165-76. [PMID: 18978360 PMCID: PMC2639085 DOI: 10.1093/humupd/dmn049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 09/11/2008] [Accepted: 09/22/2008] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. METHODS Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. RESULTS Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. CONCLUSIONS All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
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Affiliation(s)
- Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki, Finland.
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Abstract
OBJECTIVE The objective of this study was to determine whether the presence of cervicitis influenced the accuracy of visual inspection with acetic acid (VIA). MATERIALS AND METHODS In a pilot study, 502 women from rural El Salvador were screened for cervical cancer using methods including colposcopy and VIA. The presence of cervicitis was assessed by grading the amount of inflammation on each woman's cervical biopsy. Data from 495 women found to be free of cervical neoplasia were analyzed for the present study. RESULTS In this study population, 74% of women were classified as having cervicitis. Both the result of visual inspection and the result of colposcopy were highly associated with the presence of cervicitis (p =.007 and p =.006, respectively). Women with cervicitis were twice as likely to have a positive VIA result as women without cervicitis (odds ratio = 2.0, 95% CI: 1.0-3.7). CONCLUSIONS The presence of cervicitis may influence the accuracy of results obtained from colposcopy and VIA. This observation may be of particular importance in low-resource settings such as El Salvador where visual inspection methods are more commonly used in screening for cervical cancer.
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Hwang LY, Ma Y, Benningfield SM, Clayton L, Hanson EN, Jay J, Jonte J, de Medina CG, Moscicki AB. Factors that influence the rate of epithelial maturation in the cervix in healthy young women. J Adolesc Health 2009; 44:103-110. [PMID: 19167657 PMCID: PMC2662755 DOI: 10.1016/j.jadohealth.2008.10.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 10/13/2008] [Accepted: 10/17/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the longitudinal changes in the epithelial topography of the cervix in healthy young women; and to determine the sociodemographic, behavioral, and biological factors associated with the rate of cervical epithelial maturation. METHODS Healthy young women were enrolled from October 2000 to September 2002 as part of a larger study of human papillomavirus (HPV). At interval visits, interviews, infection testing, and colpophotography (3% acetic acid; 10x, 16x magnifications) were performed. Areas of total cervical face and cervical immaturity, defined as columnar and early squamous metaplasia, were quantitatively measured using computerized planimetry. Cervical immaturity was expressed as percentage of total cervical face. This analysis includes the first consecutive 145 women with greater than 10% immaturity at baseline. The rate of cervical maturation was defined as change in percent-immaturity. Predictors included sociodemographics, sexual behaviors, and infections. Data analyses included multivariate generalized linear models with repeated measures. RESULTS The baseline mean age was 17.8 years. Colpophotographs were available from 815 total visits, representing 2.7 years mean follow-up per woman and 5.9-month mean intervals. Women began the study with a median of 39% immaturity and ended with 8% immaturity. After adjusting for time and baseline percent-immaturity, an increased rate of cervical maturation was associated with oral contraceptive pill use (parameter estimate -.023, p =.04) and smoking (-.039, p =.01). CONCLUSIONS Cervical maturation was documented during relatively short time periods for the vast majority of these women. Oral contraceptive pills and smoking may accelerate the maturational process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.
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Cytomegalovirus (CMV) infection—related to male and/or female infertility factors? Fertil Steril 2009; 91:67-82. [DOI: 10.1016/j.fertnstert.2007.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/11/2007] [Accepted: 11/11/2007] [Indexed: 11/18/2022]
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Chen J, Zhou D, Liu Y, Peng J, Li C, Chen W, Wang Z. A comparison between ultrasound therapy and laser therapy for symptomatic cervical ectopy. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1770-1774. [PMID: 18471953 DOI: 10.1016/j.ultrasmedbio.2008.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 01/13/2008] [Accepted: 03/14/2008] [Indexed: 05/26/2023]
Abstract
The purpose of this study was to compare the clinical efficacy of ultrasound (US) therapy and laser therapy in patients with symptomatic benign ectopy of the uterine cervix. Patients with symptomatic benign ectopy of the cervix (n = 200) were enrolled in this study. Abundant leukorrhea, contact bleeding, recurrent cervicitis and pelvic pain were also evaluated. Patients were allocated alternately to the US and laser groups. In the laser group, Nd: YAG laser was used for tissue vaporization destruction. In the US group, the therapeutic US device Seapostar (Chongqing Haifu [HIFU] Technology, Co. Ltd., Chongqing, China) was applied. Neither anesthesia nor analgesia was used. Results showed that patients in both groups tolerated the procedure well and had excellent treatment outcomes. A symptomatic cure rate of 97.33% was obtained in the US group, and 98.81% was obtained in the laser group (p > 0.05). Ectopy areas were managed with a success rate of 95.95% in the US group, and 96.43% in the laser group (p > 0.05). The rate of side effects (including vaginal reactive discharge and colporrhagia) was found to be lower in the US group than that in the laser group. Mild-to-moderate bleeding occurred in US group (8.42%) and laser group (45.56%). The bleeding rate in the US group is significantly lower than that in the laser group (p < 0.01). We conclude that focused US can treat symptomatic ectopy of the cervix successfully, with excellent clinical results and minimal risk. Focused US therapy appears to be a promising new treatment method for symptomatic ectopy of the uterine cervix.
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Affiliation(s)
- Jinyun Chen
- Institute of Ultrasound Engineering in Medicine, Chongqing Medical University, Chongqing, China
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64
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Abstract
The risk of human immunodeficiency virus (HIV) transmission during sexual activity is dependent on the infectivity of the HIV-positive individual and the susceptibility of the uninfected partner. HIV is most often transmitted during periods of high HIV load, but factors such as the type of sexual activity and the innate and genetic defenses of the uninfected partner exert a strong influence on the risk of transmission. Certain factors, such as coinfection with other sexually transmitted diseases or the presence of genital lesions in either sexual partner, amplify the risk of transmission that is predicted on the basis of sexual contact alone. In the absence of more-reliable options, such as a vaccine, factors that define HIV infectivity and susceptibility and factors that amplify the risk of HIV transmission, may serve as critical targets for containment of the HIV epidemic.
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Affiliation(s)
- Myron S Cohen
- University of North Carolina School of Medicine, Chapel Hill, 27599-7030, USA.
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Chu TY. Risk Factors and Genetic Markers of Human Papillomavirus-induced Cervical Carcinogenesis: A Focus on Chinese Populations in Southeast Asia and Southern China. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
PURPOSE OF REVIEW Sexually transmitted infections impact significantly on global health. Whereas Chlamydia, Neisseria gonorrhoea and syphilis have been extensively examined, there remains a paucity of knowledge of nonchlamydial and nongonococcal cervicitis, an arguably more prevalent but poorly characterized condition with uncertain clinical implications. With increasing application of molecular diagnostic methods for the detection of sexually transmitted infections and a growing body of literature on cervicitis, a review is timely. RECENT FINDINGS The number of putative aetiological agents implicated in cervicitis is growing and includes Mycoplasma genitalium, herpes simplex virus, cytomegalovirus, bacterial vaginosis and Trichomonas. The potential role of cervicitis in HIV transmission has been highlighted. Increasing broad-spectrum antibiotic usage with associated emergence of antimicrobial resistance reinforces the need for targeted antibiotic therapies, including the management of cervicitis. SUMMARY As our understanding of the aetiology and significance of cervicitis, particularly nonspecific cervicitis, improves, management will be refined. Advances in molecular diagnostic testing will facilitate this process, but urinary nucleic acid amplification testing should not replace clinical examination while cervicitis prevalence and significance is not yet established. A standardized approach to cervicitis research, particularly with consensus of case definition, may facilitate outcomes that can be more generally applied in clinical practice.
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Affiliation(s)
- M Josephine Lusk
- RPA Sexual Health, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Machado Junior LC, Dalmaso ASW, Carvalho HBD. Evidence for benefits from treating cervical ectopy: literature review. SAO PAULO MED J 2008; 126:132-9. [PMID: 18553039 PMCID: PMC11026019 DOI: 10.1590/s1516-31802008000200014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 04/09/2007] [Accepted: 03/07/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND PURPOSE Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.
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Affiliation(s)
- Luís Carlos Machado Junior
- Centro de Saúde Escola Samuel Barnsley Pessoa, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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68
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Yang K, Li J, Liu Y, Ma B, Roberts H, Tan J, Tian J, Wu T, Zhang P. Microwave therapy for cervical ectropion. Cochrane Database Syst Rev 2007; 2007:CD006227. [PMID: 17943899 PMCID: PMC8922973 DOI: 10.1002/14651858.cd006227.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical ectropion is considered as one of the most common types of chronic cervicitis in China. Topical treatments for cervical ectropion including microwave tissue coagulation, are widely used in many hospitals in China. Nowadays, the necessary intervention for inflammatory cervical ectopy is controversial. OBJECTIVES To compare the efficacy and potential side effects of microwave tissue coagulation with other interventions or no intervention in the treatment of cervical ectropion. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2006, Issue 1), MEDLINE (1966 to 2005), EMBASE (1974 to 2005); The Chinese Biomedical Database (CBM, 1978 to 2005), The Chinese Medical Current Contents (CMCC, 1994 to 2005), CAJ Full-text Database (1994 to 2005) and Chinese Scientific Journals Database (1989 to 2005). We also searched related literature on the Internet with search engines such as Google, searched the reference lists of articles and hand searched relevant Chinese journals. SELECTION CRITERIA Only authentic randomized controlled trials (RCTs) were included. DATA COLLECTION AND ANALYSIS Two authors independently interviewed the original authors of claimed RCTs published in China and then assessed the quality of the three included RCTs and extracted data. MAIN RESULTS No studies were found that met the participant inclusion criteria of the protocol. Although three studies were identified as authentic RCTs from 92 potential RCTs, it was not possible to confirm that the participants were symptomatic prior to treatment. Of these three studies two trials compared microwave therapy with laser and one compared microwave therapy with interferon-alpha suppository therapy. Microwave therapy showed a better effect on cervical appearance over laser therapy in the women with grade II and III and also improved cervical appearance over interferon-alpha suppository therapy. There was no difference in grade I women. Microwave therapy showed less adverse bleeding than laser therapy during the treatment. However, the methodological quality of the three RCTs was generally low. No trial compared treatment to no intervention and most trials didn't assess relief of symptoms or quality of life and satisfaction, which are very important to women. AUTHORS' CONCLUSIONS There are no RCTs comparing microwave therapy with other treatments or no treatment in symptomatic women with cervical ectropion. Although microwave therapy improved the appearance of the cervix over both laser therapy and interferon-alpha suppository therapy it is not clear if there is any other benefit for women.
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Affiliation(s)
- K Yang
- LanZhou University, Centre of Evidence Based Medicine of LanZhou University, No.103 Dong Gang West-Road, Lanzhou, Gansu, China, 730000.
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69
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Affiliation(s)
- Erica Monasterio
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California, USA
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70
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Abstract
In the past several years, the collective understanding of cervicitis has extended beyond the recognition of Chlamydia trachomatis and Neisseria gonorrhoeae as the prime etiologic suspects. Trichomonas vaginalis and herpes simplex virus cause cervicitis, and both Mycoplasma genitalium and bacterial vaginosis have emerged as new candidate etiologic agents or conditions. However, major gaps in our knowledge of this common condition remain. Putative etiologic agents have not been identified in many women with cervicitis. Moreover, cervicitis occurs in a relatively small proportion of women with chlamydia or gonorrhea. Finally, scant research has addressed the clinical response of nonchlamydial and nongonococcal cervicitis to antibiotic therapy, and there are no data on the benefit of sex partner treatment for such women. New research into the etiology, immunology, and natural history of this common condition is needed, especially in view of the well-established links between cervicitis and an increased risk of upper genital tract infection and human immunodeficiency virus type 1 acquisition.
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Affiliation(s)
- Jeanne M Marrazzo
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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Baeten JM, Lavreys L, Overbaugh J. The influence of hormonal contraceptive use on HIV-1 transmission and disease progression. Clin Infect Dis 2007; 45:360-9. [PMID: 17599316 DOI: 10.1086/519432] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 04/04/2007] [Indexed: 11/03/2022] Open
Abstract
Women account for nearly one-half of new human immunodeficiency virus type 1 (HIV-1) infections worldwide, including the majority of infections in Africa. Biological and epidemiological studies suggest that hormonal contraceptive use could influence susceptibility to HIV-1, as well as infectivity and disease progression for those who become infected. However, not all studies have shown this relationship, and many questions remain. Safe and effective contraceptive choices are essential for women with and at risk for HIV-1 infection. Thus, understanding the effect, if any, of hormonal contraception on HIV-1 disease among women is a public health priority.
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Affiliation(s)
- Jared M Baeten
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Geisler WM, Chow JM, Schachter J, McCormack WM. Pelvic Examination Findings and Chlamydia trachomatis Infection in Asymptomatic Young Women Screened With a Nucleic Acid Amplification Test. Sex Transm Dis 2007; 34:335-8. [PMID: 17028510 DOI: 10.1097/01.olq.0000240344.20665.63] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nucleic acid amplification tests (NAATs) allow chlamydia screening in asymptomatic women who otherwise may not have pelvic examinations. How often these women have examination findings that may prompt empiric therapy is unclear. OBJECTIVE The objective of this study was to assess the relationship of chlamydia with pelvic examination findings in asymptomatic women screened by NAAT. METHODS The authors conducted a retrospective analysis of clinical data from 577 young asymptomatic women screened by chlamydial transcription-mediated amplification (TMA). RESULTS TMA was positive in 68 (11.8%). The most common examination finding was vaginal discharge (5.9%) followed by cervical ectopy (3.6%), endocervical mucopus (2.3%) or easily induced bleeding (2.3%), and cervical motion (1.4%) or adnexal (0.7%) tenderness. On multivariate analysis, only easily induced bleeding or mucopus predicted chlamydia (adjusted odds ratio [AOR] = 4.7; P = 0.010 and AOR = 4.4; P = 0.015, respectively). CONCLUSIONS Abnormal pelvic examination findings were infrequent in asymptomatic young women screened by a chlamydial NAAT. However, endocervical bleeding or mucopus, when present, predicted chlamydia.
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Affiliation(s)
- William M Geisler
- STD Program, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
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73
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Myer L, Denny L, Wright TC, Kuhn L. Prospective study of hormonal contraception and women's risk of HIV infection in South Africa. Int J Epidemiol 2006; 36:166-74. [PMID: 17175547 DOI: 10.1093/ije/dyl251] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many women using hormonal contraceptives are also at risk of sexually transmitted HIV infection, but data are mixed on whether hormonal contraception increases women's risk of HIV. We investigated associations between HIV incidence and use of combined oral contraceptives (COC), norethindrone enanthate (NET-EN) or depot medroxyprogesterone acetate (DMPA) in a cohort of South African women. METHODS Participants were 4200 HIV-negative women aged 35-49 years enrolled into a cervical cancer screening trial. At enrollment, women were tested for sexually transmitted infections and reported on their sexual behaviour and contraceptive use. During the 24 months of follow-up, women reported on their sexual behaviours and contraceptive use and underwent repeat HIV testing. RESULTS During the 5010 person-years of follow-up, 111 incident HIV infections were observed (HIV incidence, 2.2 infections/100 person-years). At enrollment, 21% of women reported using hormonal contraception, primarily DMPA (14% of all women) or NET-EN (5%). After adjusting for sexual risk behaviours and sexually transmitted infections, the incidence of HIV was similar among women using COC, NET-EN or DMPA compared with women not using any hormonal method [incidence rate ratios and 95% confidence intervals, 0.65, 0.16-2.66; 0.79, 0.31-2.02 and 0.96, 0.58-1.59, respectively]. There was also no association between increased duration of DMPA use and HIV incidence (P-value for trend, 0.51). CONCLUSIONS These findings contribute to the evidence from general population cohorts of women that hormonal contraceptive use is not associated with increased risk of HIV acquisition. Nonetheless, family planning services are an important venue for HIV prevention activities.
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MESH Headings
- Adult
- Age Distribution
- Contraceptives, Oral/administration & dosage
- Contraceptives, Oral/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Female
- HIV Infections/epidemiology
- HIV Infections/transmission
- Humans
- Incidence
- Medroxyprogesterone Acetate/administration & dosage
- Medroxyprogesterone Acetate/adverse effects
- Middle Aged
- Norethindrone/administration & dosage
- Norethindrone/adverse effects
- Norethindrone/analogs & derivatives
- Prospective Studies
- Risk Factors
- Sexual Behavior
- Sexually Transmitted Diseases/epidemiology
- South Africa/epidemiology
- Time Factors
- Uterine Cervical Neoplasms/diagnosis
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
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74
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Sheeder J, Stevens-Simon C, Lezotte D, Glazner J, Scott S. Cervicitis: to treat or not to treat? The role of patient preferences and decision analysis. J Adolesc Health 2006; 39:887-92. [PMID: 17116520 DOI: 10.1016/j.jadohealth.2006.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/06/2006] [Accepted: 06/09/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE Mucopurulent cervicitis is neither a sensitive nor a specific indicator of antibiotic sensitive infection. This analysis examines the positive and negative ramifications of treating cervicitis empirically as a Chlamydial (CT) infection. It begins where prior analyses leave off, with the number of cases of pelvic inflammatory disease (PID) prevented. METHODS Three treatments were compared: 1) treat empirically/refer partner; 2) test, treat, and base partner treatment on results; 3) test, base treatment on results. The outcomes were the physical sequelae of PID and the psychological sequelae of being diagnosed with CT in a hypothetical cohort of 500 teenagers with cervicitis, among whom the prevalence of CT averaged 33%, but ranged between 10% and 70%. RESULTS At a CT prevalence of 33%, Treatments 1 and 2 prevented three times as many cases of PID-related physical sequelae (n = 14) as Treatment 3 (n = 5). However, to prevent these 14 cases of physical sequelae, with Treatment 1, 163 teens needlessly suffer the psychological sequelae of a false CT diagnosis and with Treatment 2, 101 do so. The ratio of physical sequelae prevented to psychological sequelae caused, changed in relationship to the prevalence of CT, but was always numerically most favorable with Treatment 3. Moreover, it was the only therapeutic approach for which overall morbidity never exceeded the PID-related physical morbidity incurred in the absence of treatment. CONCLUSIONS By including the effects of over diagnosing and treating CT, we have demonstrated how the risks and benefits of empiric and nonempiric cervicitis therapy vary in relationship to CT prevalence. Failure to consider both the physical and the psychological aspects of patient well-being may mean that well-intentioned policies to reduce physical morbidity do not result in an overall improvement in health of teenagers.
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Affiliation(s)
- Jeanelle Sheeder
- Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Sciences Center, The Children's Hospital, 1056 East 19th Street, Box B025, Denver, CO 80218, USA.
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75
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Myer L, Wright TC, Denny L, Kuhn L. Nested Case–Control Study of Cervical Mucosal Lesions, Ectopy, and Incident HIV Infection Among Women in Cape Town, South Africa. Sex Transm Dis 2006; 33:683-7. [PMID: 16614588 DOI: 10.1097/01.olq.0000216026.67352.f9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to test whether cervical mucosal lesions and ectopy increase women's susceptibility to HIV infection. STUDY DESIGN HIV-seronegative women ages 35 to 65 years (n = 5773) enrolled into a cervical cancer screening trial were followed for up to 36 months. All HIV seroconverters (n = 86) in the cohort were compared with randomly selected controls (n = 324) who did not seroconvert. Magnified photographs of the cervix taken during speculum examination at enrollment were evaluated for cervical mucosal lesions and ectopy using standard criteria. RESULTS The presence of mucosal lesions (observed among 19% of controls) was associated with increased risk of HIV seroconversion (adjusted odds ratio [AOR] = 1.93; 95% confidence interval [CI] = 1.07-3.48). Ectopy extending over >20% of the cervix was also associated with HIV seroconversion (AOR = 2.18; 95% CI = 1.01-4.69). CONCLUSIONS Visible lesions of cervical mucosa and cervical ectopy may be markers of increased susceptibility to HIV infection among women. Protection of the mucosa of the cervix may provide an important approach for new HIV prevention technologies.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa
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76
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Bramante M. Genital Hygiene. THE VULVA 2006:183-216. [DOI: 10.1201/9781420005318-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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77
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Auerswald CL, Muth SQ, Brown B, Padian N, Ellen J. Does partner selection contribute to sex differences in sexually transmitted infection rates among African American adolescents in San Francisco? Sex Transm Dis 2006; 33:480-4. [PMID: 16645551 DOI: 10.1097/01.olq.0000204549.79603.d6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known regarding whether partner characteristics explain sex differences in sexually transmitted infection (STI) rates in nonclinic-based, school-aged African American youth. MATERIALS AND METHODS A random digit dial household sample of 14- to 19-year-old youth in San Francisco reported the total number, age, race, and perceived history of incarceration, gang membership, and level of sexual activity of their partners. Youth were tested for gonorrhea and chlamydia. RESULTS Female participants were more likely than male participants to have a partner who was older or had been incarcerated and less likely to have a non-African American partner. Controlling for partner number, female's odds ratio (OR) for having an STI was 1.39 (95% confidence interval [CI] = 0.98-1.98; P = 0.07). Controlling for partner incarceration and number of partners, the borderline sex difference was eliminated (OR = 1.07; 95% CI = 0.70-1.63). CONCLUSION Sex differences in STI rates among African American adolescents may be determined more by the risk of the partner than the risk of the individual.
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Affiliation(s)
- Colette L Auerswald
- Division of Adolescent Medicine, Department of Pediatrics, University of California at San Francisco, San Francisco, California 94143-0503, USA.
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78
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Caliskan D, Subasi N, Sarisen O. Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic. Eur J Obstet Gynecol Reprod Biol 2006; 127:244-51. [PMID: 16377067 DOI: 10.1016/j.ejogrb.2005.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 10/25/2005] [Accepted: 11/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. STUDY DESIGN This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. RESULTS The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. CONCLUSION Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.
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Affiliation(s)
- Deniz Caliskan
- Public Health Department, Ankara University School of Medicine, Münzeviler Sokak No: 1, 06590 Akdere-Ankara, Turkey.
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79
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Abstract
STI are among the most common pathological conditions affecting sexually active adolescents. Both screening of asymptomatic adolescents and a thoughtful, thorough approach to the evaluation of symptoms are critical measures in STI identification and control.
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Affiliation(s)
- Cynthia Holland-Hall
- Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Children's Hospital, 700 Children's Drive, Columbus, 43205, USA.
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80
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Omoniyi-Esan OG, Osasan SA, Ojo OS. Non-neoplastic diseases of the cervix in Nigerians: a histopathological study. Afr Health Sci 2006; 6:76-80. [PMID: 16916295 PMCID: PMC1831974 DOI: 10.5555/afhs.2006.6.2.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND Diseases of the cervix are common in young sexually active women. Non-neoplastic diseases are predominantly inflammatory and are common but there are a few publications on the subject compared to neoplastic diseases of the cervix. MATERIALS AND METHODS The surgical day books of the Histopathology department of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife, Nigeria from the year 1990-1999 (Ten years) were studied for all cervical biopsies. RESULTS Four hundred (400) cervical surgical biopsies were received during this period. 150 (37.5%) of the cases were non-neoplastic lesions. Age range was 20-69 years with peak incidence at 40-49 years. Histological distribution showed 123 cases (82%) were chronic non-specific cervicitis. Eighteen cases (12%) were chronic cervicitis with koilocytic change pathognomonic of Human Papilloma Virus (HPV) infection, two-third (12 cases) of which occur within 40-49 years. There were five cases (3.3%) of chronic granulomatous cervicitis, three cases (2.0%) of acute cervicitis and only one case (0.7%) of microglandular endocervical hyperplasia. CONCLUSION All the histological types were found within the peak age incidence of 40-49 years. Chronic non-specific cervicitis was the most common non-neoplastic cervical lesion and it occurs in all age groups of women studied. In 12% of patients it is associated with cytopathic effect of HPV. This has obvious implication for the occurrence of carcinoma of the cervix in our country. We recommend routine pap smear test in this group of patients especially, as a way of reducing the occurrence of carcinoma of the cervix.
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Affiliation(s)
- Olutoyin G Omoniyi-Esan
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife, Nigeria.
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81
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Castle PE, Jeronimo J, Schiffman M, Herrero R, Rodríguez AC, Bratti MC, Hildesheim A, Wacholder S, Long LR, Neve L, Pfeiffer R, Burk RD. Age-Related Changes of the Cervix Influence Human Papillomavirus Type Distribution. Cancer Res 2006; 66:1218-24. [PMID: 16424061 DOI: 10.1158/0008-5472.can-05-3066] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately 15 human papillomavirus (HPV) types cause virtually all cervical cancer whereas other HPV types are unrelated to cancer. We were interested in whether some noncarcinogenic types differ from carcinogenic in their affinity for the cervical transformation zone, where nearly all HPV-induced cancers occur. To examine this possibility, we tested cervical specimens from 8,374 women without cervical precancer and cancer participating in a population-based study in Guanacaste for >40 HPV types using PCR. We compared age-group specific prevalences of HPV types of the alpha9 species, which are mainly carcinogenic and include HPV16, to the genetically distinct types of the alpha3/alpha15 species (e.g., HPV71), which are noncarcinogenic and common in vaginal specimens from hysterectomized women. We related HPV detection of each group to the location of the junction between the squamous epithelium of the ectocervix and vagina and the columnar epithelium of the endocervical canal. Models evaluated the independent effects of amount of exposed columnar epithelium (ectopy) and age on the presence of alpha9 or alpha3/alpha15 types. Prevalence of alpha9 types (7.6%) peaked in the youngest women, declined in middle-aged women, and then increased slightly in older women. By contrast, prevalence of alpha3/alpha15 types (7.6%) tended to remain invariant or to increase with increasing age. Detection of alpha9 infections increased (P(trend) < 0.0005) but alpha3/alpha15 infections decreased (P(trend) < 0.0005) with increasing exposure of the columnar epithelia. Older age and decreasing cervical ectopy were independently positively associated with having an alpha3/alpha15 infection compared with having an alpha9 infection. These patterns need to be confirmed in other studies and populations. We suggest that these genetically distinct groups of HPV types may differ in tissue preferences, which may contribute to their differences in carcinogenic potential.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute/NIH, 6120 Executive Boulevard, Bethesda, MD 20892-7234, USA.
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82
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Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. THE LANCET. INFECTIOUS DISEASES 2005; 5:786-94. [PMID: 16310150 DOI: 10.1016/s1473-3099(05)70298-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravaginal practices such as "dry sex" and douching have been suggested as a risk factor that may increase women's susceptibility to HIV infection. These behaviours appear common in different populations across sub-Saharan Africa, where practices include the use of antiseptic preparations, traditional medicines, or the insertion of fingers or cloths into the vagina. We systematically review the evidence for the association between women's intravaginal practices and HIV infection. Although a number of cross-sectional studies have shown that prevalent HIV infection is more common among women reporting intravaginal practices, the temporal nature of this association is unclear. Current evidence suggests that bacterial vaginosis, which is a likely risk factor for HIV infection, may be a mediator of the association between intravaginal practices and HIV. Although biologically plausible mechanisms exist, there is currently little epidemiological evidence suggesting that intravaginal practices increase women's susceptibility to HIV infection. Further research into factors that increase women's susceptibility to HIV will help to inform the design of vaginal microbicides and other HIV prevention interventions.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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83
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Mohllajee AP, Curtis KM, Martins SL, Peterson HB. Hormonal contraceptive use and risk of sexually transmitted infections: a systematic review. Contraception 2005; 73:154-65. [PMID: 16413846 DOI: 10.1016/j.contraception.2005.08.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 08/11/2005] [Indexed: 11/15/2022]
Abstract
Previous research has suggested that hormonal contraceptive users, compared with nonusers, may be at increased risk for acquiring sexually transmitted infections (STIs). We searched the MEDLINE and EMBASE databases for all articles from January 1966 through February 2005 for evidence relevant to all hormonal contraceptives and STIs (including cervical chlamydial and gonococcal infection, human papillomavirus, trichomoniasis, herpes and syphilis). We used standard abstract forms and grading systems to summarize and assess the quality of 83 identified studies. Studies of combined oral contraceptive and depot medroxyprogesterone use generally reported positive associations with cervical chlamydial infection, although not all associations were statistically significant. For other STIs, the findings suggested no association between hormonal contraceptive use and STI acquisition, or the results were too limited to draw any conclusions. Evidence was generally limited in both amount and quality, including inadequate adjustment for confounding, lack of appropriate control groups and small sample sizes. The observed positive associations may be due to a true association or to bias, such as differential exposure to STIs by contraceptive use or increased likelihood of STI detection among hormonal contraceptive users.
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Affiliation(s)
- Anshu P Mohllajee
- Centers for Disease Control and Prevention, Division of Reproductive Health, WHO Collaborating Center in Reproductive Health, Atlanta, GA 30341, USA
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84
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Halbreich U. The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions--the need for interdisciplinary integration. Am J Obstet Gynecol 2005; 193:1312-22. [PMID: 16202720 DOI: 10.1016/j.ajog.2005.02.103] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 02/04/2005] [Accepted: 02/18/2005] [Indexed: 11/17/2022]
Abstract
Pregnancy and peripartum/perinatal periods are characterized by significant biologic as well as psychosocial processes and changes that influence the 2 individuals at focus (mother and fetus), as well as their interactions with the immediate environment. Multiple intertwined pathologic pregnancy processes (hormonal, biologic, stress and other mental occurrences) may lead to fetal distress, preterm delivery (PTD), low birth weight (LBW), and other delivery complications as well as to postpartum disorders. PTD and LBW in particular have been demonstrated to be associated with significant mortality as well as short- and long-term morbidity. Underlying processes and risk factors for PTD, LBW and postpartum disorders may overlap. Their impact on the offspring is compounded. Currently, the multiple clinical and research disciplines that are concerned with the various aspects of pregnancy, delivery, and postpartum period are not conceptually and practically integrated. Specifically, obstetricians are more concerned with delivery complications, whereas mental health professionals are concerned with postpartum depression. An interdisciplinary approach is needed for better understanding of developmental processes and the development of measurements and interventions to prevent long-term impact on the offspring.
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Affiliation(s)
- Uriel Halbreich
- Biobehavior Program, State University of New York at Buffalo, NY 14214, USA.
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85
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Risser WL, Bortot AT, Benjamins LJ, Feldmann JM, Barratt MS, Eissa MA, Risser JMH. The epidemiology of sexually transmitted infections in adolescents. ACTA ACUST UNITED AC 2005; 16:160-7. [PMID: 16044389 DOI: 10.1053/j.spid.2005.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.
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Affiliation(s)
- William L Risser
- Department of Pediatrics, Division of Adolescent Medicine, University of Texas Medical School at Houston, 77030, USA
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86
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Affiliation(s)
- Catherine Stevens-Simon
- Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Sciences Center, Denver, 80218, USA.
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87
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Friedek D, Romanik M, Ekiel A, Chelmicki Z, Martirosian G. Occurrence of chlamydial cervicitis in Upper Silesia, Poland. Clin Microbiol Infect 2005; 11:683-4. [PMID: 16008626 DOI: 10.1111/j.1469-0691.2005.01206.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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Prakash M, Patterson S, Kapembwa MS. Hormonal upregulation of CCR5 expression on T lymphocytes as a possible mechanism for increased HIV-1 risk. J Acquir Immune Defic Syndr 2005; 38 Suppl 1:S14-6. [PMID: 15867601 DOI: 10.1097/01.qai.0000167028.33525.f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Manyu Prakash
- Department of Genito-Urinary/HIV Medicine, Imperial College of Science Technology and Medicine at Northwick Park, St Mark's Hospitals, Harrow, UK
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89
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Marrazzo JM. Mucopurulent Cervicitis: No Longer Ignored, but Still Misunderstood. Infect Dis Clin North Am 2005; 19:333-49, viii. [PMID: 15963875 DOI: 10.1016/j.idc.2005.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The last decade has produced considerable advances in the diagnosis of the common etiologies of mucopurulent cervicitis (MPC), including Chlamydia trachomatis and Neisseria gonorrhoeae, and in the delineation of key aspects of their pathogenesis. Despite this, clear understanding of why these bacteria cause cervical inflammation in a minority of women who is infected with either organism is limited. Furthermore, many women who have MPC have neither of these infections detected, even when highly sensitive diagnostic tests are used. This article describes current data regarding this common condition, and charts new developments that might inform a more comprehensive understanding of MPC and its management, and of the more subtle signs of cervical inflammation that may impact women's susceptibility to a variety of infectious diseases, including HIV-1.
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Affiliation(s)
- Jeanne M Marrazzo
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98104, USA
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90
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Milam MR, Pollock JW, Nick AM, Scott T, Jones HW. The effect of hormonal contraception on the adequacy of colposcopic examination of the cervix. Am J Obstet Gynecol 2005; 192:1368-9. [PMID: 15902111 DOI: 10.1016/j.ajog.2005.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether the use of hormonal contraception affects the adequacy of colposcopic examination of the cervix. STUDY DESIGN A retrospective chart review of patients seen in the Vanderbilt University Medical Center Colposcopy Clinic from 2000-2002. Patient age, use of hormonal contraception, and adequacy of colposcopic examination were recorded for analysis. RESULTS Of all the colposcopic records reviewed, 526 of 1156 met inclusion criteria. Study patients ranged in age from 14 to 51 years. The prevalence of the visible squamocolumnar junction ranged from 75% to 91%. The multivariate logistic regression analysis showed that both age and use of hormonal contraception significantly influence adequacy of colposcopic examination (P < .001, P = .001, respectively). CONCLUSION The use of combination oral contraceptives is associated with an increased likelihood of adequate colposcopy.
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Affiliation(s)
- Michael R Milam
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, Tenn 37232-2521, USA.
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91
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Cherpes TL, Melan MA, Kant JA, Cosentino LA, Meyn LA, Hillier SL. Genital tract shedding of herpes simplex virus type 2 in women: effects of hormonal contraception, bacterial vaginosis, and vaginal group B Streptococcus colonization. Clin Infect Dis 2005; 40:1422-8. [PMID: 15844064 DOI: 10.1086/429622] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 01/06/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Genital infections due to herpes simplex virus type 2 (HSV-2) are characterized by frequent reactivation and shedding of the virus and by the attendant risk of transmission to sexual partners. We investigated the effects of vaginal coinfections and hormonal contraceptive use on genital tract shedding of HSV-2 in women. METHODS A total of 330 HSV-2-seropositive women were followed every 4 months for a year. At each visit, one vaginal swab specimen was obtained for detection of HSV-2 by polymerase chain reaction, a second vaginal swab specimen was obtained for detection of group B Streptococcus (GBS) organisms and yeast by culture, and a vaginal smear was obtained for the diagnosis of bacterial vaginosis by Gram staining. RESULTS HSV-2 DNA was detected in 88 (9%) of 956 vaginal swab specimens. Independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.3-6.8), bacterial vaginosis (aOR, 2.3; 95% CI, 1.3-4.0), high-density vaginal GBS colonization (aOR, 2.2; 95% CI, 1.3-3.8), and use of hormonal contraceptives (aOR, 1.8; 95% CI, 1.1-2.8). CONCLUSIONS The present study identifies hormonal contraceptive use, bacterial vaginosis, and high-density vaginal GBS colonization as risk factors for genital tract shedding of HSV-2 in women. Because hormonal contraceptives are used by millions of women worldwide and because bacterial vaginosis and vaginal GBS colonization are common vaginal conditions, even modest associations with HSV-2 shedding would result in substantial attributable risks for transmission of the virus.
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Affiliation(s)
- Thomas L Cherpes
- Department of Medicine, Division of Infectious Disease, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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92
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Martino JL, Youngpairoj S, Vermund SH. Vaginal douching: personal practices and public policies. J Womens Health (Larchmt) 2005; 13:1048-65. [PMID: 15665661 DOI: 10.1089/jwh.2004.13.1048] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaginal douching is associated with adverse reproductive health outcomes, yet both health providers and women are often poorly informed about details of this practice. METHODS We searched the English language articles in the MEDLINE database (1965-March 2004) to describe vaginal douching products, policies of professional organizations, predictors of douching practice, douching methods used, timing of use, and motivation. A key report was obtained from the Food and Drug Administration (FDA) via the Freedom of Information Act. Additional product information was obtained from manufacturers. Primary key terms for the literature search included (vagina OR vaginal) and (douche OR douching). Health effects of douching are reviewed briefly; personal practices and public policies are highlighted. RESULTS From the literature search, we identified 432 papers, of which 150 were reviewed in detail. Contrary to the assumptions of many health professionals, douching products are only loosely regulated by the FDA. Few professional organizations have clearly stated policy statements regarding douching. In the United States, the prevalence of douching varies considerably by race (more common among African Americans) and age cohort (more common in women born earlier). Internationally, vaginal douching is common in some cultures and is rare in others. Opinions of mothers, peers, and health professionals, in addition to marketing of commercial products, affect douching behavior. CONCLUSIONS Regulation of vaginal douching products and public education efforts on douching behavior need to be reassessed. Because of the preponderance of evidence that suggests an association between vaginal douching and adverse reproductive health outcomes, professional and public health associations should consider educational and policy activities to discourage women from douching.
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Affiliation(s)
- Jenny L Martino
- Departments of Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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93
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Sun CA, Hsiung CA, Lai CH, Chen CA, Chou CY, Ho CM, Twu NF, Feng WL, Chuang MH, Hsieh CY, Chu TY. Epidemiologic correlates of cervical human papillomavirus prevalence in women with abnormal Pap smear tests: A Taiwan cooperative oncology group (TCOG) study. J Med Virol 2005; 77:273-81. [PMID: 16121376 DOI: 10.1002/jmv.20447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To explore factors affecting human papillomavirus (HPV) prevalence in all grades of cervical neoplasia among Chinese women, 1,264 women with abnormal cervical cytology attending the gynaecologic clinics of 11 major medical centres in Taiwan. Patients were interviewed and underwent complete gynaecologic examination including colposcopy. Cervical scrapings were collected for HPV DNA detection by both Hybrid Capture-2 (high-risk probe) and L1 consensus PCR-reverse line blot. The prevalences of HPV in the four different diagnosis groups: (i) suspicious (n = 316), (ii) low-grade intraepithelial lesion (n = 474), (iii) high-grade intraepithelial lesion (n = 450), and (iv) cancer (n = 16), were 36.1%, 74.7%, 83.6%, and 100%, respectively. In the latter two groups, Patients less than 30 or 40 years old, respectively, tended to be infected more frequently with HPV than the older patients were. The main correlates of HPV prevalence were lifetime number of sex partners (odds ratio (OR) for two or more partners: 2.44; 95% CI, 1.44-4.15), vaginal douching after intercourse (OR for douching frequently: 1.44; 95% CI, 1.01-2.04), vitamin supplementation (OR for regular vitamin supplement: 0.71, 95% CI, 0.55-0.92), and performance of Pap smear tests (OR for never having a Pap smear performed: 2.22; 95% CI, 1.19-4.17). The risk for vaginal douching was augmented by the promiscuity of sex partners (OR of 3.19 (1.91-5.34)) and smoking (OR of 1.90 (1.15-3.13)), whereas vitamin supplementation reduced the odds ratio to 1.35 (0.85-2.15). The results of this study provide further evidence of the role of HPV in cervical carcinogenesis. The data also indicate the main areas of risk for the prevalence of HPV in cervical neoplasia in Chinese women living in Taiwan.
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Affiliation(s)
- Chien-An Sun
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
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94
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Morrison CS, Bright P, Wong EL, Kwok C, Yacobson I, Gaydos CA, Tucker HT, Blumenthal PD. Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sex Transm Dis 2004; 31:561-7. [PMID: 15480119 DOI: 10.1097/01.olq.0000137904.56037.70] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Several previous studies have suggested that hormonal contraception could be associated with increased risk of cervical infections. However, few high-quality prospective studies have examined this relationship. GOAL The goal of this study was to measure the effect of oral contraceptives (OC) and depot-medroxyprogesterone acetate (DMPA) on the acquisition of cervical chlamydial and gonococcal infections. STUDY Women attending 2 reproductive health centers in Baltimore, MD, were enrolled into a prospective cohort study. Participants were 15 to 45 years and were initiating OCs or DMPA or not using hormonal contraception. Interviews, physical examinations, and testing for incident cervical infections were conducted at 3, 6, and 12 months. RESULTS The analysis included 819 women. Most were single (77%) and nulliparous (75%); 43% were black. Median age was 22 years. During the study, 45 women acquired a chlamydial or gonococcal infection (6.2 per 100 women-years). DMPA use (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.6-8.5), but not OC use (HR, 1.5; 95% CI, 0.6-3.5), was significantly associated with increased acquisition of cervical infections after adjusting for other risk factors. Cervical ectopy was not an important mediator of cervical infection risk. CONCLUSIONS DMPA use, but not OC use, appeared to be significantly associated with increased acquisition of cervical chlamydial and gonococcal infections.
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Affiliation(s)
- Charles S Morrison
- Family Health International, Research Triangle Park, North Carolina 27709, USA.
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95
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Downs JS, Murray PJ, Bruine de Bruin W, Penrose J, Palmgren C, Fischhoff B. Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial. Soc Sci Med 2004; 59:1561-72. [PMID: 15279915 DOI: 10.1016/j.socscimed.2004.01.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A longitudinal randomized design was used to evaluate the impact of a theoretically based, stand-alone interactive video intervention on 300 urban adolescent girls' (a) knowledge about sexually transmitted diseases (STDs), (b) self-reported sexual risk behavior, and (c) STD acquisition. It was compared to two controls, representing high-quality informational interventions. One used the same content in book form; the other used commercially available brochures. Following randomization, the interventions were administered at baseline, with booster sessions at 1, 3, and 6 months. Self-reports revealed that those assigned to the interactive video were significantly more likely to be abstinent in the first 3 months following initial exposure to the intervention, and experienced fewer condom failures in the following 3 months, compared to controls. Six months after enrollment, participants in the video condition were significantly less likely to report having been diagnosed with an STD. A non-significant trend in data from a clinical PCR assay of Chlamydia trachomatis was consistent with that finding.
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Affiliation(s)
- Julie S Downs
- Department of Social & Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213-3890, USA.
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96
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Scott A, Glasier AF. Are routine breast and pelvic examinations necessary for women starting combined oral contraception? Hum Reprod Update 2004; 10:449-52. [PMID: 15192060 DOI: 10.1093/humupd/dmh031] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Millions of women worldwide use combined oral contraception (COC). Most of them are in good health and have no contraindications to using any contraceptive method. Although extremely safe for the vast majority of women and even though the absolute risk of complications is very small, COC is associated with an increased relative risk of serious conditions including cardiovascular disease and breast and cervical cancer. In many countries, breast and pelvic examinations are routinely undertaken annually for all women using hormonal contraception. Breast and pelvic examination have low detection rates for abnormality and may yield clinically irrelevant results, causing anxiety and inconvenience to the patient for no obvious gain. There is no good evidence to support routine breast or pelvic examination either for women starting hormonal contraception or for monitoring long-term use.
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Affiliation(s)
- A Scott
- Lothian Health Family Planning and Well Woman Services, 18 Dean Terrace, Edinburgh EH4 1NL.
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97
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Wong T, Singh A, Mann J, Hansen L, McMahon S. Gender Differences in Bacterial STIs in Canada. BMC Womens Health 2004; 4 Suppl 1:S26. [PMID: 15345089 PMCID: PMC2096668 DOI: 10.1186/1472-6874-4-s1-s26] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
HEALTH ISSUE: The incidence of bacterial sexually transmitted infections (STIs) is rising in Canada. If these curable infections were prevented and treated, serious long-term sequelae including infertility, and associated treatment costs, could be dramatically reduced. STIs pose a greater risk to women than men in many ways, and further gender differences exist in screening and diagnosis. KEY FINDINGS: Reported incidence rates of chlamydia, gonorrhea, and infectious syphilis declined until 1997, when the trend began to reverse. The reported rate of chlamydia is much higher among women than men, whereas the reverse is true for gonorrhea and infectious syphilis. Increases in high-risk sexual behaviour among men who have sex with men were observed after the introduction of potent HIV suppressive therapy in 1996, but behavioural changes in women await further research. DATA GAPS AND RECOMMENDATIONS: STI surveillance in Canada needs improvement. Reported rates underestimate the true incidence. Gender-specific behavioural changes must be monitored to enhance responsiveness to groups at highest risk, and more research is needed on effective strategies to promote safer sexual practices. Geographic and ethnic disparities, gaps, and needs must be addressed. Urine screening for chlamydia should be more widely available for women as well as men, particularly among high-risk men in order to prevent re-infections in their partners. As women are more likely to present for health examinations (e.g. Pap tests), these screening opportunities must be utilized. Female-controlled methods of STI prevention, such as safer topical microbicides, are urgently needed.
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Affiliation(s)
- Thomas Wong
- Centre for Infectious Disease Prevention and Control, Health Canada, 400 Cooper Street, Suite 2005, Ottawa, Canada
| | - Ameeta Singh
- Infections Diseases Medical Consultant STD, Alberta Health and Wellness, 23rd Floor, Telus Plaza North Tower, Edmonton, Canada
| | - Janice Mann
- Centre for Infectious Disease Prevention and Control, Health Canada, Tunney's Pasture, Ottawa, Canada
| | - Lisa Hansen
- Centre for Infectious Disease Prevention and Control, Health Canada, Tunney's Pasture, Ottawa, Canada
| | - Sharon McMahon
- Centre for Infectious Disease Prevention and Control, Health Canada, Tunney's Pasture, Ottawa, Canada
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98
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Stuart GS, Castaño PM. Sexually transmitted infections and contraceptives: selective issues. Obstet Gynecol Clin North Am 2003; 30:795-808. [PMID: 14719851 DOI: 10.1016/s0889-8545(03)00074-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It is important to examine the successful completed research and use it to move forward in practice to halt the almost 50% unintended pregnancy rate in the United States and the continued worldwide epidemic of HIV and other STIs. A significant development has been the evidence supporting the IUD as a valuable contraceptive option available to many women, including women who are HIV infected, with no increased risks of infertility or PID. Evidence exists that OCPs may increase chlamydial infection acquisition and cervicitis, but it is unlikely that OCP use is associated with PID. The lack of female-controlled dual method protection remains a void, but with the introduction of products such as FemCap and Reality condom and the continuing progress of microbicides and spermicides, the future is brighter. Clearly research into the interactions of STIs and contraceptives must continue to discern how best to approach a resolution to these public health concerns that affect women and the global population.
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Affiliation(s)
- Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
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Oh MK, Funkhouser E, Simpson T, Brown P, Merchant J. Early onset of vaginal douching is associated with false beliefs and high-risk behavior. Sex Transm Dis 2003; 30:689-93. [PMID: 12972791 DOI: 10.1097/01.olq.0000079526.04451.de] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaginal douching in young women has been linked to a variety of adverse reproductive health consequences. OBJECTIVES To explore associations with early onset (< or =15 years old) of douching. STUDY DESIGN A confidential survey was self-administered to convenience samples of women attending seven primary care clinics. RESULTS The mean age of the 726 evaluable participants was 27.9 years (ranges, 14-63 years). Twenty-two percent of participants believed douching "kills germs that cause infections," and 27% agreed that "women believe douching prevents pregnancy." A history of having ever used douching products was reported by 73%. Of those who had douched, 24% began the practice at age < or =15 years. Compared with those who began at a later age, those who began at age < or =15 years were also more likely to have begun sexual intercourse under 16 years of age (AOR 2.63; P<0.001), to believe that douching kills germs that cause STDs (AOR=2.15 P=0.004), and to currently douche more than once per month (AOR=2.08; P=0.009). CONCLUSION This study indicates that early onset of vaginal douching is associated with false beliefs and sexual debut at younger age.
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Affiliation(s)
- M Kim Oh
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233-1711, USA.
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100
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Mao C, Hughes JP, Kiviat N, Kuypers J, Lee SK, Adam DE, Koutsky LA. Clinical findings among young women with genital human papillomavirus infection. Am J Obstet Gynecol 2003; 188:677-84. [PMID: 12634640 DOI: 10.1067/mob.2003.164] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Constance Mao
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
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