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Di Stanislao M, Coada CA, De Terlizzi F, Di Costanzo S, Fiuzzi E, Mezzapesa F, Dondi G, Paoli D, Damiani GR, Raspagliesi F, Bogani G, Ditto A, Morganti AG, De Iaco P, Perrone AM. Laser Therapy in Heavily Treated Oncological Patients Improves Vaginal Health Parameters. Cancers (Basel) 2024; 16:2722. [PMID: 39123449 PMCID: PMC11311561 DOI: 10.3390/cancers16152722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
This study aimed to investigate the efficacy and duration of multiple non-ablative intravaginal CO2 laser (V-lase®) cycles in breast cancer patients, gynecological and other pelvic cancers previously subjected to multiple oncological treatments. This prospective study enrolled women under the age of 65 years who reported vaginal symptoms. Data on the Vaginal Health Index (VHI), vaginal length (VL), vaginal pain measured using a Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI) were collected at baseline and before each laser application, and at subsequent follow-up visits. A total of 170 laser applications were performed on 113 women with various types of cancer. Most patients (57.5%) had received radiotherapy-based treatments before receiving laser treatment. Vaginal health parameters and sexual function improved significantly with each laser application. However, a temporary decline in these improvements occurred during the intervals between cycles. Such worsening was reversed with the subsequent cycle in all groups of patients, irrespective of the type of oncological treatments they had undergone. Multiple course vaginal laser therapy showed promising results as a potential treatment for vaginal atrophy in heavily treated gynecological and breast cancer patients, necessitating further research to determine the optimal time interval between cycles to ensure sustained positive effects.
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Affiliation(s)
- Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Camelia Alexandra Coada
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | | | - Stella Di Costanzo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Enrico Fiuzzi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Francesco Mezzapesa
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Giulia Dondi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
| | - Damiano Paoli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | | | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | | | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
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Bogani G, Sopracordevole F, Ciavattini A, Ghelardi A, Vizza E, Vercellini P, Casarin J, Pinelli C, Ghezzi F, De Vincenzo R, Di Donato V, Golia D'augè T, Giannini A, Sorbi F, Petrillo M, Capobianco G, Vizzielli G, Restaino S, Cianci S, Scambia G, Raspagliesi F. HPV-related lesions after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer: A focus on the potential role of vaccination. TUMORI JOURNAL 2024; 110:139-145. [PMID: 37978580 DOI: 10.1177/03008916231208344] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To date, no data supports the execution of vaccination after hysterectomy for high-grade cervical intraepithelial neoplasia (CIN2+) and early-stage cervical cancer. We aim to evaluate the potential effect of vaccination after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer. METHODS This is a multi-center retrospective study evaluating data of women who develop lower genital tract dysplasia (including anal, vulvar and vaginal intra-epithelial neoplasia) after having hysterectomy for CIN2+ and FIGO stage IA1- IB1 cervical cancer. RESULTS Overall, charts for 77 patients who developed lower genital tract dysplasia were collected. The study population included 62 (80.5%) and 15 (19.5%) patients with CIN2+ and early-stage cervical cancer, respectively. The median (range) time between hysterectomy and diagnosis of develop lower genital tract dysplasia was 38 (range, 14-62) months. HPV types covered by the nonavalent HPV vaccination would potentially cover 94.8% of the development of lower genital tract dysplasia. Restricting the analysis to the 18 patients with available HPV data at the time of hysterectomy, the beneficial effect of nonvalent vaccination was 89%. However, considering that patients with persistent HPV types (with the same HPV types at the time of hysterectomy and who developed lower genital tract dysplasia) would not benefit from vaccination, we estimated the potential protective effect of vaccination to be 67% (12 out of 18 patients; four patients had a persistent infection for the same HPV type(s)). CONCLUSIONS Our retrospective analysis supported the adoption of HPV vaccination in patients having treatment for HPV-related disease. Even in the absence of the uterine cervix, HPV vaccination would protect against develop lower genital tract dysplasia. Further prospective studies have to confirm our preliminary research.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Francesco Sopracordevole
- Gynecologic Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Rosa De Vincenzo
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Tullio Golia D'augè
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Flavia Sorbi
- Department of Obstetrics and Gynecology. University of Florence, Florence, Italy
| | - Marco Petrillo
- Department of Obstetrics and Gynecology. University of Sassari, Sassari, Italy
| | | | - Giuseppe Vizzielli
- Gynecologic Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Stefano Restaino
- Department of Medical Area (DAME), Clinic of Obstretics and Gynecology Santa Maria della Misericordia, University Hospital Azienda Sanitaria Universitaria Friuli Centrale, University of Udine, Udine, Italy
| | - Stefano Cianci
- Department of Human Pathology of Adult and Childhood, G. Barresi Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Li Y, Wei Y, Huang J, Gu L, Hong Z, Qiu L. Efficacy and influencing factors of CO 2 laser, topical photodynamic therapy versus therapy combined with CO 2 laser pretreatment for vaginal low-grade squamous intraepithelial lesions with high-risk HPV infection. Photodiagnosis Photodyn Ther 2024; 46:104017. [PMID: 38368914 DOI: 10.1016/j.pdpdt.2024.104017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/10/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Vaginal intraepithelial neoplasia (VaIN) is a group of diseases of squamous epithelial dysplasia and carcinoma in situ occurring in the vagina, which is associated with high-risk human papillomavirus (HR-HPV) infection. OBJECTIVES To evaluate the efficacy and safety of Carbon dioxide (CO2) laser, 5-aminolevulinic acid photodynamic therapy (PDT) and PDT combined with CO2 laser pretreatment for VaIN1 with HR-HPV infection, and analyze the factors affecting the clearance of HR-HPV. METHODS Patients with HR-HPV infection and pathological diagnosis of VaIN1 and received laser or PDT or PDT combined with laser pretreatment were recruited. A total of 45 patients received one to three times CO2 laser (laser Group), 15 patients received three times PDT (PDT Group) and 15 patients received CO2 laser once and PDT three times (laser + PDT Group). HPV testing, cytology and colposcopy examinations at 3-6 months and 9-12 months after treatment were analyzed to assess the outcomes of the treatment. RESULTS There was no significant difference in regression rate of VaIN1 among the laser Group, the PDT Group and the laser + PDT Group (3-6 month follow-up: 57.78% vs 73.3% vs 80 %, 9-12 month follow-up: 68.89% vs 80% vs 86.67 %, P>0.05). HR-HPV remission rates were also similar in the three groups (3-6 month follow-up: 26.67% vs 46.67% vs 46.67 %, 9-12 month follow-up: 40 % in all groups, P>0.05). Compared to HR-HPV negative group, patients in the HR-HPV positive group were older and had more pregnancies. Menopause and multiple vaginal lesions were more common in the HR-HPV positive group. Adverse reactions were mild in the PDT Group. The laser Group and the laser + PDT Group had more adverse effects, such as increased vaginal secretion, vaginal bleeding, scarring and local pain. CONCLUSION For patients with VaIN1 at risk of progression, ALA-PDT presents itself as a viable choice for those who are well-informed and can consent to its costs and benefits. The addition of CO2 laser pretreatment may not increase the benefit of ALA-PDT treatment of VaIN1. Older age, menopause, more times of pregnancies, and multiple vaginal lesions might affect HR-HPV regression.
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Affiliation(s)
- Yuling Li
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingting Wei
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinhua Huang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liying Gu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Preti M, Boldorini R, Gallio N, Cavagnetto C, Borella F, Pisapia E, Ribaldone R, Bovio E, Bertero L, Airoldi C, Cassoni P, Remorgida V, Benedetto C. Human papillomavirus genotyping in high-grade vaginal intraepithelial neoplasia: A multicentric Italian study. J Med Virol 2024; 96:e29474. [PMID: 38373185 DOI: 10.1002/jmv.29474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
This study aimed to analyze the human papillomavirus (HPV) genotype distribution in a large cohort of high-grade vaginal intraepithelial neoplasia (VaIN) (vaginal HSIL, VaIN2/3) patients from two Italian referral centers. We included all patients with histologically confirmed VaIN2/3 from the Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Torino, Italy, and Ospedale Maggiore della Carità, Novara, Italy, between 2003 and 2022. After the histological evaluation of formalin-fixed paraffin-embedded samples, we performed HPV genotyping with VisionArray HPV Chip 1.0. We detected HPV DNA in 94.4% of VaIN2/3 (168/178), with HPV 16 as the most prevalent genotype, accounting for 51.8% of all infections, 41.2% of VaIN2 and 77.6% of VaIN3 cases. Other frequent genotypes were HPV 58 (8.3%, 10.9% of VaIN2 and 2.0% of VaIN3), HPV 73 (5.4%, 5.0% of VaIN2 and 6.1% of VaIN3), and HPV 31 (5.4%, 6.7% of VaIN2 and 2.0% of VaIN3). 73.2% of VaIN2/3 had a single HPV genotype infection and 26.8% a multiple infection (20.8% a double infection, 4.8% a triple infection, and 1.2% a quadruple infection). Single infection was more frequently present in VaIN3 than VaIN2 (81.6% vs. 69.8%). 69.1% of single infections and 73.3% of multiple infections had one or more genotypes covered by nine-valent HPV vaccine. HPV vaccination is expected to have a large impact on reducing the incidence of vaginal intraepithelial neoplasia.
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Affiliation(s)
- Mario Preti
- Obstetrics and Gynecology Unit 1, Department of Surgical Sciences, Sant' Anna Hospital, University of Torino, Torino, Italy
| | - Renzo Boldorini
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Niccolò Gallio
- Obstetrics and Gynecology Unit 2, Department of Surgical Sciences, Sant' Anna Hospital, University of Torino, Torino, Italy
| | - Cristina Cavagnetto
- Department of Maternal-Neonatal and Infant Health, Division of Obstetrics and Gynaecology, Ospedale Degli Infermi, University of Turin, Biella, Italy
| | - Fulvio Borella
- Obstetrics and Gynecology Unit 1, Department of Surgical Sciences, Sant' Anna Hospital, University of Torino, Torino, Italy
| | - Elena Pisapia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Raffaella Ribaldone
- Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Enrica Bovio
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Valentino Remorgida
- Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Chiara Benedetto
- Obstetrics and Gynecology Unit 1, Department of Surgical Sciences, Sant' Anna Hospital, University of Torino, Torino, Italy
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Maehama T, Shimada S, Sakamoto J, Shibata T, Fujita S, Takakura M, Takagi H, Sasagawa T. Chemical Peeling Therapy Using Phenol for the Cervico-Vaginal Intraepithelial Neoplasia. Viruses 2023; 15:2219. [PMID: 38005896 PMCID: PMC10675195 DOI: 10.3390/v15112219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Objective: This study aimed to validate the use of liquid phenol-based chemical peeling therapy for cervical and vaginal intraepithelial neoplasia (CIN and VaIN, respectively), with the goal of circumventing obstetric complications associated with surgical treatment and to determine the factors associated with treatment resistance. Methods: A total of 483 eligible women diagnosed with CIN, VaIN, or both, participated in this study. Participants underwent phenol-based chemical peeling therapy every 4 weeks until disease clearance. Disease clearance was determined by negative Pap tests for four consecutive weeks or by colposcopy. HPV genotyping was conducted at the onset of the study and after disease clearance in select cases. Our preliminary analysis compared the recurrence and persistence rates between 294 individuals who received phenol-based chemical peeling therapy and 189 untreated patients. Results: At 2 years following diagnosis, persistent disease was observed in 18%, 60%, and 88% of untreated patients with CIN1-3, respectively, and <2% of patients with CIN who received phenol-based chemical peeling therapy. Among 483 participants, 10 immune-suppressed patients required multiple treatments to achieve disease clearance, and 7 were diagnosed with cervical cancer. Of the 466 participants, except those with cancer or immune suppression, the number of treatment sessions until CIN/VaIN clearance ranged from 2 to 42 (average: 9.2 sessions). In total, 43 participants (9.2%) underwent surgical treatment. Six patients (1.3%) experienced recurrence of CIN2 or worse, suggesting that treatment failed in 46 patients (9.9%). No obstetrical complications were noted among the 98 pregnancies following this therapy. Factors associated with resistance to this therapy include immune suppression, ages 35-39 years, higher-grade lesions, and multiple HPV-type infections. Conclusions: Phenol-based therapy is safe and effective for CINs and VaINs. Women aged < 35 years and with persistent CIN1 or CIN2 with a single HPV-type infection are suitable candidates for phenol-based chemical peeling therapy. However, this therapy requires multiple lengthy sessions.
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Affiliation(s)
- Toshiyuki Maehama
- Department of Obstetrics and Gynecology, Yuai-Medical Center, Tomishiro 901-0224, Okinawa, Japan;
| | - Sumire Shimada
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Jinichi Sakamoto
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Takeo Shibata
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Satoko Fujita
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Masahiro Takakura
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Hiroaki Takagi
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun 920-0293, Ishikawa, Japan
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Borella F, Gallio N, Mangherini L, Cassoni P, Bertero L, Benedetto C, Preti M. Recent advances in treating female genital human papillomavirus related neoplasms with topical imiquimod. J Med Virol 2023; 95:e29238. [PMID: 38009696 DOI: 10.1002/jmv.29238] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
Human papillomavirus (HPV) encompasses a group of viruses that infect the skin and mucous membranes. In the presence of certain factors, persistent infection with high-risk HPVs can trigger a process of neoplastic transformation. Imiquimod is a topical agent that acts as a Toll-like receptor 7/8 agonist, stimulating the innate and adaptive immune system to exert antitumor and antiviral effects. It has been approved for the treatment of various skin conditions, however, its efficacy and safety in the management of HPV-related-neoplasms of the lower genital tract, such as vulvar, vaginal, and cervical neoplasia, are still under investigation. This review summarizes the current evidence on the use of imiquimod for the treatment of HPV-induced lesions of the female lower genital tract, focusing on its indications, mechanisms of action, outcomes, and predictors of response.
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Affiliation(s)
- Fulvio Borella
- Obstetrics and Gynecology Unit 1, Sant' Anna Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Niccolò Gallio
- Obstetrics and Gynecology Unit 2, Sant' Anna Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luca Mangherini
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Obstetrics and Gynecology Unit 1, Sant' Anna Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Preti
- Obstetrics and Gynecology Unit 1, Sant' Anna Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
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Hernández-Rosas F, Rey-Barrera M, Hernández-Barajas F, Rangel-Soto C, García-González MS, Franco-González SS, de León-Bautista MP. Unveiling Hidden Risks: Intentional Molecular Screening for Sexually Transmitted Infections and Vaginosis Pathogens in Patients Who Have Been Exclusively Tested for Human Papillomavirus Genotyping. Microorganisms 2023; 11:2661. [PMID: 38004673 PMCID: PMC10672824 DOI: 10.3390/microorganisms11112661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/26/2023] Open
Abstract
Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) worldwide, with popular screening methods including the Papanicolaou test and HPV genotyping. However, in clinical practice, coinfections with other pathogens are often underestimated. Therefore, our study aims to describe the prevalence of STIs and vaginosis in urogenital samples from patients who had been tested exclusively for HPV genotyping. METHODS This analytical, prospective, cross-sectional study included 408 males and females. Eligible participants had positive and negative HPV genotyping test results and agreed to early detection or had HPV antecedents. They provided the same urogenital samples used for HPV detection and, through our multiplex in-house PCR assay, we screened for Candida spp., Ureaplasma spp., Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus 1 and 2 (HSV), Mycoplasma spp., molluscum contagiosum virus (MCV), Treponema pallidum, Haemophilus spp., Staphylococcus aureus, and Klebsiella spp. The subsequent statistical analysis aimed to reveal correlations between HPV genotypes and the identified pathogens. RESULTS Of the participants, 72.1% (n = 294) tested positive for HPV genotypes. HR-HPV (high-risk HPV) genotypes comprised 51 (8.1%), 66 (7.1%), and 58 (6.1%). Haemophilus spp., Ureaplasma spp., Candida spp., Staphylococcus aureus, and Mycoplasma spp. frequently co-occurred with HPV infection (p < 0.05). Gender-based variations were notorious for Ureaplasma spp., Mycoplasma spp., and MCV (p < 0.05). Coinfections were prevalent (43.9%), with a positive HPV result elevating the risk for Trichomonas vaginalis, Mycoplasma spp., Staphylococcus aureus, HSV, and MCV (OR > 1, p < 0.05). HPV 16 correlated with HSV and Ureaplasma spp., while HPV 6 was linked with HSV and MCV (p < 0.05). CONCLUSIONS This screening strategy uncovered significant coinfections and associations between HPV genotypes and pathogens, underscoring the importance of routine screening to explore clinical implications in urogenital health.
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Affiliation(s)
- Fabiola Hernández-Rosas
- Biomedical Engineering Faculty, Engineering Division, Anahuac Queretaro University, Querétaro 76246, Mexico;
- Research Center, Anahuac Queretaro University, Querétaro 76246, Mexico
| | | | - Flavio Hernández-Barajas
- Translational Medicine, Vanguard and Technology Transfer Sector, Human Health Department, Central ADN Laboratories, Morelia 58280, Mexico
| | - Claudia Rangel-Soto
- Translational Medicine, Vanguard and Technology Transfer Sector, Human Health Department, Central ADN Laboratories, Morelia 58280, Mexico
| | | | | | - Mercedes Piedad de León-Bautista
- Translational Medicine, Vanguard and Technology Transfer Sector, Human Health Department, Central ADN Laboratories, Morelia 58280, Mexico
- Escuela de Medicina, Universidad Vasco de Quiroga, Morelia 58090, Mexico
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