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Hu SY, Tsang SH, Chen F, Pan QJ, Zhang WH, Hong Y, Sampson JN, Hildesheim A, Zhao FH, Kreimer AR. Association Between Common Vaginal Infections and Cervical Non-Human Papillomavirus (HPV) 16/18 Infection in HPV-Vaccinated Women. J Infect Dis 2021; 223:445-451. [PMID: 32614401 PMCID: PMC7982446 DOI: 10.1093/infdis/jiaa384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND How vaginal infections such as bacterial vaginosis, Candida spp, and Trichomonas vaginalis affect persistence of human papillomavirus (HPV) infection is not well established. Our study aimed to evaluate the association between common vaginal infections and cervical non-HPV16/18 infection, as risk factors associated with persistence of nonvaccine HPV types will become increasingly relevant in the setting of HPV vaccination. METHODS We performed an analysis in 2039 AS04-HPV16/18-vaccinated women enrolled in a phase II/III trial in China, who were HPV DNA negative at month 0 and 6 and had at least 1 subsequent follow-up visit. Vaginal infections were detected in liquid-based cytology according to the diagnostic criteria of the Bethesda System. Associations between vaginal infections and incident and 6-month persistent non-HPV16/18 infections in the cervix were evaluated using generalized estimating equations, adjusting for the age at initial vaccination, as well as HPV types in the persistence analysis. RESULTS Study visits with any vaginal infection had a statistically significant increased risk of incident non-HPV16/18 infection compared to those without vaginal infections (odds ratio [OR], 1.44 [95% confidence interval {CI}, 1.09-1.92]). However, vaginal infections were not associated with 6-month persistent non-HPV16/18 infection (OR, 1.02 [95% CI, .62-1.69]). CONCLUSIONS Our study suggests that common vaginal infections are not associated with persistence of non-HPV16/18 infection among HPV16/18-vaccinated women.
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Affiliation(s)
- Shang-Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Feng Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin-Jing Pan
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Hua Zhang
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Hong
- Department of Obstetrics and Gynecology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Marques MPC, Pinto AC, Soares LC, Macedo JMB, Dos Santos DF, de Oliveira MAP. Protease inhibitor effects on prevalence of bacterial vaginosis and human papillomavirus-related lesions. J Obstet Gynaecol Res 2020; 46:899-906. [PMID: 32185840 DOI: 10.1111/jog.14245] [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: 11/14/2019] [Revised: 02/13/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
AIM Antiretrovirals of the protease inhibitor (PI) class tend to achieve low concentrations in biological fluids. This study aimed to analyze possible changes in the vaginal microbiome and frequency of cervical human papillomavirus (HPV)-DNA and HPV-related lesions associated with the use of PI in antiretroviral therapy (ART). METHODS Eighty-eight women with human immunodeficiency virus infection were divided in two groups: ART with PI and without PI. All the participants underwent anamnesis with demographic data collection. The total DNA, used as the template in the polymerase chain reaction-based assays for the detection of HPV-DNA, was extracted from cervical samples during cervical cytopathology. RESULTS There were no differences between the groups with respect to HPV-related lesions. Despite the higher prevalence of bacterial vaginosis (BV) in the PI group (33.96% vs 17.14%), the difference was insignificant when considering all women (P = 0.066). When women with a detectable viral load and a CD4+ T-cell count <200 were excluded in both groups, BV was found to be more prevalent in the PI group (odds ratio, 3.349; 95% confidence interval, 1.113-11.41, P = 0.049). No associations were found between BV and age, condom use, cervical HPV, time with current ART regimen, unprotected receptive anal intercourse and cervical HPV-related lesions. CONCLUSION The use of PI did not alter the frequencies of HPV-DNA and HPV-related lesions. However, an increased frequency of BV was found in women using PI after excluding women with a detectable viral load and a CD4+ T-cell count of <200.
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Affiliation(s)
- Marcos P C Marques
- Department of Gynaecology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Department of Gynaecology, University of Grande Rio, Duque de Caxias, Brazil
| | - Amanda C Pinto
- Department of Biochemistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Leila C Soares
- Department of Gynaecology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Jacyara M B Macedo
- Department of Biochemistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Wickramasinghe RPTB, Senanayake H, De Silva C. Intrauterine Foley catheter for 48 versus 24 hours for cervical ripening: A randomized controlled trial. Int J Gynaecol Obstet 2020; 149:225-230. [PMID: 32010972 DOI: 10.1002/ijgo.13109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the safety of keeping an intrauterine Foley catheter for 48 hours versus 24 hours for cervical ripening. METHODS A randomized controlled trial was conducted at the De Soysa Hospital for Women, Sri Lanka from April 1 to December 31, 2014 (trial registration: SLCTR/2014/006). Low-risk women with a Bishop score ≤5 at 40 weeks + 5 days of gestation were allocated to either 24-hour (n=107; Group A) or 48-hour (n=94; Group B) groups. Proportions developing spontaneous onset of labor (SOL), neonatal status, pre- and post-procedure C-reactive protein (CRP), cervical smears, and placental histology in those who experienced SOL were compared. RESULTS In Group A, 35 (32.7%) experienced SOL, against 54 (57.4%) in Group B (P<0.001, odds ratio 2.78, 95% confidence interval 1.56-4.93). There was no difference in mean length of active labor (7.48 vs 7.69 hours), cesarean delivery (16% vs 14%), bacterial vaginosis rates in post-induction cervical smear (10.3% vs 6.7%), mean CRP increase (4.08 vs 3.91 IU), evidence of chorioamnionitis (5.7% vs 11.1%), mean 1 and 5-minute Apgars, number of neonates with pyrexia (8.4 vs 8.5%), and admission to the Special Care Baby Unit (15% vs 12.8%). CONCLUSION Group B experienced a statistically significant increase in SOL, without increasing infectious and neonatal morbidity.
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Affiliation(s)
| | | | - Chandu De Silva
- Department of Pathology, University of Colombo, Colombo, Sri Lanka
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Anand KV, Pimple SA, Mishra GA, Sahare RV, Pathuthara S, Deodhar KK, Shastri SS. Reliability of conventional Papanicolaou smear in diagnosing bacterial vaginosis among women with clinical genital infection. South Asian J Cancer 2020; 9:13-16. [PMID: 31956611 PMCID: PMC6956588 DOI: 10.4103/sajc.sajc_421_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Bacterial vaginosis (BV) is a common reproductive tract infection (RTI) reported among Indian women. BV can influence the persistence of high-risk oncogenic human papillomavirus, a causative factor for cervical cancer. BV and cervical cancer are major public health issues in a developing country like India. It becomes important for a resource-constrained country like India with poor healthcare access to implement control measures to screen and treat RTI in an attempt to prevent the risk for cervical cancer. Papanicolaou (Pap) smear is an established screening tool for cervical cancer and the diagnosis of RTIs, forms a part of its evaluation. The present study explores the validity of conventional Pap smear in diagnosing BV. METHODOLOGY Pap smear and Gram stain smear were collected for 254 women with clinically evident cervicitis/cervicovaginitis (genital infection). Using the Nugent score on Gram stain as a gold standard, we determined the sensitivity and specificity of Pap smear to diagnose BV. RESULTS The overall prevalence of BV in the study population was 44% using the Nugent score. Pap smear showed sensitivity and specificity of 70.9%. (CI- 61.5% - 79.2%) and 56.8% (CI - 48.2%-65.2%), respectively. The positive predictive value of Pap smear to diagnose BV was 56.5% (CI - 47.8%-64.9%), and the negative predictive value was 71.2% (CI - 61.8%-79.4%). CONCLUSION In the present study, conventional Pap smear demonstrates good accuracy to detect BV. Pap testing for cervical cancer screening can additionally serve as an effective screening tool for diagnosing BV among women with genital infection in healthcare settings.
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Affiliation(s)
- Kavita Vivek Anand
- Department of Preventive Oncology, Tata Memorial Centre, Affliliated to Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sharmila Anil Pimple
- Department of Preventive Oncology, Tata Memorial Centre, Affliliated to Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Tata Memorial Centre, Affliliated to Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rupali V. Sahare
- Department of Microbiology, R. N. Cooper General Hospital, Mumbai, Maharashtra, India
| | - Saleem Pathuthara
- Department of Cytopathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar K. Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Surendra S. Shastri
- Department of Health Disparities Research, Division of Cancer Prevention and Population Science, MD Anderson Cancer Centre, Houston, USA
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Virtanen S, Rantsi T, Virtanen A, Kervinen K, Nieminen P, Kalliala I, Salonen A. Vaginal Microbiota Composition Correlates Between Pap Smear Microscopy and Next Generation Sequencing and Associates to Socioeconomic Status. Sci Rep 2019; 9:7750. [PMID: 31123296 PMCID: PMC6533281 DOI: 10.1038/s41598-019-44157-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
Recent research on vaginal microbiota relies on high throughput sequencing while microscopic methods have a long history in clinical use. We investigated the correspondence between microscopic findings of Pap smears and the vaginal microbiota composition determined by next generation sequencing among 50 asymptomatic women. Both methods produced coherent results regarding the distinction between Lactobacillus-dominant versus mixed microbiota, reassuring gynaecologists for the use of Pap smear or wet mount microscopy for rapid evaluation of vaginal bacteria as part of diagnosis. Cytologic findings identified women with bacterial vaginosis and revealed that cytolysis of vaginal epithelial cells is associated to Lactobacillus crispatus-dominated microbiota. Education and socio-economic status were associated to the vaginal microbiota variation. Our results highlight the importance of including socio-economic status as a co-factor in future vaginal microbiota studies.
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Affiliation(s)
- Seppo Virtanen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Rantsi
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Virtanen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland.,Finnish Cancer Registry, Helsinki, Finland
| | - Kaisa Kervinen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Nieminen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Kalliala
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Martínez-Girón R, Martínez-Torre C, van Woerden HC, Zapico-Ortíz N. Observation of an association between ground-glass-like globules in Papanicolaou smears and bacterial vaginosis. Cytopathology 2017; 28:241-242. [PMID: 28332269 DOI: 10.1111/cyt.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Martínez-Girón
- CFGS Anatomic Pathology and Cytology, Institute of Piedras Blancas, Asturias, Spain
| | | | - H C van Woerden
- Centre for Health Science, University of the Highlands and Islands, Inverness, UK
| | - N Zapico-Ortíz
- Cytology Section, Anatomic and Pathology Service, Central University Hospital of Asturias, Oviedo, Spain
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Guo YL, You K, Qiao J, Zhao YM, Geng L. Bacterial vaginosis is conducive to the persistence of HPV infection. Int J STD AIDS 2012; 23:581-4. [PMID: 22930296 DOI: 10.1258/ijsa.2012.011342] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the effects of bacterial vaginosis (BV) on the outcomes of high-risk human papillomavirus infection (HR-HPV). BV was diagnosed on Papanicolaou-stained cytology slides of 707 HPV-positive patients. HR-HPV DNA expression was analysed using the Hybrid Capture II (HC-II) assay. Of the 707 HR-HPV-positive female patients, 298 (42.1%) exhibited clearance of HR-HPV. The remaining 409 patients had persistent HR-HPV infection. The persistent HR-HPV group and the clearing group had similar rates of BV at the beginning of the study. At the end of the study, the persistent HR-HPV group had a BV prevalence of 11.2% while the clearing group had a significant lower BV prevalence of 5.0%. A decreased clearance of HPV was found in women with current BV, compared with women without BV. Furthermore, the natural history of HPV was not affected by the HPV viral load or the BV prevalence at the beginning of the study (P > 0.05). Bacterial vaginosis appears conducive to the persistence of HPV infection.
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Affiliation(s)
- Y-L Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
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Levi AW, Harigopal M, Hui P, Schofield K, Chhieng DC. Comparison of Affirm VPIII and Papanicolaou tests in the detection of infectious vaginitis. Am J Clin Pathol 2011; 135:442-7. [PMID: 21350100 DOI: 10.1309/ajcp7tbn5vzuglzu] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
To compare the Affirm VPIII molecular test (Becton Dickinson, Burlington, NC) with morphologic identification used in routine Papanicolaou (Pap) test screening in the detection and identification of Candida species, Trichomonas vaginalis, and Gardnerella vaginalis, we identified 431 cases with a concomitant Pap test and Affirm VPIII assay performed from the archives of a large academic institution. The study population consisted of women ranging in age from 17 to 79 years (mean and median ages, 33 and 31 years, respectively). With a routine Pap test, 60 patients (13.9%) were found to have bacterial vaginosis, 60 (13.9%) candidiasis, and 3 (0.7%) Trichomonas infection. With the Affirm VPIII assay, 183 (42.5%) patients tested positive for G vaginalis, 70 (16.2%) positive for Candida species, and 10 (2.3%) positive for T vaginalis. The differences were statistically significant. The results demonstrate that our patient population had a high incidence of bacterial vaginosis/Candida vaginitis; however, the Affirm VPIII was a more sensitive diagnostic test for the detection and identification of all 3 organisms compared with the Pap test.
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Affiliation(s)
| | | | - Pei Hui
- Department of Pathology, Yale University, New Haven, CT
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Diagnosis and management of bacterial vaginosis and other types of abnormal vaginal bacterial flora: a review. Obstet Gynecol Surv 2010; 65:462-73. [PMID: 20723268 DOI: 10.1097/ogx.0b013e3181e09621] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED Bacterial vaginosis (BV) is a common cause of abnormal vaginal discharge. It is characterised by an overgrowth of predominantly anaerobic organisms (Gardnerella vaginalis, Prevotella spp., Peptostreptocci, Mobiluncus spp.) in the vagina leading to a replacement of lactobacilli and an increase in vaginal pH. BV can arise and remit spontaneously, but often presents as a chronic or recurrent disease. BV is found most often in women of childbearing age, but may also be encountered in menopausal women, and is rather rare in children. The clinical and microscopic features and diagnosis of BV are herein reviewed, and antibiotic and non-antibiotic treatment approaches discussed. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the participant should be better able to analyze bacterial vaginosis clinically, formulate an oral antibiotic treatment regimen for bacterial vaginosis and use vaginal treatments for bacterial vaginosis.
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Donders GGG, Berger J, Heuninckx H, Bellen G, Cornelis A. Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device. Contraception 2010; 83:352-6. [PMID: 21397094 DOI: 10.1016/j.contraception.2010.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The levonorgestrel intrauterine system (LNG-IUS) combines a uterine foreign body and the continuous release of low-dose levonorgestrel for contraception. Its influence on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women, especially those who develop recurrent vaginosis or Candida vulvovaginitis. STUDY DESIGN Slides of 286 women who had a Pap smear taken before and 1 to 2 years after placement of a LNG-IUS were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV). RESULTS Prior to insertion, there were no differences in vaginal flora abnormalities between women using different kinds of contraception. LNG-IUS users did not have different rates of AVF, BV, AV or CV, but the general risk to develop any infection was increased. Uterine bleeding after insertion did not seem to predict a different flora type. CONCLUSION We found that Pap smears suggested more vaginal infections after 1 year of LNG-IUS use than prior to insertion of the device.
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ERIKSSON KATARINA, ADOLFSSON ANNSOFIE, FORSUM URBAN, LARSSON PERGÖRAN. The prevalence of BV in the population on the Åland Islands during a 15-year period. APMIS 2010; 118:903-8. [DOI: 10.1111/j.1600-0463.2010.02678.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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