Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology.”

Genotype distribution of cervical HPV among Caribbean women in a population-based study in Martinique: The DEPIPAPUFR study

The Caribbean ranks seventh among the world regions most affected by cervical cancer. HPV-prevalence and genotype distributions also differ from regions. Knowledge of HPV genotype profiles is important for patients care and HPV vaccination implementation. The objective of this study was to describe HPV genotype distribution and risk factors in a population-based cohort of women in Martinique. In this study, 1312 women were included and underwent cervical cancer screening with successful sample collection between 2009 and 2014. Sociodemographic and clinical variables were recorded. Cytological examination of cervical vaginal smear was performed and classified(Bethesda). Detection of HPV DNA was performed with the PapilloCheck© Kit from Greiner Bio-one. Genotypes were analyzed for18 high-risk HPV (hrHPV) and 6low-risk HPV(lrHPV) types. A total of 1075 women were included with a mean age of 49.1±10.5 years. HPV prevalence was 27.6% (297/1075) with 19.4% (209/1075) women with only hrHPV, 5.3% (57/1075) with only lrHPV. Multiple infections (hrHPV/lrHPV) were detected in 31/240 cases of hrHPV (12.9%). A total of 353 hrHPV genotypes were analyzed; the most common HPV types were HPV51 (11.0%), HPV68 (10.8%), HPV53 (9.1%) and HPV 52 (7.1%). HPV16 and HPV18 represented respectively 4.8% and 4.0% of hrHPV genotypes. Abnormal cytology was observed in 34 cases (3.2%), with 14 ASCUS (1.3%), 10 LSIL (0.9%), 5 HSIL (0.5%), 3 ASC-H (0.3%) and 2 AGC (0.2%). Fifteen (44.1%) were hrHPV and 4 (14.7%) lrHPV; 7 cases of hrPHV were in the age-group 25–34 years. Among 1041cases of normal cytology, 225 had positive hrHPV detection (21.6%). This is the first population-based study of HPV profiles in our country, and we found a high prevalence of hrHPV. The most common genotypes were HPV51, 68, 53. These results could serve for cancer vaccination strategies and HPV surveillance in Martinique.

Anal human papillomavirus infection and its relationship with abnormal anal cytology among MSM with or without HIV infection in Japan

Anal high-risk human papillomavirus (hr-HPV) infection is widely considered a cause of anal cancer. However, epidemiological data are quite limited in Japan. This study investigated anal HPV infections and cytological abnormalities among MSM with or without HIV infection. Anal swabs were obtained, and cytological results were examined. Hybrid capture-based methodology was used for hr-HPV genotyping. The exclusion criterion was a history of vaccination against HPV. 644 subjects participated, and the overall prevalence of hr-HPV was 59.7% (95% CI 54.7–62.3), HIV-infected had higher prevalence than HIV-uninfected (68.9% vs 40.6%) p < .001. Among hr-HPV-infected participants, 82.8% (312/377) were infected with at least one of 9 valent vaccine-covered hr-HPV genotypes. From regression analysis, detection of abnormal cytology correlated positively with HIV infection (OR 2.17 [95% CI 1.51–3.13]), number of hr-HPV genotypes infected (OR 1.83 [1.59–2.10]), history of STI (OR 1.58 [1.14–2.22]) and No. of lifetime sexual partners (OR 1.56 [1.10–2.21]), albeit multivariate analysis identified the number of detected hr-HPV genotypes (adjusted OR 1.78 [1.54–2.06]) as the independent risk factor for abnormal cytology. High rates of anal hr-HPV infection, especially 9-valent HPV vaccine-preventable hr-HPV were detected among our MSM participants in Japan. HPV vaccination should also be encouraged for MSM in Japan.

Prevalence, Types, and Factors of HPV Infection Among Women With Abnormal Cervical Cytology Screening at Ramathibodi Hospital

Background: Cervical cancer is the second leading cancer among Thai women. Human papillomavirus (HPV) is the most common cause of cervical cancer. HPV16 and HPV18 are the most prevalence types in women with cervical cancer. Objectives: To study the prevalence and types of HPV infection and its associated risk factors among women with abnormal cervical cytology screening. Methods: This cross-sectional study purposively recruited 376 women who had abnormal cervical cytology screening by liquid-based cytology at the outpatient clinic, Ramathibodi Hospital from August 2015 until March 2016. HPV genotyping was done by the polymerase chain reaction (PCR). Analysis of the personal characteristics was done using descriptive statistics. Results: The prevalence of HPV infection was 41.5%. Among them, a single infection was found in 78.8% of women. The most common genotypes were HPV16 (8.5%) and HPV52 (7.7%). But HPV18 was found in only 1.9%. The characteristic which was significantly associated with HPV infection was age, nulliparity, and high-graded dysplasia (P < .05). Conclusions: High prevalence rate of HPV infection was found among women with abnormal cytology. High-risk HPV prevalence and type distribution may be useful for public health authorities in assessing the cervical screening program.

176Associated factor for abnormal cervical citology in women with HIV at a hospital in Peru

Background Women living with HIV (WLWH) are at higher risk of abnormal cervical lesions. The aim of this study was to determine the risk factors associated with abnormal cytology in WLWH Methods A case-control study was performed, all WLWH &gt;18 years were enrolled at Cayetano Heredia Hospital during 2012-2015. A case and control were defined as a WLWH with abnormal pap smear and with normal pap smear, respectively. Factors associated with the increased risk of abnormal pap smear in WLWH were assessed using logistic regression modeling Results We assessed 141 cases and 227 controls. Alcohol consumption was diagnosed in 30.5% (43/141) of the case group and 18.1% (41/227) of the control group. In the case group, 75.2% (106/141) were on antiretroviral treatment (ART) while 85.1% (193/227) in the control group were in ART. Additionally, 37% of cases (40/106) and the 23.1 % of controls (40/173) had virologic failure. The multivariate model showed that alcohol consumption (OR 1.77, IC95% 1.06-2.95), be in virologic failure (OR 2.41, IC95% 1.55-3.74) and were on ART (OR 0.07, IC95% 0.02-0.23) were associated with abnormal cytology Conclusions Alcohol consumption and virologic failure are significant risk factors associated with abnormal cytology. ART was found to be a protective factor. Screening for these factors in WLWH, should be considered for promoting the prevention with pap smear. Key message We have to have consider periodic screening with pap smear for cervical cancer in this population as mandatory

Is there any possibility of uterine sarcoma, STUMP and benign myoma variants in the patients operated for myoma uteri

Malignant pathologies may be observed in the histopathological examination of the patients who were operated with the diagnosis of myoma uteri. We aimed to investigate the rates of detection of uterine sarcoma, smooth muscle tumor of uncertain malignant potential and benign myoma variants who were operated due to myoma uteri. Patients who were operated with the diagnosis of myoma uteri between 2012-2018 were included. Patients with and without malignant pathology were compared in terms of their characteristics. The malignancy was encountered in 39 patients (1.5%) among 2583 patients. A significant difference was found between the patients with and without malignancy in terms of age, admission complaints, and cervical smear results. Patients in the malignant group were found to be older (52.5±11.0 vs 48.1±6.1, p=0.016). Postmenopausal bleeding was significantly a more common complaint in the malignant group (p=0.028). The rate of abnormal cytology in the cervical smear results in the malignant group was 5.1% (p=0.004). Pathology reports of the patients who were operated for myoma uteri may result with malignancy. In the preoperative evaluation, it is necessary to pay attention to the patients’ characteristics, to evaluate the risk factors for the possibility of a malignancy.

A study on cervical cytopathology in HIV positive pregnant women in Southern part of Assam, India

Background: The association between abnormal cervical cytology and HIV infection status in pregnant women was evaluated to correlate with CD4 cell count, viral load and ART compliance in HIV positive pregnant patients with the presence of ASC-US, LSIL and HSIL.Methods: Cervical samples were collected at the Antenatal Clinic of Silchar Medical College and Hospital. An Ayre’s spatula was used to collect samples from the ectocervix and a cytology brush to collect samples from the endocervix.Results: Of a total of 75 antenatal attendees, 43 were HIV positive and 32 were HIV negative. Abnormal cytology (N=26, 60.46%) was more common in HIV positive group compared to the HIV negative group (N=7, 21.87%) with a p value of <0.05. Cytological abnormalities were found to be associated with immunosuppression, defined as CD4 count <200 cells/mm3 and was also associated with high viral load(>10,000/mm3) and poor treatment follow up with ART.Conclusions: HIV positive pregnant women are more likely to have cervical lesions as compared to the HIV negative. This higher frequency of abnormal findings in PAP cytology in HIV positive pregnant women with higher viral loads suggest association between preinvasive cervical lesions and human immune deficiency.

Patterns of anxiety and distress over 12 months following participation in HPV primary screening

ObjectivesMany countries are now using primary human papillomavirus (HPV) testing for cervical screening, testing for high-risk HPV and using cytology as triage. An HPV-positive result can have an adverse psychological impact, at least in the short term. In this paper, we explore the psychological impact of primary HPV screening over 12 months.MethodsWomen were surveyed soon after receiving their results (n=1133) and 6 (n=762) and 12 months (n=537) later. Primary outcomes were anxiety (Short-Form State Anxiety Inventory-6) and distress (General Health Questionnaire-12). Secondary outcomes included concern, worry about cervical cancer and reassurance. Mixed-effects regression models were used to explore differences at each time point and change over time across four groups according to their baseline result: control (HPV negative/HPV cleared/normal cytology and not tested for HPV); HPV positive with normal cytology; HPV positive with abnormal cytology; and HPV persistent (ie, second consecutive HPV-positive result).ResultsWomen who were HPV positive with abnormal cytology had the highest anxiety scores at baseline (mean=42.2, SD: 15.0), but this had declined by 12 months (mean=37.0, SD: 11.7) and was closer to being within the ‘normal’ range (scores between 34 and 36 are considered ‘normal’). This group also had the highest distress at baseline (mean=3.3, SD: 3.8, scores of 3+ indicate case-level distress), but the lowest distress at 12 months (mean=1.9, SD: 3.1). At 6 and 12 months, there were no between-group differences in anxiety or distress for any HPV-positive result group when compared with the control group. The control group were less concerned and more reassured about their result at 6 and 12 months than the HPV-positive with normal cytology group.ConclusionsOur findings suggest the initial adverse impact of an HPV-positive screening result on anxiety and distress diminishes over time. Specific concerns about the result may be longer lasting and efforts should be made to address them.

Distribution of HPV genotypes among women with abnormal cytology results in Alberta, Canada

Background: Persistent infection with a subset of human papillomavirus (HPV) genotypes can cause abnormal cytology and invasive cervical cancer. This study examines the circulating HPV genotype strains in a local population of the province of Alberta (a largely unvaccinated population) to establish baseline frequency of vaccine and non-vaccine genotypes causing abnormal cervical cytology. Method: Remnant liquid-based cytology specimens from the Alberta Cervical Cancer Screening Program (March 2014–January 2016) were examined. Only specimens from women who had a cytology grading of atypical squamous cells of undetermined significance or higher were included. HPV genotype was determined for all samples, and results were stratified by demographics and cytology results. Results: Forty-four unique HPV genotypes were identified from 4,794 samples. Of the 4,241 samples with a genotype identified, the most common genotypes were HPV 16, 18, 31, and 51, with 1,599 (37.7%), 441 (12.2%), 329 (7.8%), and 354 (8.4%), respectively. HPV9 vaccine genotypes made up 73.2% of these genotyped samples. Compared with specimens in which HPV9 vaccine genotypes were not detected, those with a genotype covered by the HPV9 vaccine were from younger women (33 y [interquartile range {IQR] 28 to 42] versus 40 y [IQR 32 to 51]; p < 0.00001). Conclusions: The baseline distribution of HPV genotypes in this largely unvaccinated population indicates that the HPV 9 vaccine provides good protection from high-risk HPV infections. Determining the frequency of genotypes causing abnormal cytology in this population post–vaccine implementation will be important to assess efficacy of vaccination and monitor for any potential genotype replacement.