Anal cancer in systemic lupus erythematosus patients is a neglected condition / Câncer anal em pacientes com lúpus eritematoso sistêmico é uma condição negligenciada

Patients with systemic lupus erythematosus have a higher incidence of neoplasms associated with human papillomavirus infections, such as those that affect the vulva, the vagina, and the cervix; however, little is known about the frequency of anal cancer among these patients. Although there are recommendations for screening for this cancer in immunosuppressed individuals, it is possible that this procedure is not strictly followed. We describe the case of a 47-year-old woman with systemic lupus erythematosus who was treated with immunosuppressants and developed advanced anal squamous cell carcinoma after adequate treatment and healing of a high-grade cervical squamous intraepithelial lesion. Five years after the completion of the anal cancer treatment, the patient presented with cystic hepatic lesions that were histopathologically confirmed to be metastatic squamous cell carcinoma. This report aimed to highlight the need for anal cancer screening in patients with lupus, particularly if there was a history of cervical cytopathological alterations. (AU)

Resumo Pacientes com lúpus eritematoso sistêmico apresentam maior incidência de neoplasias associadas a infecções por HPV, como aquelas que acometem a vulva, a vagina e o colo do útero, mas pouco se sabe sobre a frequência de câncer anal entre essas pacientes. Embora existam recomendações para o rastreamento desse câncer em indivíduos imunossuprimidos, é possível que esse procedimento não esteja sendo rigorosamente seguido. Descrevemos uma mulher de 47 anos com lúpus eritematoso sistêmico, tratada com imunossupressores, que desenvolveu um carcinoma escamocelular anal avançado após tratamento adequado e cicatrização de lesão intraepitelial escamosa cervical de alto grau. Cinco anos após o término do tratamento do câncer anal, a paciente apresentou lesões císticas hepáticas cujo resultado citopatológico confirmou ser carcinoma escamocelular metastático. O presente relato teve como objetivo chamar atenção para a necessidade do rastreamento do câncer anal em pacientes com lúpus, principalmente se houver história prévia de alterações citopatológicas cervicais. (AU)

Distribution of HPV infection subtypes and HPV vaccination intention in Liaoyang / 公共卫生与预防医学

To analyze the distribution of HPV infection subtypes and HPV vaccination intention in Liaoyang area. Methods A total of 3 612 women in Liaoyang area who underwent HPV screening at the Department of Gynecology and Obstetrics of Liaoyang Central Hospital from November 2017 to December 2019 were enrolled in this study. The HPV infection in the population was analyzed, and the differences in HPV infection and multiple HPV infection of people at different ages were compared. The influencing factors of vaccination willingness were analyzed. Results There were 576 patients with HPV infection, and the infection rate was 15.95%. The difference in HPV infection at different ages was statistically significant (χ2=9.261, P=0.000), and the difference in multiple HPV infections at different ages was statistically significant (P<0.05). Among low-risk infections, HPV55, HPV61, and HPV81 were the main subtypes, and among high-risk infections, HPV16, HPV51, HPV66, and HPV53 were the main subtypes. In the multivariate analysis, the HPV vaccination intention of people with lower age and lower monthly family income, college students and students with non-medical majors was significantly lower. Conclusion The high-risk types of HPV in Liaoyang area are mainly HPV16, HPV51, HPV66, and HPV53. It is recommended to focus on the intervention of young people, people with low family monthly income, college students and students with a non-medical major to reduce the incidence of cervical cancer.

Meta-analysis on effect of Kushen Gel on high-risk cervical HPV infection / 中草药

Objective: To systematically evaluate the effectiveness of Kushen Gel in the treatment of cervical high-risk human papillomavirus (HR-HPV) infection. Methods: The Cochrane Library, PubMed, Embase, Medline, Wanfang, VIP, CNKI, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on Kushen Gel in the treatment of the cervical high-risk HPV infection from their inception to December 2019. Two researchers screened the articles, extracted the data, assessed the risk of bias of the eligble studies independently, and performed Meta-analysis with RevMan 5.3. Results: A total of 583 cases were included in five RCTs. The Meta-analysis showed that HR-HPV negative rate [RR = 1.38, 95% CI(1.20, 1.58), P 0.05). Conclusion: The therapeutic effect of applying Kushen Gel can increase the rate of clearance of HPV, reduce HPV-DNA load, and reduce postoperative complication. There is no evidence that the use of Kushen Gel after LEEP can reduce the recurrence rate of CIN2/CIN3. Due to the limitation of the quantity and quality of the included studies, the results need to be further verified and updated by more high-quality RCTs.

Knowledge, attitude, and practice among staff associated with Human Papillomavirus vaccine of young children in Iran

@#Introduction: This study aimed to evaluate knowledge, attitudes, practice associated with Human Papillomavirus (HPV) Vaccine for Young Children among lecturers and health staffs of Shahid Beheshti University of Medical Sciences (SBMU). Method: This was a cross-sectional study with 220 adults from five different specialties, randomly selected. Data was collected using 45-item questionnaire on knowledge (12- item), attitude (18-item) and practice (15-item) (KAP) about HPV. The demographic questionnaire included information on age, gender, level of education, occupation, and marital status. Content validity was calculated by content validity ratio (CVR) and content validity index (CVI). Reliability was evaluated using test-retest and by Cronbach’s Alpha coefficient, internal consistency was calculated values >0.81 which considered as satisfactory. Results: The mean age of the studied population was 37.70± 8.07 (23-67) years. Of the 220 participants, 80 (36.4%) were males and 140 (63.6%) were females. In evaluating KAP in the men and women, the mean and standard deviation of knowledge were estimated at good level and one-way ANOVA analysis showed significant differences between women and men (p=0.019). There was no significant difference in men and women related to attitude (p=0.92) and practice (p=0.38). Conclusion: The KAP about HPV among participants was significantly higher at good levels compared to average levels. Women's knowledge was significantly higher than men. Attitude and practice could have been higher because there was consensus to the usage of vaccine among the specialists to prevent HPV.

Current Status of Human Papillomavirus Infection and Introduction of Vaccination to the National Immunization Program in Korea: an Overview

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection and is associated with the development of cervical cancer. The purpose of this report is to provide the literature evidences on selecting the HPV vaccine for national immunization program (NIP) in Korea. To complete these tasks, we reviewed domestic and foreign literature on the current status of HPV infection, efficacy and effectiveness of HPV vaccine, safety of vaccine and cost effectiveness analysis of vaccination business. Given that the median age of first sexual intercourse is continuing to fall, this may have serious implications for HPV infection and cervical cancer incidence at the age of 20s. The World Health Organization recommends that the HPV vaccination should be included in the NIP being implemented in each country. Both the bivalent and quadrivalent vaccines have a 90% or greater preventive efficacy on cervical intraepithelial lesion 2–3 and cervical cancer by the HPV 16 or HPV 18. In the future, if HPV vaccination rate as part of NIP increases, it is expected that the incidence of HPV infection, genital warts, and cervical precancerous lesions will be decreased in the vaccination age group. Therefore, in order to increase the HPV vaccination rate at this point in Korea, social consensus and efforts such as the introduction and promotion of HPV vaccine to the NIP according to appropriate cost-effectiveness analysis are required.

Human papillomavirus infection and male reproductive health / 中华男科学杂志

Human papillomavirus (HPV) infection is one of the worldwide sexually transmitted diseases (STD), and the DNA of HPV can exist in the normal epithelium of reproductive organs of both men and women. Because the majority of HPV infections are asymptomatic, healthy HPV-carriers become the main source of the infection. Studies show that HPV infection in men is correlated with STD, infertility, tumor of reproductive organs, and infection in the sexual partners. Therefore, measures should be taken to reduce male HPV infection, including circumcision, fewer sexual partners, and condom use.

Oncogenic human papillomavirus detection in penile lichen sclerosus: An update.

Aims: Aim of this study was to better address a possible association of human papillomavirus (HPV) infection with penile lichen sclerosus (LS). Study Design: Paraffin-embedded penile biopsies obtained from adult patients with genital LS retrieved from institutional pathology files were evaluated. Place and Duration of Study: The study has been performed in the Dermatology Clinic of the University of Catania, Italy, spanning a 19-year period. Methodology: We previously demonstrated a high (17.4%) HPV detection rate in a study on 46 patients with genital LS. In this retrospective analysis we extended the analysis to a larger number of patients in order to strengthen these former data. HPV infection was assessed by polymerase chain reaction (PCR) in paraffin-embedded penile biopsies obtained from the glans or inner foreskin of 92 adult patients with penile LS and in brush cytology smears of penile healthy mucosa from an equal number of randomly selected control males matched for age. Statistical evaluation was performed using conditional logistic regression analysis. Results: PCR disclosed the presence of high risk HPV infection in 22.83% of LS patients (HPV 16:16 cases; HPV 18:1 case; HPV 31:1 case; HPV 45:2 cases; HPV 68:1 case) vs 15.21% of controls, (HPV 16:4 cases; HPV 31:1 case; HPV 53:1 case; HPV 56:1 case; HPV 68:1 case; HPV 70:1 case; HPV 81:5 cases). Statistical regression analysis confirmed that the rate of oncogenic HPV infection was higher among patients with genital LS than among healthy controls (χ2=8.26; P<.01; OR=3.59). Conclusion: These data suggest a possible pathogenetic interplay between LS and oncogenic HPV infection in the development of LS-associated penile cancer.

Clinical analysis of 15 cases with vaginal intraepithelial neoplasia and vaginal cancer after operations of cervical cancer or cervical intraepithelial neoplasia / 医学研究生学报

Objective Although the correlation between high risk human papilloma virus (hrHPV) infection and cervical cancer ( CC ) or cervical intraepithelial neoplasia ( CIN ) is well known , vaginal cancer ( VC ) or vaginal intraepithelial neoplasia ( VAIN) also caused by hrHPV has not received enough attention .This article aims to explore the clinical characteristics of VC or VAIN after operations of CC or CIN in order to provide evidence for the treatment of these diseases . Methods The clinical charac-teristics and treatment of 15 cases with VC or VAIN after operations of CC or CIN were reviewed from Jan 2010 to May 2013 in our hos-pital. Results The mean age was (53.6 ±10.82) years, ranged from 39 to 73 years.The duration from the first operation to devel-oped VAIN or VC was (25.07 ±18.31) months, ranged from 1 to 60 months.There are 4 cases developed VC, 4 cases VAINⅢand 2 cases VINⅡfrom 10 CC patients;and 3 cases developed VC , 2 cases VAINⅢfrom 5 CINⅢpatients.hrHPV test were positive in all 15 patients.Treatment in these series were performed including total vaginectomy in 8 patients (3 VC, 4 VAINⅢ and 1 VAINⅡpatients), pelvic lymphonectomy in 1;upper vaginectomy in 2 patients (1 VC, 1 VAINⅢ), radiation or chemo-radiation therapy in 3 (3 VC), interferon muscle injection combined with topical application of estrogen and acyclovir gel in 2 (1 VC, 1 VAINⅡ). Conclusion Careful follow-up after CC or CIN operations are very important because continued hrHPV infection may result VC and VAIN lesions.Vaginectomy may be the best therapy .Interferon muscle injection combined with topical application of estrogen and acyclovir gel are also alternatively therapy , especially for hard to operate patients . Radiation therapy seems to be not very adaptable for VAIN patients .

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE: To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus METHODS: This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay. RESULTS: A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection. CONCLUSIONS: The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus. .

Human papillomavirus risk factors for infection and genotype distribution in aboriginal women from Northern Argentina / Virus papiloma humano (hpv) en mujeres de la etnia Pilagá del nordeste argentino: Factores de riesgo de infección y distribución de tipos virales

The mortality rate for cervical cancer (CC) in Northern Argentina is three times higher than the average for the country (7.8 deaths/100 000 women). We determined the prevalence and genotype distribution of human papillomavirus (HPV) in 227 sexually active women of the native Pilagá community in Formosa, Argentina. We also conducted an HPV-16 variant analysis and studied several community factors that might play a role in viral entry and infection. Endo- and exocervical samples were tested for HPV DNA with MY09/11-PCR or with GP5+/6+-PCR. HPV was detected in 46.7% of the samples and 21 different types were found; the most frequent being HPV-16 (19.4%), -6 and -18 (5.3%), -58 (3.5%) and -31 and -33 (3.1%). In relation to HPV-16 variants, 68.2% were European and 31.8% Asian-American. Among the cofactors analyzed only disposal of human excreta to the open air (P=0.01) was significantly associated with HPV infection. Our prevalence estimates clearly show that Pilagá women are highly exposed to or infected with high risk HPV types and therefore are at a high risk of developing precancerous lesions and eventually CC at the population level.

La tasa de mortalidad por cáncer cervical (CC) en la región norte de la Argentina es tres veces más alta que la media del país (7.8 muertes/100 000 mujeres). En el presente trabajo se determinó la prevalencia de infección por virus papiloma humano (VPH) y la distribución y frecuencia de los genotipos en 227 mujeres sexualmente activas de la etnia aborigen Pilagá (Formosa, Argentina). También se realizó un análisis de las variantes intratípicas de VPH-16 presentes en la comunidad y se analizaron diversos factores socioculturales que podrían tener algún rol destacado en la transmisión de la infección viral. Se estudiaron muestras de células endo-exocervicales mediante PCR basadas en los cebadores MY09/11 y GP5+/6+ con posterior restricción enzimática y/o hibridación dot-blot. La infección por VPH fue detectada en el 46.7% de las mujeres analizadas. Fueron identificados 21 genotipos, de los cuales los más frecuentes fueron HPV-16 (19.4%), -6 y -18 (5.3%), -58 (3.5%) y -31 y -33 (3.1%). Respecto al HPV-16, se encontraron 68.2% de variantes europeas y 31.8% de asiático-americanas. Entre los cofactores analizados, solo la disposición de excretas al aire libre estuvo significativamente asociada con la infección por VPH (P = 0.01). Los datos obtenidos reflejan que la comunidad Pilagá está altamente expuesta a las infecciones por genotipos de alto riesgo de VPH, lo cual puede estar asociado a una alta incidencia de lesiones cervicales preneoplásicas y neoplásicas.

Infecção pelo Papilomavírus humano (HPV) em mulheres de Florianópolis, Santa Catarina / Human Papillomavirus (HPV) infection in women of Florianópolis, Santa Catarina, Brazil

Introdução: a infecção pelo papilomavírus humano (HPV) é a doença sexualmente transmissível mais frequente no mundo e apresenta um amploespectro de manifestações, desde a infecção assintomática até o carcinoma invasivo. Estima-se que pelo menos 50% das pessoas sexualmente ativas venham a adquirir esta infecção em algum momento de suas vidas. Objetivo: determinar a prevalência da infecção pelo HPV e identificar a frequência dos grupos virais de baixo e alto risco oncogênico em mulheres atendidas para consulta ginecológica de rotina em Florianópolis, bem como verificar a associação entre a presença do vírus e alguns fatores de risco. Métodos: trata-se de estudo transversal, de caráter descritivo. Foram avaliadas 100 mulheres atendidas em ambulatório para consulta ginecológica de rotina, selecionadas aleatoriamente. Todas tiveram amostra cervical submetida ao teste de DNA-HPV pelo método de Captura Híbrida II® e responderam a um questionário sobre fatores de risco. Resultados: das 100 mulheres analisadas, 21 (21%) apresentaram positividade para o DNA-HPV. O HPV de alto risco oncogênico esteve presente em 71% e o de baixo risco em 52% das amostras positivas, incluindo as infecções mistas. A infecção pelo vírus de alto risco foi associada às pacientes com início de atividade sexual precoce. Outros fatores avaliados como idade, escolaridade, número de parceiros sexuais, paridade, uso de anticoncepcionais orais, doença sexualmente transmissível e tabagismo não mostraram relação com a infecção pelo HPV. Conclusão: a prevalência de HPV na população estudada foi de 21%, com 71% para vírus de alto risco e 52% para vírus de baixo risco oncogênico, incluindo infecções mistas. A detecção do vírus de alto risco foi associada ao início precoce de atividade sexual.

Introduction: the Human Papillomavirus (HPV) infection is the most frequent sexually transmitted disease in the world and has many clinical manifestations,from asymptomatic infection to invasive carcinoma. At least 50% of sexually active people will have this infection in their life. Objective:to determine the prevalence of HPV and identify the frequency of high risk and low risk virus groups in women attending gynecologic routine as wellas evaluate the association between the presence of these viruses and some risk factors. Methods: this is a cross-sectional study. A hundred randomized selected women who attended the gynecologic service for routine test were evaluated. All of them had cervical specimens tested for DNA-HPV by the Hybrid Capture II assay and answered a questionnaire to acess risk factors. Results: twenty-one (21%) out of 100 analyzed women showed positivity for DNA-HPV. High risk HPV was detected in 71% and low risk HPV in 52% of positive specimens, including mixed infections. Infection with high risk types was associated with younger age at first sexual intercourse. Other evaluated risk factors such as age, level of education, number of sexual partners, parity, use of oral contraceptives, sexually transmitted disease and smoking did not show relation to HPV infection. Conclusion: the prevalence of HPV in the studied population was 21%, with 71% of high risk virus and 52% of low risk types, including mixed infections. High risk HPV detection was associated with younger age at first sexual intercourse.

Electrocolposcopic and thinprep cytologic test in diagnosis of subclinical human papillomavirus infection and cervical intraepithelial neoplasia / 上海第二医科大学学报

Objective To investigate the diagnostic value of thinprep cytologic test(TCT) and electronic colposcope(EC) examination in patients with subclinical human papillomavirus(HPV) infection(SPI) and cervical intraepithelial neoplasia(CIN),and explore its concordance with pathologic diagnosis. Methods A total of 1 125 females were examined with TCT,744 of whom diagnosed with abnormality by TCT or suspect of cervical lesions were examined with EC,and multiple punch biopsies were performed in 706 of those with abnomal EC images and suspected diseases. ResultsThe sensitivity of TCT,EC examination and the combined examination of TCT and EC for SPI and CIN were 88.74%,88.79% and 90.63%,respectively,the specificity 85.44%,80.38% and 96.41%,respectively,the positive predictive value 74.06%,68.90% and 91.10%,respectively,and the negative predictive value 94.19%,93.61% and 96.21%,respectively.By the combination of the two examinations,the specificity and positive predictive value were significantly increased(P

Alterations of p16INK4A and p18INK4C, Human Papillomavirus infections and Expression of the Cell Cycle Associated Proteins in Cervical Carcinomas / 대한산부인과학회잡지

OBJECTIVE: We analyzed the gene status of p16INK4A, p18INK4C, the expression of cell cycle associated proteins (p16INK4A, p18INK4C, cyclin D1, CDK4, pRb, and p53), and human papillomavirus (HPV) infection to investigate whether the inactivation of these genes participated in carcinogenesis, and to evaluated the expression of cell cycle associated proteins and HPV infections. METHODS: We examined forty-one primary cervical carcinomas (17 adenocarcinomas, 13 keratinizing squamous cell carcinomas, and 11 nonkeratinizing squamous cell carcinomas) using PCR, comparative multiplex PCR, PCR-SSCP, methylation-specific PCR, and immunohistochemistry. RESULTS: Ninety percent of cervical carcinomas showed HPV infection. HPV type 16 was detected in 41% and HPV type 18 was found in 44%. Homozygous deletions at p16INK4A gene were observed in 2 cases, but the mutation of p16INK4A and alterations of p18INK4C gene were not detected. The promoter hypermethylation for p16INK4A in nine cases (31%) of 29 cervical carcinomas was found. Expression of p16INK4A protein was observed in 93% and p18INK4C protein expression was noted in 78%. Positive immunostaining for cyclin D1 was only identified in 5%, whereas positive immunostaining for CDK4 was observed in 95%. Expression of pRb protein was found in 93% and p53 protein in 24% of cervical carcinomas. CONCLUSION: These results suggest that high risk HPV infections and methylation of the p16INK4A promoter region seem to play an important role in the pathogenesis of cervical carcinomas. Alterations of p18INK4C gene and cyclin D1-CDK4 pathway does not contribute significantly in the cervical carcinogenesis.

Atypical Condyloma of Uterine Cervix: It's Cytological Similarity to Squamous Cell Carcinoma

Atypical condyloma is a variant of flat condyloma characterized by the presence of atypical koilocytes having large hyperchromatic, smudged and often bizarre nuclei. Atypical condyloma can be frequently misdiagnosed on cytologic smear and on tissue sections by its marked cellular atypia, as high grade dysplasia, in situ or even invasive squamous cell carcinoma. We described two cases of atypical condyloma of the female genital tract. The cytologic features and histologic changes were reminiscent of those of invasive squamous cell carcinoma and severe degree of dysplasia of the uterine cervix. The differential findings between atypical condyloma and squamous cell carcinoma were discussed in detail.