Update on human papillomavirus - Part II: complementary diagnosis, treatment and prophylaxis,

Abstract In this nonsystematic review, the complementary diagnosis, treatment, prevention, and control of human papillomavirus are discussed. The histopathology is addressed regarding its indications, main findings and limitations, as a complementary diagnostic method largely used by dermatologists. Electron microscopy is briefly reviewed, along with its contribution to the accumulated knowledge on HPV, as well as the relevance of research in using this technology for future advances in diagnosis and treatment. Molecular information about the virus is continuously increasing, and the practical applications of HPV serology, molecular identification and genotyping are discussed. Vaccines are a valuable tool in primary HPV infection prevention and are now available in many countries; their composition, indications, and adverse effects are revisited. Local and systemic treatment options are reviewed and off-label prescriptions are discussed. Finally, health education focusing on HPV infection as a sexually transmitted infection of worldwide relevance and the many barriers to improve primary and secondary prevention are addressed.

Diagnostic screening of HPV genotypes in 555 Ecuadorian mestizo women of seven provinces, and comparison with other Latino American populations / Tamizaje diagnóstico de genotipos de VPH en 555 mujeres mestizas ecuatorianas, de siete provincias, y comparación con otras poblaciones latinoamericanas

Objective: this paper aims to perform diagnostic screening of HPV in healthy Ecuadorian mestizo women, from seven provinces, and compare the findings with other Latin American populations. Material and methods: genotyping was done with two different oligonucleotides MY09 and MY11; a fragment of 450 base pairs was amplified,L1 region of the viral genome. Results: it analyzed 555 women, 35 were positive for HPV (6.3%). Genotypes found in relation to oncogenic risk, were 6, 11, 16, 18, 31, 33, 35, 42, 45, 51, 52, 53, 58, 59, 61, 81. 12/35 women (34.3%) presented high-risk genotypes. Four positive cases were also observed in women older than 55 years (0.36%). The 14 published studies of Ecuadorian women showed that the most prevalent genotypes are 16, 18, 31, 52, 53, 56 and 58; while in the eight Latin American Studies the most prevalent are 16, 18, 31, 45, 52 and 58. Conclusion: although there are several studies on HPV genotyping on Latin American populations, there is an important gap related to ethnicity and the prevalence of the virus. In addition, most of them have not compared similar and common subtypes in the population. The general prevalence of HPV in the studied population was 6.3%. It found that genotypes 16, 18, 31, 52, 53, 56 and 58 are the most prevalent in Ecuadorian normal mestizo women. Genotypes 53 and 56 are common in Latino populations. Larger studies, in different ethnic groups are needed to identify other prevalent genotypes in certain geographical areas..(AU)

Objetivo: realizar tamizaje diagnóstico de VPH en mujeres mestizas ecuatorianas sanas, de siete provincias, y comparar los hallazgos con otras poblaciones latinoamericanas. Material y métodos: el genotipado se realizó con dos oligonucleótidos diferentes MY09 y MY11; se amplificó un fragmento de 450 pares de bases, correspondiente a la región L1 del genoma viral. Resultados: se analizó 555 mujeres, 35 fueron positivas para VPH (6,3%). Los genotipos encontrados en relación con el riesgo oncogénico fueron 6, 11, 16, 18, 31, 33, 35, 42, 45, 51, 52, 53, 58, 59, 61, 81. 12/35 mujeres (34,3%) presentaron genotipos de alto riesgo. También se observaron cuatro casos positivos en mujeres mayores de 55 años (0,36%). Los 14 estudios publicados de mujeres ecuatorianas mostraron que los genotipos más prevalentes son 16, 18, 31, 52, 53, 56 y 58; mientras que en los ocho estudios latinoamericanos los más prevalentes son 16, 18, 31, 45, 52 y 58. Conclusión: aunque existen estudios sobre la prevalencia de VPH, aún existe una brecha sobre la relación entre la etnicidad y la prevalencia del virus. Además, los estudios en América Latina no han comparado subtipos similares y comunes en la población. La prevalencia general del VPH en la población estudiada fue del 6,3%. Este estudio encontró que los genotipos 16, 18, 31, 52, 53, 56 y 58 son los más prevalentes en las mujeres mestizas ecuatorianas sanas. Los genotipos 53 y 56 son los más comunes en las poblaciones latinas. Se necesitan estudios más grandes, en diferentes grupos étnicos para identificar otros genotipos prevalentes en ciertas áreas geográficas..(AU)

Distribuição dos genótipos de papilomavírus humano em mulheres do estado da Bahia, Brasil / Genotype distribution of human papillomavirus in women from the state of Bahia, Brazil

OBJETIVO: O objetivo foi descrever a distribuição dos genótipos do papilomavírus humano e a frequência de infecções por múltiplos genótipos, bem como avaliar a associação entre genótipos de papilomavírus humano, faixa etária e resultados cito-histopatológicos. MÉTODOS: Estudo retrospectivo de corte transversal realizado entre junho de 2010 e outubro de 2013 em Salvador, Bahia, Brasil. Foram revisados 351 prontuários de mulheres com genotipagem positiva pelo teste PapilloCheck(r), usado para detectar 24 tipos de papilomavírus humano. Os achados cito-histopatológicos foram classificados em grupos de: achados negativos para neoplasia (exames citopatológico e histopatológico negativos), lesão de baixo grau (achado citopatológico - lesão intraepitelial de baixo grau - ou achado histopatológico - neoplasia intraepitelial cervical grau 1, neoplasia intraepitelial vaginal grau 1 ou condiloma e lesão de alto grau (achado citopatológico - lesão intraepitelial de alto grau - ou histopatologia com laudo maior ou igual a neoplasia intraepitelial cervical grau 2 ou neoplasia intraepitelial vaginal grau 2). RESULTADOS: O genótipo de alto risco mais frequente foi o HPV 16, com 18,5%; intervalo de confiança de 95% (IC95%) 14,6-23,0, seguido pelo HPV 56 (14%; IC95% 10,5-18,0) e o HPV 39 (13,4%; IC95% 9,5-16,8). O HPV 18 (5,4%; IC95% 3,3-8,3) esteve entre os menos comuns. Entre os tipos de baixo grau, o HPV 42 (15,7%; IC 95% 12,0-20,0), o HPV 6 (11,4%; IC95% 8,3-15,2) e o HPV 44/55 (11,1%; IC95% 8,0-14,9) foram os mais encontrados, enquanto o HPV 11 (2,8%; IC95% 1,4-5,2) foi o menos frequente. A proporção do HPV 16 aumentou com a severidade das anormalidades cito-histopatológicas de 13,8% (12/87) nas lesões de baixo grau para 42,4% (14/33) nas lesões de alto grau. Houve ...

PURPOSE: The aim of this study was to evaluate the human papillomavirus genotypes and the frequency of multiple human papillomavirus infections, as well as to assess the association between human papillomavirus genotype, cyto-histopathological abnormalities and age range. METHODS: A retrospective cross-sectional study was carried out between June 2010 and October 2013 in Salvador, Bahia, Brazil. We analyzed 351 results of positive human papillomavirus genotyping performed using the PapilloCheck(r) test, designed to detect 24 human papillomavirus types. The cyto-histopathological abnormalities were classified as negative (negative cytology and histopathology), low-grade lesions (cytologic low-grade squamous intraepithelial lesion diagnosis or histopathologic cervical intraepithelial neoplasia 1 or vaginal intraepithelial neoplasia 1 diagnosis) and high-grade lesions (cytologic high-grade squamous intraepithelial lesion diagnosis or histopathologic cervical intraepithelial neoplasia 2+ or vaginal intraepithelial neoplasia 2+ diagnosis). RESULTS: The most frequently detected high risk human papillomavirus genotype was HPBV 16, with 18.5%, 95% confidence interval (95%CI) 14.6-23.0, followed by HPV 56 (14%; 95%CI 10.5-18.0) and HPV 39 (13.4%; 95%CI 9.5-16.8). HPV 18 (5.4%; 95%CI 3.3-8.3) was among the least frequent types. Among the low risk types, HPV 42 (15.7%; 95%CI 12.0-20.0), HPV 6 (11.4%; 95%CI 8.3-15.2) and HPV 44/55 (11.1%; 95%CI 8.0-14.9) were the most frequent, while HPV 11 (2.8%; 95%CI 1.4-5.2) was the least common. The proportion of HPV 16-positive women increased with severity of cyto-histopathological abnormalities: 13.8% (12/87) in low-grade lesion and 42.4% (14/33) in high-grade lesion. There was association between low- or high-grade cyto-histopathological lesion and the high risk genotypes, HPV16, HPV 52, HPV 73 and HPV 82, and the low risk type, HPV 43. Women under 30 years showed a significantly higher frequency ...

Relación citohistológica en mujeres con diagnóstico de papiloma virus humano / Cytohistologic relation in women with diagnosis of human papilloma virus of Camagüey municipality

Fundamento: En la actualidad el cáncer cérvicouterino es la segunda causa de cáncer ginecológico a nivel mundial después del de mama. Objetivo: Describir la relación citohistológica en mujeres con diagnóstico de papiloma virus humano (PVH) por biopsia del municipio Camagüey. Método: Se realizó un estudio descriptivo en el Hospital Docente Gineco-Obstétrico Ana Betancourt de Mora en los años 2005-2006. La muestra la constituyeron 159 mujeres con diagnóstico de PVH en las que se estudió la edad y los resultados citológicos e histológicos. Los resultados seexpresaron en números absolutos y relativos y se expusieron en tablas, gráficos y texto. Resultados: El 42,7 por ciento de las pacientes tenían edades comprendidas entre 30 y 39 años y el 24,5 por ciento estaban entre 20 y 29 años. Se observó coincidencia diagnóstica en 84 (52,8 por ciento ) mujeres, principalmente entre las que presentaron PVH asociado a NIC I y NIC II. En 25 (15,7 por ciento ) se encontraron resultados negativos falsos en la citología. Conclusiones: La infección por PVH predominó en las mujeres con edades entre 30 y 39 años. Los resultados citológicos e histológicos coincidieron en más de la mitad de las enfermas con diagnóstico de PVH asociado a NIC I y NIC II, no así en las restantes.

Background: At the present time cervix uteri cancer is the second cause of worldwide gynaecological cancer after the mamma´s. Objective: To describe the cytohistologic relation in women with diagnosis of human papilloma virus (HPV) by biopsy in Camagüey municipality. Method: A descriptive study at Ana Betancourt de Mora Gyneco-Obstetric Teaching Hospital in 2005-2006 years. The sample was constituted by 159 women with diagnosis of HPV in which age, cytologic and histological results were studied. Results in absolute and relative numbers were expressed and exposed in tables, charts and text. Results: The 42,7 percent of the patients had ages between 30 and 39 years and the 24,5 percent were between 20 and 29 years. Diagnostic coincidence in 84 (52.8 percent ) women was observed, mainly among who presented HPV associated to NIC I and NIC II. In 25 (15.7 percent ) false negative results were found in the cytology. Conclusions: The infection by HPV predominated in women with ages between 30 and 39 years. Cytologic and histological results coincided in over the half of sick persons with diagnosis of HPV associated to NIC I and NIC II, no like this in the remaining.