ABSTRACT
Cervical cancer is a significant public health problem in low- and middle-income countries, accounting for 85% of new cases worldwide. Due to poorly organized screening programs, cervical cancer is more likely to develop in vulnerable groups who do not initiate or rarely undergo screening. Cervical cytology and detecting high-risk human papillomavirus types are the recommended screening tools. Further, these strategies allow for accurately identifying women at a higher risk of cervical cancer and establishing screening times. New detection tools, such as novel biomarkers or automatic HPV detection in the vagina or urine, can improve screening coverage. This review aims to identify the challenges faced by detection programs and screening tools in Mexico to provide evidence-based recommendations to improve early detection programs for cervical cancer.
ABSTRACT
Cervical ectopy is a benign condition of the lower genital tract that is frequently detected in women of reproductive age. Although cervical ectopy is regarded as a physiological condition, some women experience symptoms such as leucorrhoea, persistent bleeding and recurrent vaginal infections that require medical intervention. Cervical ectopy has not been linked to cervical cancer, but it is thought to facilitate the acquisition of sexually transmitted diseases (STDs), like Human Papillomavirus (HPV) infection, as it provides a favorable microenvironment for virus infection and dissemination. We and others have described the presence of oncogenic HPV types in women with symptomatic cervical ectopy. The relevance of this finding and the impact of symptomatic cervical ectopy on the cervicovaginal microenvironment (vaginal microbiota, immune and inflammatory responses) are currently unknown. To shed some light into the interplay between HPV, the vaginal microbiota and mucosal immune and inflammatory responses in the context of this condition, we enrolled 156 women with symptomatic cervical ectopy and determined the presence of HPV using a type-specific multiplex genotyping assay. Overall, HPV was detected in 54.48% women, oncogenic HPV types were found in more than 90% of HPV-positive cases. The most prevalent HPV types were HPV16 (29.4%), HPV31 (21.17%) and HPV18 (15.29%). Next, we evaluated the vaginal microbial composition and diversity by 16S rDNA sequencing, and quantified levels of cytokines and chemokines by flow cytometry using bead-based multiplex assays in a sub-cohort of 63 women. IL-21 and CXCL9 were significantly upregulated in HPV-positive women (p=0.0002 and p=0.013, respectively). Women with symptomatic cervical ectopy and HPV infection had increased diversity (p<0.001), and their vaginal microbiota was enriched in bacterial vaginosis-associated anaerobes (Sneathia, Shuttleworthia, Prevotella, and Atopobium) and depleted in Lactobacillus spp. Furthermore, the vaginal microbiota of women with symptomatic cervical ectopy and HPV infection correlated with vaginal inflammation (IL-1ß, rho=0.56, p=0.0004) and increased mucosal homeostatic response (IL-22, rho=0.60, p=0.0001). Taken together, our results suggest that HPV infection and dysbiotic vaginal communities could favor a vaginal microenvironment that might delay the recovery of the cervical epithelium in women with symptomatic cervical ectopy and favor STDs acquisition.
Subject(s)
Alphapapillomavirus , Microbiota , Papillomavirus Infections , Female , Humans , Immunity, Mucosal , Male , Microbiota/genetics , Papillomaviridae/geneticsABSTRACT
OBJECTIVE: To evaluate the maternal morbidity in < or = 16 year old pregnant teenagers. MATERIAL AND METHODS: A prospective study of the reviewed cases was carried out from June 1998 to May 1999. All pregnant teenagers which attended the Coordination for the Attention of the Teenage Patient and whose pregnancy came to term during the study period were included. The following variables were analyzed: maternal age, preexisting related diseases, number of pregnancies, number of prenatal control medical visits and the time at which these were started, and maternal morbidity secondary to pregnancy. RESULTS: Two hundred and ninety six of 330 case were included. The average maternal age was 15.1 years old (10-16 range); 68.9% had finished middle school; 82.2% were housekeepers, and 61.4% were single. Prenatal control was initiated in the 2nd trimester by 50.7% of them, while 39.5% started it in the 3rd trimester and the remaining 9.8% in the 1st trimester. The most frequent previous pathologies were: bronchial asthma (2.5%), drug addiction (2%), hypothyroidism (2%), cardiopathy (1.5%). The most common complications during pregnancy: urinary system infections (20.4%), anemia (9.8%), threats of premature labour (9.8%), premature membrane rupture (9%), hypertensive disease induced by pregnancy (3.2%), delayed intrauterine growth (2.4%) and fetal malformation (2.4%). About 44.1% of the pregnancies were interrupted by cesarean section, 35.6% by eutochia and 20.3% by instrumented labour. The most frequent complications during the puerperium were: tearing of the canal of the cervix (7%), decidual endometritis (3.3%), dehiscence of surgical wounds (2.7%), and pyelonephritis (1.6%). CONCLUSIONS: The pregnant teenager is a "special" patient form the biopsychosocial point of view, thus, she must be managed by a multidisciplinary team, with special emphasis in the problems analyzed in this study.
