Correction to: Self-sampling for human papillomavirus testing among rural young women of KwaZulu-Natal, South Africa.

Following publication of the original article [1], one of the authors reported that his name had been spelled incorrectly. It should be Galappaththi-Arachchige, not Galapaththi-Arachchige.

Self-sampling for human papillomavirus testing among rural young women of KwaZulu-Natal, South Africa.

BACKGROUND: Cervical cancer is a major problem in women and it is important to find a suitable and acceptable screening method, especially among young in low-resource areas for future human papillomavirus (HPV) vaccine follow-up investigations. The study sought to test the acceptability of self-sampling as well as the suitability of the specimen collecting devices. METHODS: Ninety-eight young women from rural KwaZulu-Natal were enrolled between March and July 2014. Collected genital specimens were transferred to colour indicator cards for HPV detection. Participants answered a questionnaire where they described their experiences with self-sampling. Samples were tested for high-risk HPV using GP5/6+ PCR. RESULTS: Of the enrolled participants, 91 answered questionnaires and indicated that self-sampling was preferred by 51/91 (56%) women while 40/91 (44%) indicated preference for sampling by a doctor (p = 0.023). The majority, 64% were comfortable using a swab, 22% preferred a brush while 11% were comfortable with both devices. Of the 98 self-sampled specimens 61 were negative for HPV in both specimens while 37 were HPV-positive in either brush or swab. Of the 37, 26 (70%) were HPV-positive in both brush and swab (kappa = 0.743) and 11 (30%) were discordant. CONCLUSIONS: Self-sampling was acceptable to the majority of participants in this rural area. The Dacron swab was the preferred device, and can be used in combination with colour indicator cards for comfortable self-sampling, easy storage and transport of specimens plus detection.

The effects of genital schistosoma haematobium on human papillomavirus and the development of cervical neoplasia after five years in a Zimbabwean population.

BACKGROUND: High-risk human papillomavirus (HPV) is responsible for cervical cancer and genital Schistosoma haematobium infection has been hypothesized to be an additional co-factor or even an independent risk factor for cervical neoplasia. The present study aimed to investigate the impact of schistosomiasis on HPV persistence and development of cell atypia in a group of rural Zimbabwean women with confirmed high-risk HPV. METHODS: A five-year follow-up was done among women previously included in a study on genital schistosomiasis. Women who had high-risk HPV at baseline were invited after 5 years for examination of cell atypia, genital schistosomiasis, and high-risk HPV. Both vaginal lavage samples (low-cost) and cervix brush samples (high-cost) were obtained for further analysis. RESULTS: Thirty-seven women were re-examined. Genital Schistosoma haematobium of a minimum of five years' duration was associated with the development high-grade squamous intraepithelial neoplasia, but not with persistent high-risk HPV. There was a high concordance between the brush and vaginal lavage (96.3% agreement, kappa 0.93); however, the number of beta-globin negative vaginal lavage samples was unacceptably high. CONCLUSIONS: Findings warrant an exploration in a larger longitudinal study where a vaginal swab should be explored.

Feasibility of collecting self-sampled vaginal swabs by mail: quantity and quality of genomic DNA.

Vaginal self-sampling may be valuable as an alternative method of cervical cancer screening in areas of poor resources, to enroll women who, otherwise, would not participate in population-based cervical cancer screening and in epidemiological follow-up studies. We assessed the reliability of mailed vaginal samples by evaluating the quantity and quality of genomic DNA in the samples. Mailed swabs (n = 201) were compared with freshly collected samples (n = 200) for DNA concentration (45.1 versus 50.9 ng/microl, respectively) and purity (mean optical density [OD] 260/280 ratio 1.88 versus 1.78, respectively). A small, non-significant, decrease in DNA yield with longer transport time was noted. The DNA yield of mailed samples was significantly lower compared to fresh samples (P < 0.002), but this lower yield had little effect on polymerase chain reaction (PCR) amplification. In conclusion, the large majority of mailed self-sampled vaginal swabs resulted in DNA of adequate purity and concentration for further research.

Microsatellite instability and HPV genotype in Polish women with cervical cancer.

INTRODUCTION: Human papillomaviruses (HPVs) are associated with anogenital cancer. Little is known about the prevalence of microsatellite instability (MSI) in cervical cancer. The aim of this study was to investigate the incidence of microsatellite instability in cervical cancer and to see whether there is a relation between MSI, HPV and clinicopathological characteristics in the study population. RESULTS: Using three assays (pU1M/2R, GP5+/6+ and E6-nested multiplex PCR) HPV was detected in 110 out of 113 patients with histologically confirmed cervical cancer. The presence of MSI was investigated in 95 of the 113 cases using seven microsatellite loci. In total, 12 out of the 95 patients (12.6%) showed MSI. None of clinicopathological parameters showed a significant difference between microsatellite stable and MSI cases. CONCLUSION: In this population of Polish cervical cancer patients, 12.6% showed microsatellite instability. There was no correlation between MSI positivity and clinicopathological parameters and/or survival.

The value of human papillomavirus detection in primary cervical cancer screening.

Human papillomavirus (HPV) is present in the vast majority of high-grade gynecological abnormalities (high-grade squamous intraepithelial lesions and worse) and, therefore, HPV detection has a very high negative predictive value. Nevertheless, introduction of HPV detection into primary screening would result in large numbers of false positives: HPV positive women with normal cytology. The prevalence of HPV in women with cytologically normal smears is age-dependent as has been shown extensively. We hypothesize that women at the age of 50, who are HPV negative and have a cytologically normal smear might be encouraged to refrain from further screening. The data available from the literature on HPV prevalence in elderly women is presented. Data of cohort studies of elderly women with and without HPV infection as well as health-economical analyses to investigate the cost-effectiveness of the proposed hypothesis are still lacking.

Risk factors for cervical cancer development: what do women think?

BACKGROUND: The current cervical cancer prevention strategy is exclusively directed towards screening, without taking into account any relationship with sexual risk factors. The introduction of human papillomavirus (HPV) detection into the screening procedure implicates that we should give attention to this relationship. The aim of this study was to investigate what knowledge women have of the relation between HPV and cervical cancer. METHODS: Rather than asking about HPV specifically, we suggested 20 risk factors for the development of cervical cancer, including viral infection, and asked 73 women visiting their general practitioner, 67 women visiting a lecture on risk factors for cervical cancer and 28 female students in biomedical sciences to rate the importance of these risk factors on a scale of 1-5. RESULTS: Genetic factors were rated highest with a mean score of 4.5. Bacterial infection ranked second highest with a mean score of 3.8. Smoking ranked fourth at a mean score of 3.6, whereas viral infection shared the sixth place with number of sexual partners with a mean score of 3.4. The presence of high voltage power lines and physical activity appropriately scored the last two places at 2.4 and 2.2, respectively. Twenty-one women suggested a role for sexually transmitted agents, but only five women (3.1%) could actually pinpoint HPV. CONCLUSION: This enquiry indicates that the risk factor 'genetic factors' was over-rated, while knowledge of the most important risk factors, i.e. smoking and sexual habits and (sexually transmitted) infections, would appear to be present to a moderate level in our population. However, knowledge of the role of HPV in cervical cancer development is lacking.