Oral antibodies to human papillomavirus type 16 in women with cervical neoplasia.

This study investigated the relationship between human papillomavirus type 16 (HPV-16) antibodies detected in oral fluid from women with cervical neoplasia, their HPV-16 antibody seroprevalence, and their cervical HPV-16 DNA presence. Cervical HPV-16 DNA was detected by polymerase chain reaction in 43.2% (35/81) of these women. The prevalence of IgG and IgA antibodies to HPV-16 virus-like particles (VLP-16) in oral fluid and was investigated by enzyme-linked immunosorbent assay. Anti-VLP-16 IgA antibodies were detected in oral fluid from 54.3% (44/81) of women with cervical neoplasia, compared with 8% (3/36) in controls (P = 0.000002). Anti-VLP-16 IgG was detected in oral fluid from 43.2.9% (25/72) and 13.3% (4/30; P = 0.029), respectively. Women who were HPV-16 DNA positive at their cervical lesion, displayed an oral fluid anti-VLP-16 IgA prevalence of 60.7% (17/28) and HPV-16 DNA negative women an oral fluid anti-VLP-16 IgA prevalence of 50% (20/40; P = 0.38). Oral fluid anti-VLP-16 IgG prevalence in HPV-16 DNA positive women was 28.6% (8/28) compared with 40% (16/40) in oral fluid from HPV-16 DNA negative women (P = 0.3). Amongst HPV-16 DNA positive women, the anti-VLP-16 IgG seroprevalence was 75% (21/28) and IgA seroprevalence 35.7% (10/28) and for the HPV-16 DNA negative women these values were 60% (24/40) and 32.5% (13/40), respectively. Oral IgA antibody testing proved no more sensitive than serum antibody detection for the determination of HPV infection but could be useful as a non-invasive screening method for women with cervical neoplasia and for estimating the mucosal antibody response to HPV vaccines.

Seroresponses to human papillomavirus types 16, 18, 31, 33, and 45 virus-like particles in South African women with cervical cancer and cervical intraepithelial neoplasia.

The aim of the study was to determine the prevalence of antibodies to human papillomavirus (HPV) types 16, 18, 31, 33, and 45 in woman in Cape Town with cervical intraepithelial neoplasia (CIN) (n = 95), cervical cancer (n = 40), female blood donors (n = 95) and children (n = 110). The enzyme-linked immunosorbent assay (ELISA) made use of baculovirus synthesised HPV virus like particles (VLPs) as antigen. Antibodies to at least one HPV type were detected in sera from 75% of cancer patients, 71.6% of CIN patients, 44.2% of blood donors and 27.3% of children. Sera from 95 women with CIN were compared with age-matched female blood donors. There was a significant association of seropositivity to VLP-16 (P = 0.006) and VLP-45 (P = 0.008) with CIN compared with the blood donors. There was also a significant difference in the seropositivity of women with CIN to any of the five virus-like particle (VLP) types compared to the blood donors (P = 0.0002: OR = 3.2). Thirty-nine of sixty-nine (56.5%) women with CIN were found to be HPV-16 DNA positive. The average age of women in this group that were VLP-16 seropositive was 34 years and those found to be VLP-16 seronegative was 52 years of age. Antibodies to all five VLP types were detected in these populations, thus an ideal vaccine should induce protection from infection by a wide range of HPV types.

Human papillomavirus in normal cervical smears from Cape Town.

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) types in South African women with normal cervical cytology and to determine whether our results are comparable to what has been found elsewhere in the world. DESIGN: Cervical smears were collected from 262 women. SETTING: The Cape Town metropolitan area. PARTICIPANTS: A total of 262 women, aged 19-85 years. Eighty-five women attended the family planning clinic of the Gynaecology Department at Groote Schuur Hospital and 177 women consulted private gynaecological practices. MAIN OUTCOME MEASURES: The prevalence and types of HPV in 192 women with normal cervical cytology. RESULTS: The incidence of HPV DNA in cervical smears from Cape Town women with normal cytology was found to be 13% (25/192) using Southern blot hybridisation. The types of HPV found in normal cervical tissue from Cape Town did not differ significantly from those found elsewhere in the world. Nine per cent (17/192) were positive for "high-risk' HPV types which are associated with premalignant and malignant cervical lesions. In the age group 20-39 years, 15 of 92 (16%) were positive for HPV DNA, while in the age group above 39 years, 3 of 53 (6%) women were positive for HPV DNA. CONCLUSIONS: In this study, 25 of 192 (13%) women with normal cytology were positive for HPV.

Typing of human papillomaviruses in cervical carcinoma biopsies from Cape Town.

Sixty-eight cervical carcinoma biopsies from women at Groote Schuur hospital in Cape Town were screened for human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) amplification with subsequent typing by hybridisation with specific oligonucleotides. Amplified DNAs which hybridised with the HPV group-specific oligonucleotide probes, but with none of the type-specific probes, were categorized as unclassified HPV types. Eighty-one percent of samples were HPV positive and the following distribution and types were detected: 46% HPV 16, 1.5% HPV 18, 6% HPV 31, 6% HPV 33, 1.5% HPV 45, and 25% unclassified HPVs. Four of the tumours had detectable dual infections with the following combinations of HPVs: HPV31/HPV33; HPV16/HPV33; HPV18/HPV16; HPV45/HPV33. Tumour DNA from the 17 PCR unclassified HPVs was analysed by Southern blotting and gave the following results: 11 were negative, 4 were positive on hybridisation but could not be typed (unclassified HPV), 1 was HPV 16, and 1 resembled the HPV 16 "variant" described previously [Williamson et al. (1989): Journal of Medical Virology 28:146-149]. Only 2 of 13 samples that were negative for HPV by PCR were positive for unclassified HPVs by Southern blot analysis. Sequencing of a PCR product revealed that one of the unclassified HPVs was HPV 52. This is the first record of HPV 52 and HPV 45 in Africa.

Repeat laparotomy in ovarian carcinoma after primary surgery.

Thirty-two patients with malignant ovarian disease were referred after primary surgery to the Gynaecological Oncology Unit of Groote Schuur Hospital, Cape Town. All 32 patients underwent a re-laparotomy with a view to accurate staging and possible cytoreductive surgery. On referral, 24 patients (75%) had stage I or II disease and the remaining 8 patients (25%) had stage III and IV disease. Twenty-seven patients (81%) had ovarian malignant disease of epithelial origin while the remaining 5 patients (19%) had ovarian disease of nonepithelial origin. Five (20.8%) of a total of 24 patients with stage I or II disease had their disease stage raised after repeat laparotomy. The overall success rate of cytoreductive surgery, i.e. less than 2 cm residual disease, was 58%.

Typing and molecular characterization of human papillomaviruses in genital warts from South African women.

Condyloma acuminata from 12 women were examined for the presence of human papillomavirus DNA. Six of the women had HPV 6a, two had HPV 11a, one had a new HPV 6 subtype, and one a new HPV 11 subtype. The new HPV 6 subtype could be distinguished from other HPV 6 subtypes on the basis of Pst I fragments as well as Hind II fragments. The new HPV 11 subtype had a different Hpa II restriction endonuclease pattern. Restriction maps of both new subtypes were constructed. Two of the biopsies did not contain detectable HPV DNA when probed with HPV 6, HPV 11, and HPV 16. Biopsies were taken from normal tissue 1 cm away from the condyloma in 11 of the patients. Only one of these normal tissue biopsies was positive for HPV by Southern blot hybridization.

Tumour marker CA125 levels in a variety of benign and malignant conditions.

The levels of tumour marker CA125 were established in 515 patients with a variety of benign and malignant conditions. With a specificity of 60.3% and an overall sensitivity for malignant tumours of 54% (extra-ovarian serous papillary carcinomas 100%), it is the most reliable tumour marker at present available for epithelial ovarian cancer and is of considerable value in the management of this condition when considered in conjunction with other clinical measurements.

Typing of human papillomaviruses in cervical intraepithelial neoplasia grade 3 biopsies from Cape Town.

DNA from 98 cervical intraepithelial neoplasia grade 3 (CIN 3) biopsies was screened, using the Southern blotting hybridization technique, for human papillomavirus (HPV) types 6, 11, 16, 18, 31, 33, and 35. HPV 16 was detected in 16 biopsies (16%), HPV 33 in eight biopsies (8%), HPV 31 in two biopsies (2%), and HPV 18 in one biopsy (1%). One of the biopsies contained both HPV 31 and 18. Six biopsies (6%) contained an HPV type very similar but not identical to HPV 16, and 35 biopsies were positive for HPV, but the Pst 1 restriction fragments were distinct from any of the HPV types used as probes. HPV was not detected in 32% (32/98) of the biopsies screened.

A clinical appraisal of stage 1 mucinous carcinoma of the ovary.

Thirty patients with stage I mucinous carcinoma of the ovary are reviewed with special reference to possible prognostic factors. The role of adjuvant therapy is discussed. Adjuvant therapy is recommended only for patients with poorly differentiated tumours and with stage Ic disease.

Combined chemotherapy and radiotherapy in patients with advanced squamous carcinoma of the cervix (cis-platinum-bleomycin-vinblastine).

In a pilot study, nine patients with advanced carcinoma of the cervix were treated with combination chemotherapy including cis-platinum, vinblastine, and bleomycin repeated at 3-week intervals for three courses followed by radiotherapy. Only one patient showed a partial response (reduction of tumor size more than 50%). There were no complete responses. Five of the nine patients have died from the disease with a median survival time of 20 months. These findings suggest that this particular combination of chemotherapy with radiotherapy does not have a significant effect in patients with advanced stage carcinoma of the cervix.

Endometrial cytology--the Endo-pap direct endometrial sampler.

A study was designed to assess the clinical characteristics and diagnostic cytological accuracy of an endometrial sampler, the Endo-pap (Monoject; Sherwood Medical, St Louis, Mo., USA), a disposable plastic curette. The Endo-pap was compared with the Accurette (Rolon, Watford, UK), another plastic endometrial sampler used for histological investigation. Microcolpohysteroscopy was also employed as part of the procedure. Fifty symptomatic patients, median age 50 years, were studied; the majority (55.6%) had been referred for postmenopausal bleeding. The Endo-pap yielded adequate specimens in 90% of patients compared with 82% with the Accurette. In 7 patients, endometrial carcinoma was correctly diagnosed with all three diagnostic methods and no false-positive diagnosis was made.

Human papillomavirus and the squamous epithelium of the female genital tract.

The evidence linking human papillomavirus (HPV) infection with cervical intra-epithelial neoplasia (CIN), cervical cancer and similar changes in the vulval and vaginal epithelium is reviewed. Reference is made to prevalence rates for HPV and CIN in South Africa and South West Africa/Namibia and the prospect of an 'epidemic' of cervical and possibly of other squamous genital cancers is discussed. Only an effective cytological screening programme with effective follow-up arrangements will prevent this; these should be priorities for future preventive medicine strategies.

Transcatheter embolization of pelvic vessels to stop intractable hemorrhage.

Six patients with severe vaginal bleeding were treated with transcatheter embolization of selected pelvic vessels. Three patients had Stage III(b) carcinoma of the cervix, one with dysfunctional uterine bleeding and two patients had gestational trophoblastic disease (GTD) with bleeding from vaginal metastases. Bleeding stopped in four of the six cases. Reasons for failure in the other two cases are given. No other reports of bleeding from vaginal metastases in metastatic GTD treated in this way have been seen in the literature.