A comparative study of cervical cytology, colposcopy and PCR for HPV in female sex workers in Singapore.

This study examined the prevalence of human papillomavirus (HPV) infection in a cohort of female sex workers in Singapore. HPV infection was diagnosed by clinical examination, Papanicolaou (Pap) smears, histology and polymerase chain reaction (PCR). One hundred and eighty-seven female sex workers who came for their routine medical screening were enrolled into the study. PCR was positive for HPV in 27 (14.4%), 20 of these had a single HPV type detected, while 7 had multiple types of HPV detected. The most common HPV types identified were types 16, 58 and 18. In conclusion, HPV infection is moderately prevalent among sex workers as tested by PCR, but routine screening with Pap smears does not appear to be a sensitive method of diagnosis for HPV infection.

Hydatidiform mole in Kandang Kerbau Hospital--a 5-year review.

BACKGROUND: This is a 5-year review of hydatidiform mole in a major maternity hospital. PATIENTS: A total of 75 patients were studied, with 35 cases of complete hydatidiform mole and 40 cases of partial hydatidiform mole. RESULTS: The annual incidence of hydatidiform mole was between 1 in 1,601 deliveries and 1 in 721 deliveries. The racial distribution was higher among the Malay and Indian population. Pre-operative diagnosis was made in 53.3% of the cases. Per vaginal bleeding was the main presenting complaint in 89.3% of cases. All patients were treated with vacuum aspiration. All patients with partial hydatidiform mole had spontaneous remission after vacuum aspiration. Three patients with complete mole required chemotherapy. Methotrexate was used. There was a significant number of patients who did not practise contraception in the initial remission period after vacuum aspiration. CONCLUSION: Education of these patients is necessary. Prognosis of patients with hydatidiform mole is good with proper follow-up. Setting up of a National Trophoblastic Centre is recommended.

Comparison of the grade of CIN in colposcopically directed biopsies with that in outpatient loop electrosurgical excision procedure (LEEP) specimens--a retrospective review.

BACKGROUND: It has been suggested that LEEP should be the standard for the diagnosis of cervical dysplasia, rather than colposcopically directed biopsy as traditionally so, since it is both diagnostic and therapeutic. PATIENTS: Seventy-eight patients who underwent LEEP at the Gynaecological Cancer Centre, KK Hospital from 1 January 1995 to 31 December 1997 for cervical dysplasia diagnosed by colposcopically directed biopsy were retrospectively reviewed. The mean age of the patients was 40.3 years (SD 8.4), with 78.2% of them with CIN I or CIN II. The mean operating time was 11.8 minutes (SD 4.9) and 53.8% (42/78) were given prophylactic antibiotics, with the only complication being moderate postoperative haemorrhage in 3.8% (3/78). The mean follow-up period was 19.1 months (SD 9.3) with the cure rate being 97.4% (76/78). RESULTS: Only half of the patients had corresponding histologies on biopsy and LEEP, with 28.2% (22/78) undergraded and 21.8% (17/78) overgraded. CONCLUSION: Significant discrepancies may be found between the results of colposcopically directed biopsy and loop excision, and LEEP, which is safe and effective may be the choice procedure for the diagnosis of cervical dysplasia.

Outpatient procedures for cervical dysplasia: a 3 year review of laser vaporisation and LEEP.

A 3 year retrospective review (1995 to 1997) of 127 patients with cervical dysplasia who underwent Laser Vaporisation of the cervix and LEEP at the Gynaecological Cancer Centre, KK Women's & Children's Hospital, Singapore, was undertaken. Amongst the patients in the Laser Vaporisation group, the mean age was 37.7 years (SD 8.8), the mean operating time was 14.8 minutes (SD 8.5), 63.6% were given prophylactic antibiotics and the mean follow up period was 15.3 months (SD 12.0), whilst in the LEEP group, mean age was 40.3 years (SD 8.4), mean operating time, 11.8 minutes (SD 4.9), prophylactic antibiotic rate, 53.8% and mean follow up period was 19.1 months (SD 9.3). Mild and moderate haemorrhage post procedure were the only complications encountered, 10.2% (5/49) in the Laser group and 3.8% (3/78) in the LEEP group. 98% (48/49) and 97.4% (76/78) of the Laser and LEEP groups, respectively, were free of disease on follow up. None of the 3 patients with persistent or recurrent disease were diagnosed as having invasive cancer. Overall, there were no significant differences in the patient characteristics, histopathology, operating times, follow up period, the use of prophylactic antibiotics, and complications in the 2 groups. The low complication rate, high disease-free rate and the relatively short operating time of Laser Vaporisation and LEEP in our study suggests that, indeed, both the procedures can be done safely and efficiently in the outpatient setting. However the discrepancy between the histology of colposcopically directed biopsy and that of LEEP specimens suggests that colposcopically directed biopsy may not be as accurate as one might believe, and further studies analysing the concordance between colposcopically directed biopsy and LEEP biopsy histologies are needed.