ThinPrep Pap-smear and cervical intraepithelial neoplasia in reproductive-aged Thai women.

OBJECTIVE: To estimate the incidence of abnormal cervical cytology by ThinPrep Pap-tests and cervical intraepithelial neoplasia (CIN) in young adult reproductive-aged Thai women. METHOD: A total of 1254 women distributed in all regions of Thailand were monitored from 2002 through 2004. Women were screened for abnormal cervical cytology using the ThinPrep method every 6 months. Interpretation of cervical cytology was based on the Bethesda system, version 2001. Women who had the ThinPrep Pap results as atypical squamous cells of undetermined significance or worse underwent colposcopic examination. The ThinPrep and all cervical tissue samples obtained from diagnostic or therapeutic procedures were analyzed and reviewed by Covance Central Laboratory Service, Inc., Indianapolis, USA. RESULT: The cumulative incidence of abnormal ThinPrep Pap-tests was as follows: 15.3 per 100 woman years (WY) (95% confidence interval [CI] 12.3, 18.9) at 6 months; 12.3 per 100 WY (95% CI 10.3, 14.6) at 12 months; and 11.6 per 100 WY (95% CI 10.0, 13.5) at 18 months. Of 1448.6 woman years of follow up, the incidence of CIN1 was 4.1 per 100 WY (95% CI 3.2, 5.3); CIN2 0.8 per 100 WY (95% CI 0.4, 1.4); and CIN3 0.6 per 100 WY (95% CI 0.3, 1.2). CONCLUSION: The incidence of abnormal ThinPrep Pap-test and CIN in young adult Thai women had been reported. No comparable data is available.

Gestational age determination and prevention of HIV perinatal transmission.

OBJECTIVE: To compare different methods of gestational age (GA) measurement for ensuring effective zidovudine (ZDV) prophylaxis to prevent mother-to-child transmission of HIV. METHODS: For 1398 HIV-infected women enrolled in a perinatal prevention trial, gestation durations were calculated based on GA estimated using ultrasound (US), date of last menstruation period (LMP), first fundal height (FH(1)), and a specific algorithm was developed to provide a "reference" GA. The performance of each GA estimate was evaluated by the percentage of women who would have received > or =8 weeks ZDV, if prophylaxis was initiated at 28 weeks. RESULTS: The performances of the algorithm, US, LMP, and FH(1) were 95.5%, 94.8%, 88.4%, and 83.7%, respectively. US and FH(1) were significantly better when estimated before and after 24 weeks, respectively. CONCLUSION: In situations where no US is available and LMP is not or imprecisely known, FH(1) can be used after 24 weeks to schedule ZDV initiation date.

A comparison of first-void urine, self-administered low vaginal swab, self-inserted tampon, and endocervical swab using PCR tests for the detection of infection with Chlamydia trachomatis.

BACKGROUND: Polymerase chain reaction (PCR) tests, AMPLICOR, Roche Diagnostics, were shown to be an acceptable and sensitive method of detecting Chlamydia trachomatis infection. The PCR test's ability to evaluate different specimen types is worth determining, as well as the acceptability to Thai women of the self-collection of samples. METHODS: Of the 1011 subjects interviewed, 953/1011 subjects (94.3%) agreed to self-test, 523 were commercial sex workers (CSWs) and 430 were outpatient women (OPW). More than half [570/953 (59.8%)] participated in the four-specimen collection, to be tested by PCR for C. trachomatis. Specimens were collected via first-void urine (FVU), self-administered low vaginal swab (LVS), self-inserted tampon, and endocervical swab (ES). The majority, 906/953 subjects (95.1%), had only three methods of specimen collection, LVS being excluded. RESULTS: The prevalence of positive C. trachomatis detection among the CSWs/OPW was 17.6/7.2%, 15.6/5.4%, 12.8/4.2%, and 11.6/5.7% using tampons, LVS, FUV, and ES collection methods respectively. Tampons were used to compare results from other specimen types in both groups. Significantly more OPWs were willing to use a tampon for repeat specimen collection (85.1%) than were the CSWs (62.3%). Willingness to use a LVS again was not significant, 75.2% in outpatient women and 74% in CSWs. CONCLUSIONS: Tampon and LVS, self-collection methods are acceptable to women in Thailand and are a good alternative method for detection of C. trachomatis.