Prevalence of high-risk HPV and atypia in liquid-based cytology of cervical and intra-anal specimens from kidney-transplanted women.

BACKGROUND: There is a high frequency of human papillomavirus (HPV)-induced lesions in cervix and anus of immunosuppressed patients. However, few studies have evaluated these lesions in kidney-transplanted women. METHODS: This cross-sectional study examined 31 kidney-transplanted women receiving immunosuppressive therapy at the General Hospital of Fortaleza in Brazil. Cervical and anal samples were collected and preserved in order to perform liquid-based cytology and a real-time polymerase chain reaction assay detecting high-risk HPV. RESULTS: The patients' ages ranged from 31 to 70 years (mean: 42.6 ± 10.4). The age of sexual debut varied from 14 to 30 years (mean: 19.7 ± 3.8). Cervical cytology was diagnosed as atypical in 25.8% of cases (atypical squamous cells of undetermined significance [ASC-US] in 2 [6.2%], atypical squamous cells, but unable to exclude a high-grade squamous intraepithelial lesion in 1 [3.1%], low-grade squamous intraepithelial lesion [LSIL] in 4 [12.4%], and squamous cell carcinoma in 1 [3.1%]). Anal cytology was atypical in 35.4% of cases (ASC-US in 1 [3.2%] and LSIL in 7 [21.7%]). The presence of cervical HPV was confirmed in 22.5% of patients, and anal HPV was found in 48.8% of the cases. The relative risk of atypical anal cytology in cases of atypical cervical cytology was 4.37 (1.35-14.20). High-risk cervical HPV did not significantly increase the risk of having atypical anal cytology. However, for HPV in the anus, this was associated with a relative risk of 10.18 (1.45-71.54). CONCLUSION: High-risk HPV and atypical cytology are very common in the cervix and anus of kidney-transplanted women. Furthermore, the presence of HPV in an anal sample correlates with an increased risk of atypical anal cytology. HPV tests could be useful tools for identifying patients who require anal cytology.

The effect of "breathable" panty liners on the female lower genital tract.

OBJECTIVE: To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation. METHODS: A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears. RESULTS: After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period. CONCLUSION: After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.

Human papillomavirus in the oral mucosa of women with genital human papillomavirus lesions.

OBJECTIVES: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases worldwide. We determined the frequency of HPV in the oral cavity of women with and without genital HPV lesions. MATERIAL AND METHODS: All patients were seen at the Department of Gynecology, Women's Health Center and the State University of Campinas, Sao Paulo, Brazil and submitted to a general physical and gynecological examination plus an evaluation of the oral cavity. Detailed histories investigated their sexual practices. HPV in the oral cavity was determined by polymerase chain reaction using consensus primers in 70 women presenting with histopathology-confirmed clinical HPV lesions in the genital region and 70 women negative by gynecological, colposcopic and cytological examination for clinical or subclinical HPV lesions. RESULTS: Oral HPV was detected in 29 (20.7%) of the subjects. Among the positive women, 26 (89.7%) were also positive for genital HPV as opposed to only 3 (2.7%) who were genital HPV-negative (p < 0.0001). The overall prevalence of HPV in the oral cavity of patients with and without genital HPV was 37.1 and 4.3%, respectively, (p < 0.0001). The presence of oral HPV was unrelated to the practice of fellatio (22% versus 19%). CONCLUSION: Patients with HPV genital infection have a greater frequency of HPV in their oral mucosa.

A resposta imune-celular da mucosa vaginal às vulvovaginites / The cellular immune response from vaginal mucosa in the vulvovaginitis

Nos últimos anos, após a epidemia de aids (síndrome da imunodeficiência adquirida), o estudo dos mecanismos de defesa vaginal têm se revestido de especial importância para a compreensão da fisiopatogênese das infecções genitais femininas. A resposta imune celular é talvez um dos principais mecanismos de proteção da mucosa vaginal mediante desenvolvimento de resposta imune local. Na placa basal do epitélio vaginal existem células de defesa (macrófagos, linfócitos, plasmócitos, células de Langerhans, eosinófilos e mastócitos) prontas para atuar. Os linfócitos são as principais células de defesa que migram pelos canais intercelulares, precedidos pelas células de Langerhans e pelos macrófagos para erradicar o microorganismo invasor. As células de defesa controlam o crescimento bacteriano e fúngico, mediante ativação de mecanismos de fagocitose. Havendo falha da imunidade celular, com a exposição da mucosa vaginal aos antígenos, pode ocorrer o desenvolvimento de infecções vaginais. Os autores revisam o tema enfatizando a importância da resposta imune adequada na manutenção do equilíbrio vaginal.

After the aids (acquired immunodeficiency syndrome) epidemic, the mechanisms of vaginal defense have been coated with special importance in the study of the genital feminine infections. The cellular immune response is perhaps one of the main protection mechanisms of the vaginal mucosa by means development of local immune response. There are many different defense cells (macrophages, lymphocytes, Langerhans cells, eosinophils and mastocytes) in the vaginal epithelium ready to be elicited. The lymphocytes are the main defense cells; they come from the basal plaque crossing the intercellular canals, preceded only by Langerhans cells and macrophages, in order to eradicate the invasive microorganisms. The defense cells control the bacterial and fungi growth, by means of phagocytosis activation. If the cellular immune response fails, vaginal infections can occur. The authors revise the theme emphasizing the importance of the adequate immune response in the vaginal equilibrium.

Fatores associados à infecçäo clínica e subclínica do trato genital feminino pelo papilomavírus humano / Associated factors in clinical and subclinical female papilomavirus infection

Os principais fatores que induzem as manifestaçöes clínicas e subclínicas da infecçäo pelo HPV ainda näo estäo definidos. Este estudo objetiva identificar os possíveis fatores sociodemográficos que poderiam estar associados às manifestaçöes clínicas e subclínicas da infecçäo pelo HPV