HPV Medical Research

HPV Medical Research - Article in Spanish

275 adolescents aged 10-19 receiving attention at the infantojuvenile department of pregnancy interruption and of sexually transmitted infections of "Ramon Gonzalez Coro" and "Eusebio Hernandez" Gynecoobstetric Teaching Hospitals, both in Havana City, were studied from August, 1999, to September, 2000, aimed at knowing the behavior of the infection caused by Trichomonas vaginalis in this population group. The results yielded 18.1 % of positivity to parasitosis. It was proved by the calculation of relative risk that the adolescents that had an active or past infection due to Trichomonas vaginalis have more possibilities of getting an infection produced by human Papilomavirus than those without this condition. It was demonstrated that 78 (28.3 %) of the total of patients examined had some type of lesion in the uterine cervix. Some risk factors as non using condon, having multiple sexual partners and the early beginning of sexual relations, which may facilitate the adquisition of this parasitosis in a population so vulnerable as the adolescents, were made known.

nfez Med. 2001 Sep;9(3):147-53.

Sexually transmitted diseases (STD) and their relationship with sexual behaviour and condom use, in a cohort of teenagers referring to a STD centre. A nine-year, prospective study

HPV Medical Research - Article in Italian

In order to assess the relationship between a diagnosis of sexually-transmitted disease (STD), sexual behaviour, condom use, and other social, demographic, and epidemiological variables in a cohort of young adults who referred to a STD centre during a 9-year period, all patients aged 13-20 years were prospectively evaluated, with special attention paid to sexual behaviour, and use of condom or other contraceptive techniques. The 284 assessed young adults represented 6.1% of all patients with a diagnosis of STD: an increasing temporal trend was noticed (from 3. % in 1991, up to 10.4% nel 1999: p<.0001). On the whole, 70.1% of subjects aged 20 years or less never used a condom during the 6 months preceding the diagnosis of STD: only 21.8% of patients reported regular condom use, and 4.9% more subjects referred occasional use, while in the remaining 3.2% of cases other contraceptive methods were employed. Among under age patients (10.6% of study population), the rate of condom use was 3.3% only, while male homosexuals always denied the use of barrier methods. Although a progressive increase in condom use was observed through the study time (from 0% encountered in 1991-1994, to 57.6% of 1999: p<.0001), this phenomenon proved linked only to the massive increase of immigrant sex workers, which occurred since 1997. When excluding from analysis any probable female prostitutes, lack of condom use tested related to the male gender (p<.05), and a low education (p<.04). Over 50% of patients reported 0-1 partners during the last 6 months, even though an increase in sexual promiscuity was observed during the last three years, compared with 1991-1996 (p<.02). Among the 297 different STD episodes (mostly nongonococcal cervicitis-vaginitis and urethritis, and HPV infection), an increasing incidence of nongonococcal STD and syphilis was found, but no correlation was observed between the spectrum of diagnosed STD, sexual behaviour, and condom use. In particular, in 69.9% of the 103 episodes nongonococcal disease occurred despite regular (65 cases), or occasional (7 episodes) condom use. Moreover, no significant relationship was disclosed between STD occurrence, condom use, and other analyzed social, demographic, epidemiological, and clinical variables. According to our survey, an increased risk of STD seems to involve young adults, and to be related to the variation of multiple demographic, epidemiological, and behavioral features. While immigration and prostitution had the major impact during the last three years, sexual promiscuity and infrequent condom use represent persistent; risk factors in this age population. Besides their diagnostic and therapeutic role, STD centres are able to carry out permanent monitoring of STD, as a starting point to plan adequate information campaigns and specific prevention strategies.

Am J Obstet Gynecol. 2005 Apr;192(4):1341-6; discussion 1346-7.

Is a change in the vaginal flora associated with an increased risk of preterm birth?

Carey JC, Klebanoff MA. Phoenix Integrated Residency Program (Maricopa Medical Center), Phoenix, AZ, USA.

OBJECTIVE: The purpose of this study was to determine if a change in the vaginal flora was associated with an increased risk of preterm birth, and to determine if metronidazole therapy before 32 weeks increased the risk of preterm birth. STUDY DESIGN: We compared cultures taken at 23 to 26 weeks of gestation with cultures taken at delivery from women enrolled in the Vaginal Infections and Preterm Birth study to analyze the association of changes in the vaginal flora with preterm birth. RESULTS: Metronidazole therapy before 32 weeks was associated with an increased risk of preterm birth (OR 1.5, 95%CI 1.05-2.1) in an unadjusted model. A change to heavy growth of Escherichia coli or Klebsiella pneumoniae at delivery was found to be associated with preterm birth (OR 2.4, 95%CI 1.6-3.8). After controlling for race, parity, prepregnancy weight <100 pounds, smoking or drinking during pregnancy, Trichomonas vaginalis, bacterial vaginosis, chlamydia, mycoplasmas, group B streptococcus, metronidazole therapy before 32 weeks, vaginal pH >5.0, and an increase in E coli or K pneumoniae , only prepregnancy weight <100 pounds (adjusted odds ratio [AOR] 2.07, 95%CI 1.01-4.21) and increased E coli or K pneumoniae in the vagina at delivery (AOR 2.99, 95%CI 1.37-6.53) were found to be significantly associated with preterm birth. CONCLUSION: An increase in E coli or K pneumoniae in the vagina is an independent risk factor for preterm birth. Changes in the vaginal flora may explain the increased risk of preterm birth seen with vaginal clindamycin or oral metronidazole therapy.

J Adolesc Health. 2005 May;36(5):437-40.

Group B streptococcal vaginitis in postpubertal adolescent girls.

Clark LR, Atendido M. Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

PURPOSE: The purpose of this study was to explore the clinical findings, diagnosis, and treatment of group B streptococcal (GBS) vulvovaginitis in a sample of adolescent girls and young women found to have this condition. METHODS: Descriptive retrospective analysis of charts of 13 adolescent girls and young women found to have GBS vulvovaginitis was performed. RESULTS: Of the girls and young women with GBS vulvovaginitis, almost all were found to have a purulent vaginal discharge (n = 12). Three had frank cervicitis and/or vaginitis on examination. Only 1 was diagnosed accurately with GBS vulvovaginitis at the time of the visit and 4 were treated with appropriate antibiotics at the time of the visit. CONCLUSIONS: GBS vulvovaginitis is a poorly diagnosed disease entity in the adolescent and young adult population. Further study is needed in the epidemiology of GBS vaginitis in postpubertal adolescent girls and women to improve the recognition, pathogenesis, and treatment of GBS vaginitis.

Obstet Gynecol. 2005 Apr;105(4):857-68.

Antibiotics for bacterial vaginosis or Trichomonas vaginalis in pregnancy: a systematic review.

Okun N, Gronau KA, Hannah ME. Department of Obstetrics and Gynaecology, Mount Sinai Hospital, and Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

OBJECTIVE: To determine whether antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis during pregnancy decreases the risk of preterm birth and associated adverse outcomes. DATA SOURCES: Pre-MEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), and the Cochrane Library were searched using the keywords "bacterial vaginosis", "Trichomonas", "Trichomonas vaginalis", "Trichomonas vaginitis", "Trichomonas infections", "pregnancy", "pregnant", "antibiotics", and "antibiotic prophylaxis". METHODS OF STUDY SELECTION: The search produced 1,888 titles, of which 1,256 abstracts were reviewed further. Of these, 1,217 were ineligible. Inclusion criteria were the following: randomized controlled trials in which antibiotics were compared with no antibiotic or placebo, for women in the second or third trimester of pregnancy with symptomatic or asymptomatic bacterial vaginosis or Trichomonas vaginalis, intact membranes, and not in labor. Exclusion criteria were as follows: published in a language other than English, dropout rate of more than 20% of women in either group, and lack of usable outcomes. Of the 39 papers reviewed in detail, 14 studies were included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: One of the authors reviewed titles obtained from the searches, and 2 reviewers independently reviewed the abstracts, excluded those that were ineligible, identified eligible papers, and abstracted the data. For women with bacterial vaginosis, antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed. For women with Trichomonas vaginalis, metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth. CONCLUSION: Contrary to the conclusions of 3 recent systematic reviews, we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women.

Publication Types:
• Review

HPV Medical Research - HPV Risks Links

Cervical Dysplasia (CIN) - An excellent article about cervical dysplasia, with diagrams depicting the different stages, from normal to cancer. From the "Alternatives in Gynecology" Web site.

Treating Cervical Dysplasia - From the Dr. Koop site, a good article on treatments for cervical dysplasia. In this article, dysplasia is referred to as "preinvasive cancer."