HPV Medical Research - Research

Watcharotone W, Sirimai K, Kiriwat O, Nukoolkarn P, Watcharaprapapong O, Pibulmanee S, Chandanabodhi S, Leckyim NA, Chiravacharadej G. Department of Obstetrics & Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

OBJECTIVES: To investigate the prevalence of bacterial vaginosis (BV) among Thai women attending a family planning clinic and to evaluate the association of BV with potential risk factors. MATERIAL AND METHOD: A cross sectional prevalence study was conducted among 800 women attending the family planning clinic, Siriraj Hospital, between August and December 2003. BV was diagnosed according to Amsel's criteria. Prevalence and risk factor models were compiled and statistically analyzed RESULTS: Among the low risk population acquiring sexually transmitted diseases, the prevalence of BV was 14.6% (117 of 800). Asymptomatic disease was recognized in up to 47.9% (56 of 117). BV was significantly more prevalent among those who used douching inside the vagina [OR = 3.98 (1.85-8.33), p < 0.01] and high a prevalence among IUD users [OR = 1.84 (1.22-2.79), p < 0.01]. Although not statistically significant, BV tended to be more prevalent among women with a lower age at first intercourse, higher numbers of lifetime partners, higher frequency of sexual intercourse and current smokers. CONCLUSION: BV is a relatively high prevalent condition. The two potential risk factors, douching inside the vagina and IUD use, can be demonstrated, adding to be more concerned about the inappropriate practice of douching and more consideration in IUD users. The other potential risk factors, the impact to adverse reproductive outcomes and the prevention of BV need further studies, particularly in various Thai populations.

Sex Transm Infect. 2005 Apr;81(2):128-32.

Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics.

Brabin L, Fairbrother E, Mandal D, Roberts SA, Higgins SP, Chandiok S, Wood P, Barnard G, Kitchener HC. Academic Unit of Obstetrics and Gynaecology and Reproductive Health Care, Research Floor, St Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK.

OBJECTIVE: To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections. METHODS: Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV. RESULTS: Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6-0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05). CONCLUSIONS: Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age.

Publication Types:
• Multicenter Study

Arch Pediatr. 2005 May;12(5):514-9.

Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis.

HPV Medical Research - Article in French

Bacterial infections remain a major cause of morbidity and mortality in newborn infants. Objective. - To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis. Method. -Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection. Results. - Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked. Conclusion. - Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

J Low Genit Tract Dis. 2004 Jan;8(1):21-4.

Fungal species changes in the female genital tract.

Martens MG, Hoffman P, El-Zaatari M. Department of Obstetrics and Gynaecology, The University of Oklahoma, College of Medicine, Tulsa, OK 74104-4070, USA.

BACKGROUND: Candidal vaginitis has traditionally been associated with Candida albicans. OBJECTIVE: Two changes occurred over the past decade: first, the dispensing of over-the-counter (OTC) topical antifungals, and second, the approval of oral fluconazole 5 years later. Both have excellent activity versus C. albicans, but less activity versus nonalbicans species. MATERIALS AND METHODS: To determine if there has been a shift in species causing vaginitis, swabs were obtained from 156 symptomatic patients during the period after the release of OTC antifungals, but before fluconazole's approval. Specimens were inoculated onto nonselective mycotic agar, with growth transferred to selective media. RESULTS: One hundred eleven patients had a diagnosis of vulvovaginal candidiasis confirmed with yeast isolated. Ninety (81.1%) were identified as C. albicans. Of the 21 nonalbicans species, 15 (71.4%) were Candida glabrata. CONCLUSIONS: Therefore, it appears that after decades of the predominance of Candida albicans, a change may be occurring resulting in an increase in nonalbicans species.

Am J Obstet Gynecol. 2003 Mar;188(3):677-84.

Clinical findings among young women with genital human papillomavirus infection.

Mao C, Hughes JP, Kiviat N, Kuypers J, Lee SK, Adam DE, Koutsky LA. Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.

OBJECTIVE: The purpose of this study was to identify clinical signs and symptoms associated with detection of human papillomavirus (HPV) DNA in the female genital tract. STUDY DESIGN: A total of 516 university students (18 to 24 years old) enrolled in a cohort study that included the collection of genital specimens for HPV DNA testing every 4 months for up to 4 years. Reported symptoms and objective clinical findings of women with and without HPV DNA were compared by multivariate analysis. RESULTS: Acute and persisting HPV infections were not associated with discharge, itching, burning, soreness, or fissures. Clinical evidence of genital warts was statistically associated only with HPV types 6 and 11. Detection of any HPV DNA was associated with bacterial vaginosis (BV). Furthermore, a time lag analysis suggests that HPV infection usually precedes detection of BV. CONCLUSION: Most women who acquire genital HPV infection are asymptomatic; some, however, are at increased risk for BV.

Obstet Gynecol. 2005 May;105(5):1268-71.

The use of acellular dermal graft for vulvovaginal reconstruction in a patient with lichen planus.

Stany MP, Winter WE 3rd, Elkas JC, Rose GS. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC.

BACKGROUND: Vulvovaginal lichen planus is an inflammatory dermatosis that can progress to an erosive form with scarring of the vulva, resorption of the labia minora, vaginal synechiae, and vaginal obliteration secondary to desquamative vaginitis. Traditionally, conservative medical therapy has consisted of topical corticosteroids and immunosuppressants. CASE: A 61-year-old woman with a history of refractory erosive vulvovaginal lichen planus presented with complete obliteration of the vaginal vault. The patient failed both medical and conservative surgical management and desired definitive management. After performing a skinning vulvectomy and simple vaginectomy, acellular dermal graft was used for grafting the vulva and creating a neovagina. CONCLUSION: Acellular dermal graft is a suitable graft material for vulvar and vaginal reconstruction in select patients, and it avoids the postoperative pain associated with graft harvest sites.

Tidsskr Nor Laegeforen. 2005 Apr 21;125(8):1026-7.

Experiences with a special vulvar clinic in Oslo

HPV Medical Research - Article in Norwegian

BACKGROUND:Women with longstanding vulvar problems have difficulties finding medical care. In 2000, a first Norwegian vulvar clinic was opened at the Olafia centre for venereology in Oslo. The initiative was continued in 2003 by a multi-professional team in the dept. of gynaecology and obstetrics at Rikshospitalet University Hospital. METHODS: Medical records from the two Vulva clinics have been reviewed in retrospect. RESULTS:During the period 2000 to 2003, a total of 217 patients had 470 visits to the Olafia clinic, mean age 31.4 years. Vulvodynia was diagnosed in 52% of all patients, 30% had a genital infection, 22% a genital dermatitis or dermatosis and 21% a primary sexual problem. At the multi-professional Rikshospitalet vulva clinic, run by specialists in gynaecology and dermato-venereology, 141 patients had 206 visits in 2003, mean age 42.5 years. Vulvodynia was diagnosed in 38%, 26% had a genital skin condition, 11% primary sexual problems, 10% a genital infection, and 10% a gynaecological problem. A few patients were healthy controls. The difference in diagnostic groups is related to the age of the patients. CONCLUSION: The options for vulvar patients have improved in Oslo. Multi-professional cooperation has been achieved in our department, which serves as a national referral centre.

HPV Medical Research - HPV Research Links

Abnormal Pap Info from Johns Hopkins - Up to date info from Johns Hopkins. Includes info about ThinPrep Pap tests and FAQs about Paps, HPV, and dysplasia.

Fact Sheet on HPV and Dysplasia - From the Rutgers Health Clinic, this is the sheet they give to women who have a positive Pap test. Has good info about both HPV and cervical dysplasia.