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Journal of Lower Genital Tract Disease
Journal Prestige (SJR): 0.602  Citation Impact (citeScore): 1 Number of Followers: 0  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1089-2591 - ISSN (Online) 1526-0976 Published by LWW Wolters Kluwer  [330 journals]
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- Evaluation of a Self-collected Device for Human Papillomavirus Screening
to Increase Cervical Cancer Screening-
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Authors: Crane; LaShonda; Fitzpatrick, Megan B.; Sutton, Elizabeth; Conageski, Christine; Favreau, Jessica; Conway, Kristin; Young, Steve; Young, Jesse; Jennings, Ashley
Abstract:
Objective The authors compared the performance of a novel self-collect device with clinician-collected samples for detection of high-risk human papillomavirus (hrHPV).Materials and Methods Eighty-two (82) participants were recruited from 5 clinical sites in the United States. Each participant performed self-collect sampling using the self-collect device followed by a standard of care clinician-collected sample. Both samples were evaluated for hrHPV using polymerase chain reaction (PCR)-based HPV assays. A subset of HPV-positive samples underwent dual staining (p16/Ki-67), and concordance was evaluated. Biopsy results collected per standard of care were recorded.Results On the Roche cobas assay, the preliminary positive percent agreement (PPA) and negative percent agreement (NPA) was 91%. Agreement for hrHPV using the BD OnClarity in PreservCyt was 100% PPA (n = 10), and 100% PPA, 93% NPA in SurePath. Dual-stain concordance was 93% (n = 16) overall, and 100% for HPV other genotypes. Seventy-one participants (n = 71; 89%) indicated they would feel confident using the self-collect device for screening if they knew they could get equal results, and 86% (n = 69) indicated that they would be more likely to get screened with this option.Conclusions The self-collect device shows high (>92%) positive and negative agreement for detection of HPV when compared with reference clinician-collected samples, with very high acceptability and preference. Furthermore, the self-samples collected with the self-collect device showed highly concordant results by dual stain, which is a novel and emerging application for a self-collected sampling device, thus enabling potential triage from 1 sample.
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- How Does Transitioning to Primary Human Papillomavirus Screening Impact
Colposcopy Services' Lessons From an Australian National Program-
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Authors: Jennett; Chloe J.; Smith, Megan A.; Machalek, Dorothy A.; Sultana, Farhana; Prang, Khic-Houy; McDermott, Tracey; Nightingale, Claire E.; Zammit, Claire M.; Pagotto, Amy; Rankin, Nicole M.; Wrede, C. David H.; Brotherton, Julia M. L.
Abstract:
Objective In 2017, Australian's National Cervical Screening Program changed from 2-yearly cytology to 5-yearly primary human papillomavirus (HPV) testing. The Stakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) aimed to capture stakeholder perspectives during implementation of the renewed National Cervical Screening Program.Materials and Methods Qualitative semistructured interviews were conducted with key National Cervical Screening Program stakeholders 11–20 months following the change, either face-to-face, online, or via phone. Data related to colposcopy services were thematically analyzed using Proctor's conceptual framework for implementation outcomes.Results The authors identified 4 overarching themes: non-adherence to guidelines, lack of preparedness, unintended consequences, and mitigation strategies. While an initial increase in colposcopy referral was expected following transition, many stakeholders found increased referrals to be inequitably spread across services and exacerbated by confusion about, or overuse of testing for, symptoms.Conclusions The study provides the first assessment of stakeholder perceptions and experiences relating to colposcopy services during a transition from cytology to HPV screening. Significant preparation is required to ensure equitable and timely access to colposcopy when transitioning cervical screening programs, including wide stakeholder communication to build confidence; clear guidelines, especially around symptoms; and adequate resourcing for colposcopy services to meet projected referral rates.
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- Endocervical Brush Cytology After Cervical Conization as a Predictor of
Treatment Failure: A Prospective Cohort Study-
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Authors: Carreras-Dieguez; Núria; Torras, Ines; Martí, Cristina; Matas, Isabel; Glickman, Ariel; Fusté, Pere; Mula, Cristina; Alos, Silvia; Hoya, Sandra; Rakislova, Natalia; Saco, Adela; Marimon, Lorena; Ordi, Jaume; Torné, Aureli; del Pino, Marta
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Objective Endocervical curettage (ECC) is the gold standard for predicting the persistence of high-grade squamous intraepithelial lesions (HSIL) after cervical conization. However, ECC has a high rate of unsatisfactory samples and may be uncomfortable for women. Endocervical sampling with brush (ECB) has been proposed as an alternative to ECC, which, in addition to the cytological evaluation, allows performing HPV testing using the same sample. The authors compared ECC and ECB performed immediately after conization to identify women with persistent HSIL.Materials and Methods This is a prospective single-center study, including 518 patients who underwent conization over a 10-year period (2012–2021). Immediately after treatment conization, the authors performed ECB sampling followed by ECC to all patients. They evaluated the accuracy of the 2 techniques for diagnosing persistent HSIL during follow-up.Results Persistent HSIL was identified in 8.9% of women. Eighteen percent of the ECC samples and only 7% of ECB cytology were unsatisfactory (p < .001). The accuracy of detecting persistent HSIL was similar for ECB and ECC (89.0%, 95% CI = 85.9–91.5 vs 90.8%, 95% CI = 87.7–93.2; p = .797). Adding HPV testing to ECB cytological evaluation increased the accuracy to 91.5% (95% CI = 88.8–93.6).Conclusions ECB can be reliably used to identify women with persistent HSIL after conization, as its accuracy is similar to ECC, with a lower rate of unsatisfactory results. The technique allows adding HPV testing to cytological evaluation, improving the accuracy of the test.
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- Risk of High-Grade Cervical Dysplasia in Older Patients With a Positive
Human Papillomavirus Cervical Screening Test-
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Authors: Preston; Marta; Richards, Anthony
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Introduction The Australian National Cervical Screening Program has mandated management algorithms that are uniform across all age groups, but evidence is emerging that perhaps the risk of high-grade squamous intraepithelial lesion (HSIL) may decrease in the postmenopausal period.Objective The aim of the study is to identify whether patients ≥50 years of age referred to a tertiary colposcopy service have a different risk of HSIL or greater (+).Materials and Methods This is a retrospective cohort study of 3239 referrals to a hospital colposcopy clinic with a positive human papillomavirus (HPV) cervical screening test between December 2017 and May 2023. Patients were included if they were aged 25–74 years, had a cervix, and completed an outpatient colposcopic assessment. Medical records were analyzed to determine the incidence of HSIL+ for each age group and compared them using χ2 and multivariable regression.Results The overall incidence of invasive carcinoma was 0.93% and HSIL/adenocarcinoma-in-situ was 20.38%. Patients ≥50 years of age were less likely to have HSIL or greater diagnosed than those
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- The Influence of Genital Lichen Sclerosus on Sexual Health and Well-being:
A Tripartite Comparative Analysis-
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Authors: Bettolini; Luca; Maione, Vincenzo; Arisi, Mariachiara; Rovaris, Sara; Romanò, Carola; Tomasi, Cesare; Calzavara-Pinton, Piergiacomo; Zerbinati, Nicola; Bighetti, Stefano
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Objectives Genital lichen sclerosus (LS) is a chronic mucocutaneous disorder causing considerable discomfort. Despite this, comprehensive comparison of LS impacts on quality of life (QoL), particularly on men's health or relative to other dermatological conditions like pemphigus, are sparse. This research aims to discern the effects of LS on sexual functionality and overall QoL, benchmarking against pemphigus patients and healthy controls. The study's intent is to broaden the understanding of sexual dysfunction, satisfaction, and psychological distress attributable to LS.Materials and Methods From March 2021 to September 2023, this observational multicenter study at the affiliated university hospitals involved 176 individuals, 120 females and 56 males, with LS, pemphigus, or as controls. Questionnaires employed were the Female Sexual Function Index or the International Index of Erectile Function depending upon subject's gender, the General Health Questionnaire-12, the Clinical Lichen Sclerosus Score, and Pemphigus Disease Area Index. Differences in QoL were analyzed using either the Fisher exact test or the Mann-Whitney U test, and the correlation between Clinical Lichen Sclerosus Score sexual QoL using Spearman's coefficient.Results LS patients faced more sexual health challenges than pemphigus patients and healthy people. Women with LS had difficulties with lubrication and pain, men had less satisfaction during intercourse, and all had increased psychological distress, although less than those with pemphigus. A strong link between LS severity and worse sexual QoL, especially for women, was identified.Conclusions LS significantly affects sexual function and psychological well-being, both for men and women, reaffirming the need for comprehensive management.
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- What Are Consumers Looking for With Boric Acid'
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Authors: Stockdale; Colleen K.; Bartolo-Costello, Abigail A.; Vieira-Baptista, Pedro
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Two separate online surveys were presented to women who were confirmed to have purchased a boric acid vaginal suppository product in the previous year for themselves March 2020 (study 1) and July 2023 (study 2) to understand consumer expectations concerning the use of vaginal boric acid. Study 1 found that repeat purchasers are more likely to buy boric acid products to prevent symptoms, especially bacterial vaginosis. Study 2 confirmed boric acid was more likely to be purchased for prevention than treatment, especially odor/bacterial vaginosis, with 83% reporting they were satisfied and 40% reporting they were extremely satisfied. While boric acid has been used for decades as an alternative treatment for vaginitis, it has recently become commercially available (for vaginal application) with high levels of satisfaction.
PubDate: Wed, 01 Jan 2025 00:00:00 GMT-
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- Cervical Cancer 2010–2019: An Upper Midwest Catchment of 40,000
Square Miles-
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Authors: Ulmer; Keely K.; Wilson, Peter L.; Petereit, Mark A.; Sargent, Michele; Cina, Kristin; Kroboth, Lindsey; Petereit, Daniel G.; Harper, Diane M.
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Objectives American Indian (AI) women have a higher incidence and mortality from cervical cancer than non-Hispanic White (NHW) women in the US. This article’s purpose is to detail the clinical events in the cervical cancer prevention continuum among the AI and White women with cervical cancer on the US frontier.Materials and Methods A cancer center with a nearly 40,000 square-mile catchment area maintained a detailed cancer registry connected to the clinic records of all cervical cancer patients between 2010–2019. This catchment area provided records of both an AI and a White population. Descriptive and inferential statistics and modeling predictions detailed the prevention continuum.Results Among the 126 with cervical cancer, 20% were AI, and 78% were White. Sixty percent did not participate in cervical cancer screening within the 5 years before their diagnosis, and on average, 9.2 years passed since the last cervical cancer screening. 91% presented with symptoms, and most women presented with 2 or more symptoms. Thirteen percent underwent a colposcopic diagnostic step, significantly delaying the time to diagnosis compared to other diagnostic steps. Sixty-nine percent of the histopathologic diagnoses were squamous cell carcinoma, and 27% were adenocarcinoma. Forty-nine percent presented at stage I regardless of histopathology. Chemotherapy and radiation therapy were most commonly combined. Sixty-three percent of the population survived, and 42% survived at least 3 years from diagnosis. Younger age and earlier stages at diagnosis were the significant adjusted predictors of survival.Conclusions The authors’ detailed cervical cancer prevention continuum events provide new data questioning the use of colposcopy for women symptomatic at presentation.
PubDate: Tue, 03 Dec 2024 00:00:00 GMT-
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- Bridging Gaps in Cervical Cancer Care: A Web-Based Intervention to Improve
Knowledge and Follow-up-
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Authors: Kulkarni; Amita; Ahsan, Muhammad Danyal; LaRosa, Taylor; Webster, Emily; Ma, Xiaoyue; Cantillo, Evelyn; Frey, Melissa K.; Holcomb, Kevin M.; Safford, Monika M.; Chapman-Davis, Eloise
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Objectives Contributors to disparities and worse cervical cancer outcomes include limited education and loss to follow-up after an abnormal Pap smear. Effective interventions are necessary to engage diverse populations. The authors piloted an intervention to assess acceptability, knowledge uptake, and follow-up.Materials and Methods This prospective pilot study recruited patients scheduled for colposcopy visits at a government-insured clinic and faculty clinics within an academic medical center to use the Patient Activated Learning System (PALS). The PALS intervention included 5 short educational videos about human papillomavirus and colposcopy. Participants completed a baseline knowledge questionnaire, viewed PALS videos followed by post-intervention knowledge and acceptability surveys. Perceptions of PALS, anxiety, and impact on follow-up were evaluated.Results Of 63 (70%) participants completing the intervention, 24 (38%) were from the government-insured clinic and 39 (62%) from faculty clinics. Median age was 36 (range 30–48), 38 (63%) were racial and ethnic minorities, and 21 (33%) were non-Hispanic White. The intervention improved knowledge scores for the entire cohort (60%–75%, p < .01), even when stratified by race/ethnicity (p < .01 for all), income (p < .01), education (p < .01), practice (p < .01), and insurance type (p < .001). Participants found PALS convenient to use (4.6/5), enjoyable (4.2/5), and acceptable (4.6/5); 75% said the videos alleviated colposcopy-related anxiety, and 84% indicated PALS made them more likely to follow up. The guideline concordant follow-up rate among study completers was 73%.Conclusion In this pilot study, PALS was effective and acceptable among a diverse cohort. These free, widely viewed videos can successfully engage diverse populations to improve colposcopy knowledge and follow-up.
PubDate: Tue, 03 Dec 2024 00:00:00 GMT-
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- Trends in Cervical and Anal Cancer Incidence and Mortality in the United
States-
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Authors: McKinnish; Tyler R.; Kuroki, Lindsay M.; Schwarz, Julie K.; Mazul, Angela L.
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Objectives This article describe trends in the incidence and mortality of cervical (CC) and anal (AC) cancers by race and neighborhood socioeconomic status.Methods The Surveillance, Epidemiology, and End Results (SEER) database was used to construct a cohort of CC and AC cases from 2006 to 2018. Incidence rates and survival were calculated by race and neighborhood socioeconomic status (nSES). Annual percent change (APC) in incidence was calculated using linear regression, and 5-year overall survival (OS) by the Kaplan-Meier method.Results Of the cases, 33,487 CC and 16,018 AC cases were identified. Women of low nSES were nearly 4 times more likely to be diagnosed with cervical cancer than those of high nSES. Cervical cancer incidence declined marginally in all groups except for low nSES women who are White (APC 0.0). Women who are Black had lower 5-year OS than their nSES counterparts of other races (most notably for Black women of low nSES 53% vs White 63%). Similarly, the low nSES AC cohort contained nearly 3 times the number of diagnoses as the high nSES cohort. AC incidence increased most in women who are White (APC 1.8 and 2.2 for low and high nSES) and men who are Black and low nSES (APC 3.3). Five-year OS was lowest for men who are Asian American and Pacific Islander (40% and 50% for low and high nSES, respectively).Conclusions These data suggest a strong correlation between nSES, race, and their interaction on the incidence and survival trends of HPV-related disease and highlight inconsistent effects between cervical and anal cancers.
PubDate: Mon, 02 Dec 2024 00:00:00 GMT-
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- Human Papillomavirus Genotype Attribution and Integration in High-Grade
Vaginal Intraepithelial Neoplasia-
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Authors: Shen; Yuanming; Tang, Sangsang; Zhou, Yumei; Zhang, Qiuxue; Chen, Tingting; Li, Jingnan; Wang, Yu; Wan, Xiaoyun; Lu, Weiguo; Xu, Junfen
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Objective The aim of the study was to investigate the distribution and association between human papillomavirus (HPV) genotypes and integration as well as their correlation with cervical lesions.Methods Two hundred seven patients diagnosed with high-grade vaginal intraepithelial neoplasia (HG-VaIN) were recruited from the Women's Hospital School of Medicine Zhejiang University between 2015 and 2021 and assayed for HPV genotyping. HPV integration sequencing analysis was conducted using tissues from 53 patients with HG-VaIN and 4 patients with invasive vaginal carcinoma (IVC), along with paired cervical lesion specimens.Results A total of 207 patients with HG-VaIN were categorized as having cervical lesions unrelated to HG-VaIN (group A, 71 patients, 34.30%) or cervical lesion-related HG-VaIN (group B, 136 patients, 65.70%). With an average follow-up of 42.19 months, 12 of 153 patients progressed to IVC and were all from group B. HPV16 infection and the presence of cervical lesions were the 2 main factors associated with disease progression, with cervical lesion coexistence being an independent factor. Compared with group A (5/20, 25%), group B (17/33, 51.52%) showed a higher rate of HPV integration, as demonstrated using HPV integration sequencing analysis, with HPV16 being the most integrated genotype (72.73%). The integration analysis of 4 patients with IVC paired with cervical lesion specimens showed that 3 of the 4 pairs exhibited the same HPV infection and integration sites, indicating a high degree of homology in HPV integration between cervical lesions and HG-VaIN-induced IVC.Conclusions Patients with HG-VaIN associated with cervical lesions exhibited a higher risk of malignant transformation, necessitating more proactive treatment approaches.
PubDate: Mon, 02 Dec 2024 00:00:00 GMT-
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- Effect of Corticosteroid Phobia on Treatment Adherence and Outcome in
Women With Lichen Sclerosus: A Prospective Study-
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Authors: Borghi; Alessandro; Flacco, Maria Elena; Pacetti, Lucrezia; Schettini, Natale; Toni, Giulia; Corazza, Monica
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Objective The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes.Materials and Methods This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at the authors’ Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries.Results Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6–36.1), with a corresponding median value of 7.0 (interquartile range = 2.0–13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP.Conclusions Among the authors’ VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.
PubDate: Mon, 02 Dec 2024 00:00:00 GMT-
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- Characterizing the Frequency and Severity of Clinical Signs and
Architectural Changes in Vulvar Lichen Sclerosus-
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Authors: Ngo; Madeline; Chang, Hannah R.; Mauskar, Melissa M.
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Untreated vulvar lichen sclerosus (VLS) can have a significant negative impact on quality of life, increase the risk of neoplastic transformation, and lead to irreversible architectural changes. Early and appropriate management using ultrapotent topical steroids is crucial to alleviate symptoms and prevent long-term complications. This study aimed to characterize clinical signs and architectural changes of 364 VLS patients at a tertiary center. The majority of the patients had sought care from ≥1 provider previously, were referred by a physician, had undergone prior vulvar biopsies, and had previously tried topical steroids. The authors observed predominantly mild clinical signs alongside more frequent severe architectural changes. These findings highlight the increased need for nuanced clinical evaluation, sufficient lifelong maintenance therapy to prevent architectural changes, and improved clinical scoring systems to differentiate between active VLS disease and residual damage.
PubDate: Mon, 02 Dec 2024 00:00:00 GMT-
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- Predictors of Resolution and Recurrence of Anal High-Grade Squamous
Intraepithelial Lesions in People With HIV-
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Authors: Zhang; Joy C.; Geba, Maria C.; Newberry, Yvonne; Quass-Ferdinand, Laura; Thomas, Tania A.; Hoang, Sook
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Objective High-resolution anoscopy (HRA) with ablation of high-grade squamous intraepithelial lesions (HSIL) can prevent the development of anal cancer in people with HIV (PWH). The authors sought to characterize factors associated with successful HSIL resolution or local or metachronous recurrence.Methods The authors conducted a retrospective study of 62 PWH who underwent HRAs from December 1, 2017, to July 1, 2022. Participants were ≥30 years old with ≥2 HRAs and ≥1 HSIL lesions. Poisson and logistic regressions were used to assess factors associated with HSIL resolution and local or metachronous recurrence of HSIL.Results Of 62 PWH, 85.5% had resolution of at least 1 HSIL. Undergoing ≥5 HRAs with thermoablation was associated with HSIL resolution (adjusted rate ratio [aRR] = 2.82) (confidence interval [CI] = 1.55–5.15), p < .001). Tobacco use was negatively associated with resolution (aRR = 0.62 (CI = 0.43–0.90), p = .01). Of this cohort, 58.1% had HSIL recurrence. Having more HRAs (adjusted odds ratio [aOR] = 2.77 (CI = 1.27–6.06), p = .01) and female sex (aOR = 9.66 (CI = 1.14–81.85), p = .04) were associated with recurrence. Non-White race was negatively associated with recurrence (aOR = 0.12 (CI = 0.02–0.68), p = .04). This study was primarily limited by its retrospective nature and small sample size.Conclusion This study supports the utility of HRA/ablation for HSIL treatment with>85% of participants experiencing resolution of at least 1 HSIL. The authors found that having more HRAs was associated with a higher likelihood of resolution. However, the high rate of recurrence and progression to HSIL highlights the need for continued surveillance after treatment.
PubDate: Tue, 26 Nov 2024 00:00:00 GMT-
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- TikTok as a Source of Education and Misinformation in Lichen Sclerosus
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Authors: Foster; Jennifer; Sarlashkar, Priya; Abraham, Olivia; Negris, Olivia; Lanthier, Jaclyn; Krapf, Jill; Mauskar, Melissa M.
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Objectives The purpose of this study is to evaluate the content, delivery, and quality of medical information for vulvar lichen sclerosus on the social media platform TikTok.Materials and Methods This is a descriptive, cross-sectional study. Using the third-party data scraping tool Apify, TikTok videos tagged with #lichensclerosus or “lichen sclerosus” were identified and sorted by view count. A sample of 100 videos was reviewed by 2 independent reviewers, excluding those not discussing lichen sclerosus. Videos were assessed using a coding document, the Patient Educational Materials Assessment Tool, and the DISCERN instrument. Interrater reliability was measured, and statistical analyses included Fleiss' kappa, intraclass correlation coefficient, t tests, and Wilcoxon rank sum test with Holm-Bonferroni correction.Results Content creators included patients (46%), health care professionals (30%), and others. Topics focused on clinical disease (52%) and treatment (48%). Evidence-based medicine was discussed in 71.7% of treatment-related videos, while 51.7% included nonevidence-based approaches, with a neutral or positive sentiment. Videos discussing topical steroids often had negative sentiments. Quality assessment revealed 61% of videos were understandable, 27% actionable, and 46% contained misinformation. Videos by health care professionals had less misinformation and higher quality scores compared to patient-generated content. Commercially biased videos were more understandable but contained more misinformation.Conclusions TikTok serves as a significant platform for sharing information on lichen sclerosus, but nearly half of the content contains misinformation. Health care professionals need to engage in social media to provide accurate information and counteract misinformation. Enhanced collaboration with patient advocates and careful resource sharing can improve the quality and reliability of medical information available online.
PubDate: Mon, 28 Oct 2024 00:00:00 GMT-
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- Sexual Distress and Quality of Life in Women With Genital Erosive Lichen
Planus—A Cross-sectional Study-
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Authors: Skullerud; Kristin Helene; Gjersvik, Petter; Eberhard-Gran, Malin; Pripp, Are Hugo; Qvigstad, Erik; Vangen, Siri; Helgesen, Anne Lise Ording
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Objective The study aimed to assess sexual distress and quality of life in women with moderate-to-severe genital erosive lichen planus (GELP).Materials and Methods Thirty-six women with GELP were recruited at the Oslo University Hospital in Norway. The diagnosis was confirmed by a dermatologist with experience in vulvovaginal disease and based on characteristic clinical changes in the vulva and/or vagina, and biopsy results if available. Clinical severity was measured using the GELP score with a score ≥5 required for inclusion. Sexual distress was measured using the revised Female Sexual Distress Scale (FSDS-R), and quality of life was measured using the Dermatology Life Quality Index (DLQI). Topical steroid treatment was allowed.Results The mean FSDS-R score was 22.7 (range 0–45) with 27 women reporting high scores for sexual distress (FSDS-R score>15). The mean DLQI score was 8.8 (range 1–19) with 15 women reporting a moderate impact (DLQI score 6–10), and 12 women reporting a very large impact (DLQI score 11–20) of GELP on their quality of life. No clear correlations were found between disease severity assessed by GELP scores and FSDS-R or DLQI scores. Age was not correlated with FSDS-R or DLQI scores.Conclusions These results demonstrate that a substantial number of women with GELP experience sexual distress and a reduced quality of life.
PubDate: Fri, 25 Oct 2024 00:00:00 GMT-
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- Validation of the 2019 American Society of Colposcopy and Cervical
Pathology Online Cervical Cancer Screening Program via 9 Large-Cohort Data
of Chinese Women-
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Authors: Dai; Wenkui; Guo, Chunlei; Yang, Qing; Zhang, Yi; Wu, Di; Wang, Chun; Belinson, Jerome L.; Li, Changzhong; Du, Hui; Qu, Xinfeng; Wu, Ruifang
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Objective The aim of the study is to validate the applicability and performance of the 2019 US risk-based guideline for Chinese women.Materials and Methods The authors analyzed 10,055 cases with data on human papillomavirus testing, cytology, and pathologically confirmed diagnosis (analysis-set). According to the 2019 US risk-based guideline, the authors recorded the risk value and triage recommendations for each case. Then, they assessed the concordance of the guideline triage recommendations with pathology diagnosis for the relevant case from the real-world projects.Results Among the analysis-set, 9,495 cases with an estimated risk value were identified as analysis cohort while the remaining 560 cases were cataloged as “special cases.” Among the analysis cohort, 960 and 526 cases were pathologically confirmed as cervical intraepithelial neoplasia (CIN) 2+ and CIN3+, respectively. The US risk-based guideline recommended colposcopy or more aggressive interventions (Colp+) for 86.8% (833/960) of the CIN2+ and 95.8% (504/526) of the CIN3+ cases, with 87.1% sensitivity and 82.5% specificity for CIN3+ cases (AUC = 0.926, p < .0001). The US risk-based recommended no-Colp for 98.0% (6,142/6,269) of the pathologically confirmed CIN1 or benign cases. In addition, 97.3% (545/560) of the “special cases” cases were recommended as Colp+.Conclusions The 2019 US risk-based guideline works well with satisfied clinical sensitivity for CIN2+ and CIN3+ and seems applicable for cervical cancer screening in China.
PubDate: Tue, 22 Oct 2024 00:00:00 GMT-
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- The Distribution of Cervical Transformation Zone and Its Impact on
Colposcopic Diagnosis: A Multicenter Study in China-
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Authors: Ye; Zichen; Cui, Xiaoli; Wang, Huike; Chen, Mingyang; Lu, Qu; Jiang, Yu; Xue, Peng; Qiao, Youlin
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Objective The value of the transformation zone (TZ) is often overlooked in clinical settings. This study aims to assess TZ distribution, associated factors, and its impact on colposcopic diagnosis.Methods χ2 tests were used to analyze demographics, clinical history, and tissue samples to examine the differences in TZ distribution. Factors affecting the TZ were explored using logistic regression, and diagnostic indicators were calculated.Results A total of 5,302 individual datasets were finally included. TZ1, TZ2, and TZ3 accounted for 31.6%, 38.5%, and 30.0%, respectively. Age is the most important factor that influences the location of the TZ. The proportion of TZ3 steadily increased with age, comprising over 55% in women over 50. The colposcopic diagnostic performance shows that high-grade squamous intraepithelial lesion or worse (HSIL+) sensitivity of TZ3 (58.1%, 95% confidence interval [CI] = 52.9–63.4) is significantly lower than that of TZ1 (69.8%, 95% CI = 65.5–74.1) and TZ2 (73.2%, 95% CI = 69.7–76.8). The HSIL+ specificity of TZ3 (96.3, 95% CI = 95.3–97.4) was higher than that of TZ1 (96.3, 95% CI = 95.2–97.3) and TZ2 (92.5, 95% CI = 91.1–93.9). The HSIL+ positive predictive value (81.3%, 95% CI = 76.4–86.2) and negative predictive value (89.3%, 95% CI = 87.6–90.9) for TZ3 are high, with no significant differences when compared with TZ1 and TZ2.Conclusions Age predominantly influences TZ location, with TZ3 being most frequently found in women over 50. While TZ3 poses a higher risk of missed diagnosis during colposcopy, it remains clinically valuable in identifying diseased and nondiseased status. Increasing colposcopists' awareness of TZ importance is needed in clinical practice.
PubDate: Thu, 10 Oct 2024 00:00:00 GMT-
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- The Barriers and Perceived Benefits to Vulvar Self-Examination in the
Management of Vulvar Lichen Sclerosus-
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Authors: Adamson; Sarah R.; Willems, Anneliese; Chew, Christopher Y.; Saunders, Helen; Keogh, Louise; Veysey, Emma
Abstract:
Objectives It is common practice to advise people with vulvar lichen sclerosus to perform vulvar self-examination (VSE) to optimize topical therapy and detect changes that may represent active disease, scarring, and/or squamous cell carcinoma development. The aim of this study was to better understand people's willingness and potential barriers to performing VSE.Materials and Methods A cross-sectional survey was undertaken of all patients with vulvar LS presenting to a tertiary referral vulvar dermatology clinic in Australia, from June 2022 to January 2023. Patients who did not speak and read English were excluded. Ethics approval was obtained.Results Seventy-eight (66%) of 118 eligible patients completed the survey. Fifty-three (68%) of patients had examined their vulva at least once. Forty-one (49%) had been recommended VSE by a medical practitioner. All those recommended VSE had performed VSE at least once. In contrast, only 10 (27%) of the 37 patients not recommended VSE by a health professional had ever performed VSE. Seventy-nine percent of all patients reported that they were very likely or likely to perform VSE if it was recommended.Patients with higher education level and tampon use were more likely to perform VSE. Self-reported back problems were associated with being less likely to perform VSE.Conclusions More widespread VSE may result in earlier detection of the complications of vulvar lichen sclerosus. Most women would perform VSE if recommended by a health care provider; however, currently only half are receiving this advice. Further research should be performed to determine whether VSE affects clinical outcomes.
PubDate: Thu, 26 Sep 2024 00:00:00 GMT-
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- Statistically Significant Associations Between HPV33, HPV35, and HPV56
With Anal HSIL in a Population of MSMLWH-
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Authors: Jair; Kamwing; Abbott, Stephen E.; Aldous, Annette; Rivas, Karina I.; Connors, Kaleigh A.; Klein, David A.; Hoke, Elizabeth S.; Jordan, Jeanne A.
Abstract:
Objective The aim of the study is to determine the prevalence of high-risk human papillomavirus (hrHPV) genotypes in men who have sex with other men and are living with HIV and the factors associated with anal high-grade squamous intraepithelial lesions (HSIL).Methods Anal swabs were collected for hrHPV genotyping from a cross-sectional group (N = 163) of eligible men who have sex with other men and are living with HIV attending a high-resolution anoscopy clinic. Persistent hrHPV infections were studied in a longitudinal subset (n = 37). Association of anal HSIL with specific hrHPV genotype(s) and with HIV-1 suppression was assessed. Pearson's χ2 test with continuity correction or Fisher's exact test was used to determine statistical significance (alpha = 0.05).Results Overall prevalence of hrHPV anal infections was 93.3% (152/163). Higher numbers of hrHPV genotypes were detected per sample in the HSIL group compared with less than or low-grade squamous intraepithelial lesion (≤LSIL) group (p < .001). Proportion of participants infected with HPV33 was higher in the HSIL group (66.7%) than in ≤LSIL group (33.3%, p < .001), as was HPV35 (61.1% vs. 38.9%, p = .001) and HPV56 (56.7% vs. 43.3%, p = .022). HPV33 persistence was highly associated with HSIL (100%; 8/8) compared with ≤LSIL (0%; 0/8) (p < .001). Proportion of HIV-1 suppression (
PubDate: Wed, 11 Sep 2024 00:00:00 GMT-
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