The Role of Early Colposcopy in the Management of Females with First Episode Anogenital Warts

1994 ◽  
Vol 5 (5) ◽  
pp. 343-345 ◽  
Author(s):  
K A Ward ◽  
J R Houston ◽  
B E Lowry ◽  
R D Maw ◽  
W W Dinsmore
Keyword(s):  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Cervical Cytology ◽  
First Episode ◽  
Low Grade ◽  
High Grade ◽  
Anogenital Warts ◽  
Cervical Smear ◽  
Cervical Lesions ◽  
Increased Risk

212 females attending a genitourinary medicine (GUM) clinic with first episode anogenital warts were screened by cervical cytology and colposcopy/histology for the presence of cervical epithelial abnormalities in keeping with infection by the human papillomavirus (HPV infection) and/or cervical intraepithelial neoplasia (CIN). The prevalence of cervical epithelial abnormalities detected by cervical cytology alone was 32%, rising to 56% after colposcopic examination. However, the majority of cervical lesions detected by colposcopy alone were of low grade (HPV infection and/or CIN I). Histologically confirmed high grade cervical lesions (CIN II or CIN III) were detected more frequently in those females in whom cervical cytological examination indicated dyskaryosis in keeping with any grade of CIN, compared to females without dyskaryotic changes on cervical smear ( P<0.05, chi-squared test with Yates' correction). Early colposcopy is indicated for females with anogenital warts in the presence of a cervical smear showing dyskaryosis in keeping with any grade of CIN, because of the statistically significant increased risk of detecting a potentially progressive high grade cervical lesion. In females without dyskaryotic changes on cervical smear, the value of early colposcopy is uncertain and warrants larger more long-term trials.

scholarly journals HIV-Infected Women with Low-Grade Squamous Intraepithelial Lesion on Cervical Cytology Have Higher Risk of Underlying High-Grade Cervical Intraepithelial Neoplasia

2021 ◽  
Vol 18 (19) ◽  
pp. 10211
Author(s):  
Nawin Sakdadech ◽  
Tanarat Muangmool ◽  
Jatupol Srisomboon
Keyword(s):  
Hiv Infection ◽  
Cervical Intraepithelial Neoplasia ◽  
Sexual Debut ◽  
Intraepithelial Neoplasia ◽  
Cervical Cytology ◽  
University Hospital ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Hiv Negative

Objective: To evaluate the risk of histological high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with human immunodeficiency virus (HIV) infection who had low-grade squamous intraepithelial lesions (LSIL) on cervical cytological screening compared with HIV-uninfected women who had similar cytology. Methods: 127 HIV-positive women aged 18–65 years with LSIL cytology undergoing colposcopic examination between January 2008 and December 2019 at Chiang Mai University Hospital were reviewed. By matching 1:1 ratio for age (±5 years) and examination time period (±12 months), 127 HIV-negative women with LSIL cytology in the same period were recruited as controlled subjects for comparison. The patients’ characteristics, HIV status, CD4 counts, antiretroviral therapy, and histopathology on cervical biopsy were analyzed. Results: HIV-infected women significantly had early sexual debut (age < 20 years) and more sexual partners (≥2) than HIV-uninfected women. The risk of underlying CIN2+ in HIV-infected women was significantly higher than that in HIV-negative women (20.5% vs. 9.4%, p = 0.021) with an odds ratio (OR) of 2.47 and 95% confidence interval (CI) = 1.18–5.14. After adjustment, the risk of underlying CIN2+ in HIV-infected women remained significantly higher than that in HIV-uninfected women (adjusted OR = 2.55, 95% CI = 1.11–5.82, p = 0.027). Conclusion: Among women with LSIL on cervical cytology, the risk of underlying CIN2+ in HIV-infected women was approximately 2.5 times higher than those without HIV infection. Colposcopy is indicated particularly in the case of women with a long duration of HIV infection.

Worldwide incidence of cervical lesions: a systematic review

2014 ◽  
Vol 143 (2) ◽  
pp. 225-241 ◽  
Author(s):  
J. TING ◽  
A. F. ROSITCH ◽  
S. M. TAYLOR ◽  
L. RAHANGDALE ◽  
H. M. SOETERS ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Papillomavirus ◽  
Hpv Infection ◽  
Cervical Cytology ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Infection Incidence ◽  
Over Time

SUMMARYWe conducted a systematic review summarizing data on incidence of high- and low-grade lesions in women with normal baseline cervical cytology, stratified by age (<30 and ⩾30 years), and baseline human papillomavirus (HPV) infection. Incidence of high- and low-grade lesions in women aged ⩾30 years with a baseline HPV infection increased over follow-up time (5–127 months), although incidence generally remained <10%. Without baseline HPV infection, incidence of high-grade lesions remained low over follow-up time (<5% over 5–122 months). Incidence of high-grade lesions in women aged ⩾30 years with baseline HPV infection appeared similar to that in women aged <30 years. In some women aged <30 years, high-grade lesions can develop relatively shortly after initial HPV infection. We observed an increase in low-grade lesions over time in women aged ⩾30 years with baseline HPV infection, potentially indicative of an HPV infection that is potentially progressing to higher grade lesions.

The reporting of anal cytology and histology samples: establishing terminology and criteria

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 562 ◽  
Author(s):  
Jennifer Margaret Roberts ◽  
Deborah Ekman
Keyword(s):  
Reporting System ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Classification Systems ◽  
Low Grade ◽  
Evidence Based ◽  
High Grade ◽  
Anal Neoplasia ◽  
Anal Cytology ◽  
Bethesda System

Our understanding of the human papillomavirus (HPV) related cytomorphology and histopathology of the anal canal is underpinned by our knowledge of HPV infection in the cervix. In this review, we utilise cervical reporting of cytological and histological specimens as a foundation for the development of standardised and evidence-based terminology and criteria for reporting of anal specimens. We advocate use of the Australian Modified Bethesda System 2004 for reporting anal cytology. We propose the use of a two-tiered histological reporting system for noninvasive disease – low-grade and high-grade anal intraepithelial neoplasia. These classification systems reflect current understanding of the biology of HPV and enhance diagnostic reproducibility. Biomarkers such as p16INK4A may prove useful in further improving diagnostic accuracy. Standardisation is important because it will increase the value of the data collected as Australian centres develop programs for screening for anal neoplasia.

Vroegtijdige opsporing van voorstadia van een anaal carcinoom bij hiv-seropositieve patiënten

2021 ◽  
Author(s):  
E. GÖKCE ◽  
J. GELDOF ◽  
P. ROELANDT ◽  
J. VAN DORPE ◽  
S. CALLENS ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Digital Rectal Examination ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
High Grade ◽  
Anal Squamous Cell Carcinoma ◽  
Increased Risk ◽  
High Prevalence ◽  
Risk Patients ◽  
Hiv Seropositive

Early detection of precursor lesions of anal cancer in HIV-seropositive patients Although anal cancer is rare in the overall population, its incidence is increasing in the last decades. Especially HIV-seropositive patients have an increased risk of developing anal squamous cell carcinoma (SCC), mainly because of the high prevalence of high-grade anal intraepithelial neoplasia (AIN) among these patients. High-grade AIN is a precursor lesion for anal SCC associated with human papillomavirus (HPV) infection. Despite the lack of direct evidence demonstrating that AIN identification reduces the risk of anal cancer, experts think that screening and treatment of high-risk patients will prevent the disease. This article aims to review the current literature about AIN and discusses the screening options, including digital rectal examination, anal cytology and high-resolution anoscopy.

scholarly journals Abnormal colposcopic images in patients with preinvasive cervical lesions

2013 ◽  
Vol 3 (2) ◽  
pp. 98-102
Author(s):  
Adnan Babović ◽  
Dženita Ljuca ◽  
Gordana Bogdanović ◽  
Lejla Muminhodžić
Keyword(s):  
Intraepithelial Neoplasia ◽  
Control Group ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Cytological Examination ◽  
Chi Square ◽  
Chi Square Test ◽  
Intraepithelial Lesion ◽  
Experimental Group

Introduction: The objective of the study was to determine frequency and to compare frequency of the abnormal colposcopic images in patients with low and high grade pre-invasive lesions of cervix.Methods: Study includes 259 patients, whom colposcopic and cytological examination of cervix was done. The experimental group of patients consisted of patents with pre-invasive low grade squamousintraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL), and the control group consisted of patients without cervical intraepithelial neoplasia (CIN).Results: In comparison to the total number of satisfactory fi ndings (N=259), pathological findings were registered in N=113 (43.6 %) and abnormal colposcopic fi ndings in N=128 (49.4%). The study did notinclude patients with unsatisfactory fi nding N=22 (8.5%). Abnormal colposcopic image is present most frequently in older patients but there are no statistically important difference between age categories(Pearson Chi-Square 0.47, df -3, p=0.923). Frequency of abnormal colposcopic fi ndings (N=128) is the biggest in pathological cytological (N=113) and HSIL 58 (45.3%), LSIL 36 (28.1%). There is statisticallysignifi cant difference in frequency of abnormal colposcopic images in patients with low-grade in comparison to patients with high-grade pre-invasive cervix lesions (Chi-Square test, Pearson Chi-Square 117.14,df-12 p<0.0001).Conclusion: Thanks to characteristic colposcopic images, abnormal epithelium is successfully recognized, but the severity grade of intraepithelial lesion cannot be determined.

7. High prevalence of human papillomavirus (HPV) infection and high-grade anal intraepithelial neoplasia in HIV-seropositive women, the EVVA study

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 573
Author(s):  
Francois Coutlée ◽  
Sophie Rodrigues-Coutlée ◽  
Marie Munoz ◽  
Marie Helene Mayrand ◽  
Louise Charest ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Anal Intraepithelial Neoplasia ◽  
High Grade ◽  
Women Living With Hiv ◽  
Increased Risk ◽  
High Prevalence ◽  
Living With Hiv ◽  
Hiv Seropositive

Background Women living with HIV are at increased risk of anal HPV infection, anal intraepithelial neoplasia (AIN) and anal cancer. This study will describe the burden of infection and of high-grade AIN (AIN-2,3) in a population of HIV-infected women living in Montreal, Canada. Methods: HIV-seropositive women aged ≥18 years old are recruited in the cohort study EVVA. Participants are followed every 6 months for 2 years with questionnaires, cervical/anal HPV testing, cervical/anal cytology and high-resolution anoscopy (HRA). Results: Of the 116 first participants, 88 (75.9%, 95% confidence interval (CI) 67.3–82.8) were infected by HPV in the anal canal. In contrast, 58 of these participants (50%, 95% CI 41.1–59.0) had cervical HPV infection). The most frequent types were HPV16 (n = 19), HPV51 (n = 18), HPV81 and HPV62 (n = 15 each), and HPV45 and HPV58 (n = 14 for each). An average of 2.3 ± 3.1 HPV types (median of 1) were detected per anal sample. Of the 89 participants with satisfactory cytology, 5 had high-grade squamous intraepithelial lesions. HRA from 95 women revealed 17 AIN2,3 (17.9%, 95% confidence interval (CI) 11.4–26.9), 43 AIN1 (45.3%, 95% CI 35.6–55.3), and only 35 without AIN (36.8%, 95% CI 27.8–46.9). Biopsies from 4 women gave undetermined results. Conclusions: Our study revealed that anal HPV infection was more frequently detected than cervical infection in HIV-seropositive women. Prevalent AIN2,3 is a significant problem in women infected with HIV. Prospective follow-up of women with AIN1 will disclose the proportion of women with progressive AIN.

scholarly journals Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

2020 ◽  
Vol 96 (6) ◽  
pp. 457-463 ◽  
Author(s):  
Brandon L Guthrie ◽  
Anne F Rositch ◽  
Joy Alison Cooper ◽  
Carey Farquhar ◽  
Rose Bosire ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Hpv Infection ◽  
Cervical Neoplasia ◽  
Cervical Cytology ◽  
High Grade ◽  
Cervical Lesions ◽  
Hpv Prevalence ◽  
High Grade Lesion ◽  
Hpv Types ◽  
Hpv Screening

ObjectiveHIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies.MethodsA cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay.ResultsAmong 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive.ConclusionHR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.

scholarly journals Which Women with Vulval High Grade Squamous Intrapethelial Neoplasia (HSIL) should be Considered for Anoscopic Assessments?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Akel Randa
Keyword(s):  
Trichloroacetic Acid ◽  
Surgical Excision ◽  
Hpv Infection ◽  
Low Grade ◽  
High Grade ◽  
Hiv Status ◽  
Entire Cohort ◽  
Specificity And Sensitivity ◽  
Increased Risk ◽  
Living With Hiv

Objective: Review the results of anal assessments in women with vulval HSIL with a potential increased risk of anal HSIL, due to HIV status, macroscopic perianal lesions or vaginal/cervical intrepithelial neoplasia. Methods: Ten year retrospective review of 402 anoscopy encounters from 130 patient, who were at higher risk of anal HSIL and underwent anoscopy. Of those, only 13 women had vulval HSIL and were included. Results: Cohort mean age 51 years, 54% smoked, 15% were living with HIV, 31% had additional vaginal or cervical HPV related pathology and 77% were referred with macroscopic perianal lesions. Over half (54%) had anal biopsies demonstrating HSIL, all of whom had visible pathology.Anal cytology was available for 12 cases, varying from HPV infection (42%), HG dyskaryosis (25%) to low grade dyskaryosis (17%). The entire cohort had either anal HSIL or HPV changes and received treatment: Imiquimod (69%), laser ablation (54%), surgical excision (38%), cryotherapy (31%), electrocautery (15%) or Trichloroacetic acid (15%). Conclusion: HSIL of the vulva with visible perianal lesions must prompt anoscopy, as anal cytology specificity and sensitivity is inadequate. Vulval services should secure multi-specialty links for screening and treating HPV pathology and neoplasia, which may arise in different anatomical sites.

scholarly journals Functional association of oestrogen receptors with HPV infection in cervical carcinogenesis

2017 ◽  
Vol 24 (4) ◽  
pp. R99-R108 ◽  
Author(s):  
Balaji Ramachandran
Keyword(s):  
Invasive Carcinoma ◽  
Therapeutic Option ◽  
Squamous Metaplasia ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Cervical Lesions ◽  
Increased Risk ◽  
Cancer Initiation ◽  
Precancerous Cervical Lesions

Repeated parity and usage of oral contraceptives have demonstrated an increased risk of cervical cancer (CC) in HPV-infected women. These lifestyle observations raise the likelihood that oestrogens and HPV infection might act synergistically to affect cancers of the cervix.In vivostudies have indicated the requirement of oestrogens and ERα in the development of atypical squamous metaplasia followed by cervical intraepithelial neoplasia (CIN) I, II and III. CIN II and III are precancerous cervical lesions that can progress over time to CC as an invasive carcinoma. Recently, there has been evidence suggesting that ERα signalling in the tumour epithelium is a preliminary requisite during cancer initiation that is subsequently lost during tumorigenic progression. Conversely, continued expression of stromal ERα gains control over tumour maintenance. This review summarises the current information on the association between oestrogens and HPV infection in contributing to CC and the possibility of SERMs as a therapeutic option.

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