[Show abstract][Hide abstract] ABSTRACT: The gynaecological environment can become contaminated by human papillomavirus (HPV) from healthcare workers' hands and gloves. This study aimed to assess the presence of HPV on frequently used equipment in gynaecological practice.
In this cross-sectional study, 179 samples were taken from fomites (glove box, lamp of a gynaecological chair, gel tubes for ultrasound, colposcope and speculum) in two university hospitals and in four gynaecological private practices. Samples were collected with phosphate-buffered saline-humidified polyester swabs according to a standardised pattern, and conducted twice per day for 2 days. The samples were analysed by a semiquantitative real-time PCR. Statistical analysis was performed using Pearson's χ(2) test and multivariate regression analysis.
Thirty-two (18%) HPV-positive samples were found. When centres were compared, there was a higher risk of HPV contamination in gynaecological private practices compared with hospitals (OR 2.69, 95% CI 1.06 to 6.86). Overall, there was no difference in the risk of contamination with respect to the time of day (OR 1.79, 95% CI 0.68 to 4.69). When objects were compared, the colposcope had the highest risk of contamination (OR 3.02, 95% CI 0.86 to 10.57).
Gynaecological equipment and surfaces are contaminated by HPV despite routine cleaning. While there is no evidence that contaminated surfaces carry infectious viruses, our results demonstrate the need for strategies to prevent HPV contamination. These strategies, based on health providers' education, should lead to well-established cleaning protocols, adapted to gynaecological rooms, aimed at eliminating HPV material.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
[Show abstract][Hide abstract] ABSTRACT: We describe a human papillomavirus (HPV) vaccination program implemented since 2007 in Geneva Canton, Switzerland, that used school services, a public hospital, and private physicians as vaccination providers. We assessed program performance with the evolution of immunization coverage during the first four years of program implementation. We measured vaccination coverage of the target population using individual records of vaccination status collected by service providers and transmitted to the Geneva Canton Medical Office. The target population was 20,541 adolescent girls aged 11-19 years as of September 1, 2008, who resided in the canton when the program began. As of June 30, 2012, HPV vaccination coverage was 72.6% and 74.8% in targeted cohorts for three and two doses, respectively. The global coverage for three doses increased by 27 percentage points from December 2009 to June 2012. Coverage for girls aged 16-18 years at the beginning of the program reached 80% or more four years into the program. High coverage by this HPV vaccination program in Geneva was likely related to free vaccination and easy access to the vaccine using a combination of delivery services, including school health services, a public hospital, and private physicians, covering most eligible adolescent girls.
Public Health Reports 05/2015; 130(3):202-6. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We determined the human papillomavirus (HPV) types present in invasive cervical cancer (ICC) of women in Cameroon in order to estimate the potential efficacies of HPV prophylactic vaccines.
This is a retrospective study using 181 formalin-fixed paraffin-embedded cervical tissue samples of ICC collected from the Institute of Pathology, Gyneco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon. HPV was detected by PCR using modified GP5+/GP6+ (MGP) primers. Genotyping was performed by reverse-blot hybridisation, which allowed the detection of 9 of the 14 high-risk HPV types.
Of the 181 samples, 91.7% were squamous cell carcinomas and 6.6% were adenocarcinomas. Counting all the single and multiple infections, the three most common high-risk types in descending order were HPV16 (88%), HPV45 (32%) and HPV18 (14.8%). 54.9% of cases were infected with a single HPV type and 45.1% had two or more HPV infections.
The frequencies of HPV16, HPV45 and multiple infections are all higher than previously reported. These observations have significant implications on the consideration of vaccination strategies because each vaccine has different duration and efficacies in cross-protection of different HPV types. The method used proved to be sensitive and cost-efficient for retrospective studies where fresh materials are not available.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
[Show abstract][Hide abstract] ABSTRACT: In a previous letter published in Swiss Medical Weekly, we emphasised the need for Switzerland to change from cytology-based to human papillomavirus (HPV) screening for cervical cancer in women aged 30 years and older . According to a recent study published in The Lancet , which included individual level data from four random-ised controlled trials (RCTs) conducted in Sweden (Swe-descreen ), the Netherlands (POBASCAM [4, 5]), Eng-land (ARTISTIC ) and Italy (NTCC ), Ronco and colleagues demonstrated that HPV screening is more effective than cytology in preventing cervical cancer. This study had a median follow-up time of 6.5 years and involved more than 175,000 women. As such, it provides a significant milestone for cervical cancer detection based on HPV testing. The authors demonstrated that HPV screening offers 60–70% greater protection against cervical cancer compared with cytology and showed that HPV testing performed at 5-year intervals is safer than a 3-year interval for cytology. The implications of these findings for cervical cancer prevention are immediate and global, and suggest that international and national experts should now consider how to implement the change from cytology-based to HPV-based screening, as well as an extension of the screening interval. In response to overwhelming evidence from several good-quality RCTs, which demonstrated that HPV testing might be a more clinically effective option [8, 9], some Western countries have already adopted it as a stand-alone cer-vical cancer screening method. Countries with organised population-based screening programmes where decisions can be executed in a relatively short time period, such as England, the Scandinavian countries and the Nether-lands, tend to embrace the change more easily than countries not having a well-controlled screening system. Indeed, the Netherlands have already entered the annals of public health history as a pioneer in the implementation of an HPV-based cervical cancer screening protocol . Reluctance to accept the change may come from physicians who consider Pap smears to be part of every woman's annual visit; if intervals for screening are lengthened, they fear that women will not come for an annual checkup and may be less inclined to undergo screening. Price is another important concern, and efforts should be made to ensure that HPV testing is fully refunded by health insurance, as is the case for Pap smears. Concerns about the introduction of HPV testing have to be balanced by societal and epidemiological perspectives, because the best strategy for preventing cervical cancer is to use the most accurate test (maximising the benefits of screening) at the longest possible interval (minimising the potential harm of screening). However, Western countries, with liberal health systems and opportunistic screening depending on the initiative of individual women and physicians, have demonstrated in the history of cervical cancer prevention that, despite the presence of a general agreement in favour of new recommendations , the speed and scope of clinical adoption might greatly vary. This is particularly true because each interest group has its own directives and limitations. The United States of America was the first country with opportunistic screening to recommend HPV testing. Since 2012, the American College of Obstetricians and Gyneco-logists and the American Cancer Society have recommended that women aged 30–65 years should undergo " co-testing " with both cytology screening and HPV testing every 5 years if both tests are negative . In fact, HPV testing alone is not recommended. However, this recommendation might be about to change, because the US Food and Drug Administration has approved (on April 24 2014) HPV testing as a first-line screening method for cervical cancer screening . In the case of Switzerland, it is now time to incorporate HPV testing in the national cervical cancer screening recommendation and to update the current guidelines. Evidence suggests that longer screening intervals would be appropriate for HPV testing owing to its high negative pre-dictive value. Furthermore, the extension of the screening interval controls overscreening and reduces the detection of transient HPV infections and insignificant lesions, thus minimising the risk of undergoing unnecessary procedures. Besides the evidence provided by Ronco et al. , Elfstrom et al.  analysed data from a RCT on HPV testing in Sweden (13 years of follow-up) and found the longitudinal Swiss Medical Weekly · PDF of the online version · www.smw.ch
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 02/2015; 145. DOI:10.4414/smw.2015.14112 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Information about women's acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women's acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV.
Women were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling.
A sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30-65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling.
Educational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.
International Journal of Women's Health 01/2015; 7:149-54. DOI:10.2147/IJWH.S56307
[Show abstract][Hide abstract] ABSTRACT: Introduction. Clitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical tech-nique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited. Aims. This study aims to present the care offered and clinical outcomes of two women who received multidisci-plinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis. Methods. We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed. Results. At 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful. Conclusion. We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery. Abdulcadir J, Rodriguez MI, Petignat P, and Say L. Clitoral reconstruction after female genital mutilation/cutting: Case studies.
Journal of Sexual Medicine 11/2014; 12(1). DOI:10.1111/jsm.12737 · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV-positive women. To compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV-positive women to detect cervical intraepithelial neoplasia or grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self-HPV testing. HPV-positive women (n=259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV-positive women had both cervical biopsy and endocervical curettage to detect biopsy-confirmed CIN2+. All statistical tests were two-sided. The prevalence of HPV was 38.5%, and the mean age of HPV-positive women was 41.5±10.1 years. One hundred ninety-eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1%-59.1%), and the sensitivity of cytology was 90.0% (59.6%-98.2%). The specificity was 74.2% (95% CI, 64.2%-82.1%) for VIA and 85.2% (76.3%-91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV-positive women. Further investigations are needed to determine the optimal triage method for HPV-positive women. This article is protected by copyright. All rights reserved.
International Journal of Cancer 11/2014; 137(1). DOI:10.1002/ijc.29353 · 5.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Human papillomavirus (HPV) self-sampling (Self-HPV) may be used as a primary cervical cancer screening method in a low resource setting. Our aim was to evaluate whether an educational intervention would improve women's knowledge and confidence in the Self-HPV method. Method: Women aged between 25 and 65 years old, eligible for cervical cancer screening, were randomly chosen to receive standard information (control group) or standard information followed by educational intervention (interventional group). Standard information included explanations about what the test detects (HPV), the link between HPV and cervical cancer and how to perform HPV self-sampling. The educational intervention consisted of a culturally tailored video about HPV, cervical cancer, Self-HPV and its relevancy as a screening test. All participants completed a questionnaire that assessed sociodemographic data, women's knowledge about cervical cancer and acceptability of Self-HPV. Results: A total of 302 women were enrolled in 4 health care centers in Yaounde and the surrounding countryside. 301 women (149 in the "control group'' and 152 in the "intervention group'') completed the full process and were included into the analysis. Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group (p < 0.05), but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups. Conclusion: Educational intervention promotes an increase in knowledge about HPV and cervical cancer. Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior. Trials Registration: International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN78123709
PLoS ONE 10/2014; 9(10):e109788. DOI:10.1371/journal.pone.0109788 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the feasibility and safety of
3-port robotically assisted laparoscopic hysterectomy
(RALH), using a consecutive series of women who underwent
3-port RALH in a university hospital. From November
2010 until June 2013 we operated on 53 women, whose mean
age was 48.4 ± 7.7 years (range 35–68 years), and mean
body mass index was 27.1 ± 5.1 kg/m2 (range 19.5–42.9 kg/
m2). The indications for hysterectomy were myoma in 31
(58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4
(7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or
postmenopausal bleeding in the remaining 4 women (7.5 %).
We performed total RALH in 50 cases (94.3 %) and subtotal
in the others. The median duration of total intervention was
169 min (interquartile range 147.5–206.5 min). The mean
weight of the uterus was 209.8 ± 166.6 g (range 36–790 g)
and mean estimated blood loss was 72.3 ± 75.9 ml (range
0–300 ml). There were no perioperative complications, in
particular no blood transfusions nor conversions to laparotomy.
The median hospital stay was 4 days (interquartile
range 3–4 days). One patient was reoperated 1 month later
for vaginal vault hematoma and another was readmitted
3 weeks post-operatively due to vaginal vault dehiscence
after premature intercourse, but did not require reoperation.
Three-port RALH is feasible and safe for simple hysterectomy.
We believe this experience using minimum ports to be
useful to prepare for robotically assisted single-port
Journal of Robotic Surgery 09/2014; 8(3):221-226. DOI:10.1007/s11701-014-0454-3
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Nonattendees to cervical cancer screening are at a higher risk of developing cervical cancer. This study assessed women's willingness to perform a home-based self-sampling for human papillomavirus testing (Self-HPV) and explored the feasibility of establishing a home-based Self-HPV screening strategy in Switzerland.
MATERIALS AND METHODS: Underscreened women (n = 158) who had not underwent a Pap test in the preceding 3 years were recruited between September 2011 and September 2013. Participants completed 2 questionnaires evaluating reasons for non-attendance at a screening program, sociodemographic issues, and satisfaction with and acceptability of the Self-HPV. Descriptive data and multivariate logistic regression were used to identify variables associated with women's willingness to perform at-home self-sampling for HPV testing.
RESULTS: Lack of time because of work or childcare was the most common reason for nonattendance at a screening program. One hundred six women (82%) preferred the Self-HPV because it is easy to perform, convenient, comfortable, and private. Women were more likely to accept the Self-HPV as a future screening strategy if they had missed cervical cancer screening in the past because of lack of time (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 1.6-23.6; p < .01). Twenty-six women felt pain during self-sampling. Previous negative experiences with screening and stress during sampling were associated with higher risk for pain (OR = 7.14, 95% CI = 2.0-25.3, p < .01 and OR = 4.73, 95% CI = 1.5-14.5, p < .01, respectively).
CONCLUSIONS: The Self-HPV was accepted by nonattendees of cervical cancer screening programs. Self-sampling may promote screening among the unscreened and underscreened population of women in Switzerland while overcoming some practical barriers.
[Show abstract][Hide abstract] ABSTRACT: Endocrine disorders play a major role in approximately 8% to 12% of recurrent pregnancy loss (RPL). Indeed, the local hormonal milieu is crucial in both embryo attachment and early pregnancy. Endocrine abnormalities, including thyroid disorders, luteal phase defects, polycystic ovary syndrome, hyperprolactinaemia and diabetes have to be evaluated in any case of RPL. Moreover, elevated androgen levels and some endocrinological aspects of endometriosis are also factors contributing to RPL. In the present article, we review the significance of endocrine disease on RPL.