Elmar A Joura

Elmar A Joura
Medical University of Vienna | MedUni Vienna · Klinische Abteilung für Allgemeine Gynäkologie und gynäkologische Onkologie

MD

About

259
Publications
49,749
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
9,508
Citations
Citations since 2017
56 Research Items
4254 Citations
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
Additional affiliations
September 2015 - present
Medical University of Vienna
Position
  • Head of Colposcopy and Vulvar Services
November 2004 - present
Medical University of Vienna
Position
  • Consultant Gynecologist
November 2004 - present
Medical University of Vienna
Position
  • Professor (Associate)

Publications

Publications (259)
Article
Full-text available
BACKGROUND: The investigational 9-valent viruslike particle vaccine against human papillomavirus (HPV) includes the HPV types in the quadrivalent HPV (qHPV) vaccine (6, 11, 16, and 18) and five additional oncogenic types (31, 33, 45, 52, and 58). Here we present the results of a study of the efficacy and immunogenicity of the 9vHPV vaccine in women...
Article
Full-text available
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for pati...
Article
Background The optimal management of vulvar high-grade squamous intraepithelial lesions (vHSILs) is challenging. Surgery is the standard treatment, but recurrences are observed in half of patients. Medical treatment with imiquimod is an effective alternative, but the two modalities have not been compared in a randomised trial. The aim of this study...
Article
Full-text available
Data suggest that adjuvant human papillomavirus (HPV)-vaccination in women treated for cervical HPV diseases reduces recurrent disease. This study investigates adjuvant HPV-vaccination and the rate of recurrence in women undergoing surgery for vulvar high-grade squamous intraepithelial lesions (HSIL). From January 2013 to April 2020, we enrolled 14...
Chapter
This comprehensive and authoritative book is written by over seventy of the foremost experts working with the care of transgender and gender expansive patients for gynecologists and those working in neighboring disciplines. Among medical specialists, understanding of the complex reality and medical needs of transgender and gender diverse individual...
Article
Full-text available
Background There is limited data on human papillomaviruses (HPV) prevalence in transpeople due to low acceptance rate of screening methods. HPV tests from self-collected urine are gender-neutral, have a high acceptance, and have a comparable accuracy in females to clinician-collected samples. The aim of this study was to evaluate both the HPV preva...
Article
Full-text available
Among women aged 27-45 years, the quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) vaccine was generally well tolerated, efficacious, and immunogenic in the placebo-controlled FUTURE III study (NCT00090220; n = 3253). The qHPV vaccine was also generally well tolerated and highly immunogenic in men aged 27-45 years who participated in the sin...
Article
Full-text available
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for pati...
Article
Objective In a previous phase II trial, we showed that topical imiquimod (IMQ) therapy is an efficacious treatment for high-grade squamous intraepithelial lesion (HSIL). Aim of the present study was to investigate the non-inferiority of a 16-week topical, self-applied IMQ therapy compared to large loop excision of the transformation zone (LLETZ) in...
Article
Full-text available
Zusammenfassung Ursprünglich als Impfung gegen Gebärmutterhalskrebs geplant, haben HPV(humane Papillomviren)-Impfungen unsere Erwartungen weit übertroffen. Sie haben das Potenzial, bei Frauen und Männern mindestens 6 Karzinomtypen, deren Vorstufen sowie Genitalwarzen zu verhindern und sogar zu eliminieren. Nach 14 Jahren Anwendung wissen wir, dass...
Conference Paper
Introduction/Background* Surgery is the standard treatment for HPV-associated high-grade vulvar intraepithelial neoplasia (HSIL/VIN), but recurrences occur in about 50% of patients. Imiquimod , a topical immune response modifier, alters the local immune response in favour of HPV clearance and has been shown to be an effective treatment. The aim of...
Article
Background Efficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16–26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27–45 versus 16–26 years of age. Methods This international, open-label study (NCT031582...
Article
Background The extent of cross-protection provided by currently licensed bivalent and quadrivalent HPV vaccines versus direct protection against HPV 31-, 33-, 45-, 52-, and 58-related disease is debated. A systematic literature review was conducted to establish the duration and magnitude of cross-protection in interventional and observational studi...
Article
Introduction: Studies on the cross-protective effect of HPV bivalent and quadrivalent vaccines demonstrated inconsistent findings against additional HPV types covered by the nonavalent vaccine. The objective of this study was to conduct a systematic literature review to assess the consistency and durability of the cross-protective neutralizing ant...
Article
Full-text available
Background: There is a need to better understand HPV vaccination (HPVv) implementation in WHO Europe Region (WHO/ER), including recommendations, funding, and vaccination coverage rates (VCR). Methods: A targeted literature review (up to 31 January 2020) was conducted using national health ministry websites, WHO database, and published studies from...
Conference Paper
Introduction/Background Usual type vulvar intraepithelial neoplasia (u-VIN) is a premalignant condition of the squamous epithelium of the vulva caused by persistent infection with high-risk human papillomavirus (HPV), and classified as high grade squamous intraepithelial lesion (HSIL). Surgery is the standard treatment, but recurrences occur in abo...
Article
Full-text available
Objectives The natural history of human papillomavirus (HPV) infection has been studied extensively in young women; this study investigated HPV infection in adult women. Methods Data from 3817 women aged 24–45 years in a global trial of the 4-valent HPV (6/11/16/18) vaccine were used to calculate prevalence of anogenital infections containing 9-va...
Article
Full-text available
PurposeTo evaluate HPV and p16ink4a status as prognostic factors in patients with invasive vulvar cancer.Methods Retrospective analysis of disease-free (DFS) and disease-specific survival (DSS) of patients with invasive vulvar cancer at a single tertiary care center. Histology, HPV and p16ink4a status were evaluated in the context of a global multi...
Conference Paper
Introduction/Background Women with treatment of HSIL of the cervix have an increased risk for subsequent HPV related diseases. Developed for primary prevention, the HPV vaccines have demonstrated disease reduction in females and males after treatment of HPV related disease. We investigated the influence of HPV vaccination before or after conization...
Article
Full-text available
Objective Hypoalbuminemia, a known marker for malnutrition, has been associated with an increased risk for perioperative morbidity and poor prognosis in patients with solid tumors. The aim of this study was to investigate the prognostic and predictive value of pre-treatment serum albumin levels for survival and postoperative complications in patien...
Article
Full-text available
Vaccines against human papillomavirus (HPV) are available in Europe since 2006. They have been highly effective in preventing infection and disease caused by the vaccine types. Clinical efficacy data are available for cervical, vulvovaginal and anal precancer and invasive cervical cancer. Disease reduction is best with early vaccination and a cover...
Article
Objective: Nine-valent human papillomavirus (9vHPV) vaccine efficacy against disease and cervical surgeries related to all nine vaccine components was assessed compared with a historic placebo population. This was not assessed in the 9vHPV vaccine efficacy trial since the trial was quadrivalent HPV (qHPV) vaccine-controlled, efficacy was measured f...
Article
Full-text available
Purpose On January 1st, 2018, the ÖGZ (Austrian Society of Cytology) revised its cytological nomenclature to make it more similar to the 2015 Bethesda system. Following these changes, the Austrian Society of Gynecology and Obstetrics felt it necessary to revise the approach currently used in Austria to diagnose and treat CIN and to review the proce...
Article
Objective: To estimate the proportion of vulvar and vaginal low-grade and high-grade squamous intraepithelial lesions (LSILs and HSILs) in females 15-26 years of age attributable to 14 human papillomavirus (HPV) genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59). Methods: A post hoc analysis of prospectively diagnosed vulvar and v...
Conference Paper
Fragestellung: In den letzten beiden Jahrzehnten kam es zu einer Zunahme der Inzidenz von Vulvakarzinomen, wobei Humane Papilloma Virus (HPV) Infektionen eine zentrale Rolle spielen. Der Einfluss der HPV-Infektion auf das Rezidiv-freie Intervall sowie das Gesamtüberleben bei Patientinnen mit Vulvakarzinom wurde evaluiert. Material und Methodik: Im...
Conference Paper
Fragestellung: Neben Technetium 99 m und Patentblau wird auch immer öfter Indocyanin Grün (ICG) zur Sentinel Diagnostik bei soliden Tumoren verwendet. Methodik: Zusätzlich zur Applikation von Technetium 99 m wurde eine ICG Lösung durch fächerförmige subkutane Infiltration peritumoral appliziert. Die Identifikation des Sentinel-Lymphknotens wurde mi...
Article
Full-text available
Aim of this study was to investigate the histologic outcome of cervical intraepithelial neoplasia (CIN) during observational management. Consecutive women with histologically verified CIN and observational management were included. Histologic findings of initial and follow-up visits were collected and persistence, progression and regression rates a...
Article
Full-text available
Background: Numerous studies have addressed the impact of mode of delivery on the natural history of squamous intraepithelial lesions (SIL) in pregnant women. However, the literature is still contradictory. Patients and methods: In the course of a retrospective analysis, data of 63 pregnant women with abnormal cervical smears who were referred t...
Article
Background: The nonavalent HPV (9vHPV) vaccine is indicated for active immunisation of individuals from the age of 9 years against cervical, vulvar, vaginal and anal premalignant lesions and cancers causally related to vaccine HPV high risk types 16, 18, 31, 33, 45, 52 and 58, and to the HPV low risk types 6 and 11, causing genital warts. Objective...
Conference Paper
Fragestellung: Human Papillomavirus (HPV) wird vorwiegend per Sexualkontakt übertragen und ist ursächlich für eine Vielzahl von Krebserkrankungen. Achtsamkeit, Wissen und der Wille präventive Maßnahmen zu setzen, sind essentiell für die Reduktion der Inzidenzrate der HPV Infektionen und deren assoziierten Krankheiten. Material und Methodik: 113 Pat...
Conference Paper
Fragestellung: In den letzten beiden Jahrzehnten kam es zu einer Zunahme der Inzidenz von Vulvakarzinomen, wobei Humane Papilloma Virus (HPV) Infektionen eine zentrale Rolle spielen. Der Einfluss der HPV-Infektion auf das Rezidiv-freie Intervall sowie das Gesamtüberleben bei Patientinnen mit Vulvakarzinom wurde evaluiert. Material und Methodik: Im...
Article
Full-text available
A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9-26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16-26 years of age, sho...
Article
Background: Even if vulvar cancer is not common, over one hundred women are affected in Austria per year. There is strong evidence that basaloid and warty variants are associated with types of human papillomavirus (HPV). Methods: The aim of this study is to analyze the types of HPV in vulvar cancer in Austria. This cross-sectional period-prevale...
Article
Full-text available
Background: Primary analyses of a study in young women aged 16-26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HP...
Article
Background: The 9-valent HPV (9vHPV) vaccine was developed to prevent infection and disease related to 9 HPV types (HPV6/11/16/18/31/33/45/52/58) which cause approximately 90% of cervical cancers, HPV-related vulvar, vaginal and anal cancers, and genital warts worldwide. In a pivotal efficacy study, the 9vHPV vaccine prevented infection and diseas...
Article
Objective: To determine whether written information and/or counseling based on the WOMAN-PRO II Program decreases symptom prevalence in women with vulvar neoplasia by a clinically relevant degree, and to explore the differences between the 2 interventions in symptom prevalence, symptom distress prevalence, and symptom experience. Methods: A mult...
Conference Paper
Fragestellung: Das Erkrankungsalter ist ein wesentlicher Faktor, der den natürlichen Verlauf zervikaler intraepithelialer Neoplasien (CIN) beeinflusst. Ziel dieser Studie war es den histologischen Verlauf von CIN bei jungen Patientinnen während eines abwartenden Management zu untersuchen. Methodik: In diese Analyse wurde 783 Patientinnen eingeschlo...
Conference Paper
Fragestellung: Die inguinale Lymphadenektomie ist bei Patientinnen mit Vulvakarzinom im Frühstadium ein Teil der Standardtherapie. Hierbei kommt entweder die Sentinellymphknotentechnik oder die radikale Lymphadenektomie zum Einsatz. Inguinale Lymphknotenentfernungen sind jedoch mit einer hohen Komplikationsrate assoziiert. Ziel dieser Studie war es...
Article
Fragestellung: Die inguinale Lymphadenektomie ist bei Patientinnen mit Vulvakarzinom im Frühstadium ein Teil der Standardtherapie. Hierbei kommt entweder die Sentinellymphknotentechnik oder die radikale Lymphadenektomie zum Einsatz. Inguinale Lymphknotenentfernungen sind jedoch mit einer hohen Komplikationsrate assoziiert. Ziel dieser Studie war es...
Article
Full-text available
Background: The immunogenicity profile of the 9-valent HPV (9vHPV) vaccine was evaluated across five phase III clinical studies conducted in girls and boys 9-15 years of age and young women 16-26 years of age. The effect of baseline characteristics of subjects on vaccine-induced HPV antibody responses was assessed. Methods: Immunogenicity data f...
Article
Since 2006, three vaccines against infections and disease caused by human papillomavirus (HPV) became available in Europe—in 2006 a quadrivalent HPV 6/11/16/18 vaccine, in 2007 a bivalent HPV 16/18 vaccine and in 2015 a nonavalent HPV 6/11/16/18/31/33/45/52/58 vaccine. HPV 16 and 18 are the most oncogenic HPV strains, causing about 70% of cervical...
Article
Full-text available
Objective: To evaluate anti-Mullerian hormone, basal follicle stimulating hormone, luteinizing hormone, estradiol, and female age in women with recurrent miscarriage and to compare women with explained and idiopathic recurrent miscarriage. Design: Retrospective cohort study. Setting: University hospital, tertiary care center. Patients: Women...
Data
Dataset. Data of patients suffering from recurrent miscarriage. (XLSX) (XLSX)
Article
Full-text available
Objectives: The overall safety profile of the 9-valent human papillomavirus (9vHPV) vaccine was evaluated across 7 Phase III studies, conducted in males and females (nonpregnant at entry), 9 to 26 years of age. Methods: Vaccination was administered as a 3-dose regimen at day 1, and months 2 and 6. More than 15 000 subjects received ≥1 dose of 9v...
Article
Full-text available
BACKGROUND: HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the pu...
Article
Fragestellung: In den letzten beiden Jahrzehnten kam es zu einer Zunahme der Inzidenz von Vulvakarzinomen bei jüngeren Frauen. Dieser Anstieg ist durch HPV Infektionen bedingt. Wir präsentieren die österreichischen Daten eines internationalen Kooperationsprojektes, bei welchem die typenspezifische HPV Prävalenz in invasiven Vulvakarzinomen bestimmt...
Data
Supplementary material Fig. A.1. Percent of disease in CIN2/3 attributed to the respective high-risk HPV types using 4 attribution methods for women ages 15–26 (panel A) and women ages 24–45 (panel B). Only regions with >20 CIN2 or CIN3 lesions are shown. Minimum (Min): numerator includes only those lesions where a respective HPV type was present a...
Data
Supplementary material Fig. A-3. Percent of disease attributed to the respective high-risk HPV types in CIN1 in women ages 15–24 (Panel A) and CIN2/3 using in women ages 24–45 (Panel B), proportional method. Only regions with >20 CIN2 or CIN3 lesions are shown. Total data adapted from reference 4.
Article
Full-text available
Background: We estimated the proportion of cervical intraepithelial neoplasia (CIN) cases attributed to 14 HPV types, including quadrivalent (qHPV) (6/11/16/18) and 9-valent (9vHPV) (6/11/16/18/31/33/45/52/58) vaccine types, by region METHODS: Women ages 15-26 and 24-45 years from 5 regions were enrolled in qHPV vaccine clinical trials. Among 10,7...
Article
Full-text available
to the editor: Dr. Ebell's review of the study by Joura and colleagues asserts that the 9-valent human papillomavirus (HPV) vaccine offers only a small advantage over the quadrivalent vaccine. He bases this on his assessment of data presented for the modified intention-to-treat population that includes persons who were already infected before vacci...
Article
Full-text available
With the availability of the nonavalent human papillomavirus (HPV) vaccine, vaccinees, parents andhealthcare providers need guidance on how to complete an immunization course started with the bi- orquadrivalent vaccine and whether to revaccinate individuals who have completed a full immunizationcourse with the bi- or quadrivalent vaccine. To answer...
Article
Full-text available
Cervical glandular neoplasias (CGN) present a challenge for cervical cancer prevention due to their complex histopathology and difficulties in detecting pre-invasive stages with current screening practices. Reports of human papillomavirus (HPV) prevalence and type-distribution in CGN vary, providing uncertain evidence to support prophylactic vaccin...
Article
Full-text available
The upcoming year 2016 will be marked by two significant events: the ninevalent HPV vaccine will be available in Europe and The Netherlands will be the first country to implement primary HPV screening for the precursors of cervical cancer. Europe has a substantial burden of HPV-related disease. More than 44,000 new cases of HPV-related anogenital...
Article
Full-text available
Background: HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the p...
Article
Full-text available
An investigational monovalent HPV 16 virus like particle (VLP) vaccine has been shown to prevent persistent infection and cervical disease related to HPV 16 and was the proof of concept (2002). Designed to prevent the bulk of invasive cervical cancer, a quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccine have been available since 2006 an...