ArticleLiterature Review

Baseman JG, Koutsky LA.. The epidemiology of human papillomavirus infections. J Clin Virol 32: S16-S24

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Abstract

Infection with oncogenic human papillomavirus (HPV) types is a necessary cause of cervical cancer, the second most frequently occurring cancer in women worldwide. Rates of acquisition of HPV are high, particularly among sexually active young adults. Reported estimates of incident HPV infection among initially negative women have reached as high as 60% over a 5-year follow-up period. In this article, we review the epidemiology of HPV infection. In addition to estimates of disease frequency, we highlight risk factors for HPV infection, including the number of lifetime sex partners, which is the most salient risk factor. We discuss significant issues surrounding the natural history of HPV infection, including viral persistence versus clearance, immune response, development of lesions and development of cancer. Finally, we discuss strategies for preventing HPV infection.

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... Anogenital infection with the human papillomavirus (HPV) is the most common sexually transmitted infection in Canada and worldwide [1][2][3]. Although HPV infection is as prevalent among men [4], the focus of most research in this field has been on women due to its strong association with cervical cancer, a more common and devastating cancer. ...
... The copyright holder for this preprint this version posted December 4, 2020. ; https://doi.org/10.1101/2020.12.02.20242891 doi: medRxiv preprint 1 The periods for which costs were added were 0 to 365 days after diagnosis for AGW and carcinoma in situ and 180 days before to 730 days after diagnosis for invasive cancer . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. ...
... The copyright holder for this preprint this version posted December 4, 2020. ; https://doi.org/10.1101/2020.12.02.20242891 doi: medRxiv preprint Net total cost 1 The periods for which costs were added were 0 to 365 days after diagnosis for AGW and carcinoma in situ and 180 days before to 730 days after diagnosis for invasive cancer; 2 Standard deviation; 3 Q1 and Q3 are the first and third quartile respectively; 4 Outpatient cost includes diagnostic and therapeutic procedures. ...
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Background There is little information on the economic burden of human papillomavirus-related diseases (HPV-RDs) among men. We used province-wide clinical, administrative and accounting databases to measure the direct medical costs of HPV infections in men in Manitoba (Canada). Methods We included all males aged 9 years and older with health insurance coverage in Manitoba between January 1997 and December 2016. We identified HPV-RD patient cohorts and matched each patient to HPV-RD-free men. We estimated the net direct medical cost (excess cost of hospitalizations, outpatient visits, and prescription drugs) of patients compared to their matches for anogenital warts (AGWs) and HPV-caused cancers. We adjusted costs to 2017 Canadian dollars. For each condition, we attributed costs to HPV based on the etiological fraction caused by HPV infection. Results We found that the median net direct medical cost was about $250 for AGW patients and $16,000 for invasive cancer patients. The total cost was about $49 million or $2.6 million per year. Overall, 54%-67% ($26-$33 million) was attributable to HPV infection according different estimates of the attributable fraction. The net annual attributable cost was $2.37-$2.95 per male resident and $161-$200 per male newborn. The estimated potential savings was 30% for the bivalent vaccine and 56%-60% for the quadrivalent and nonavalent vaccines. Conclusions Overall, HPV’s economic burden on males remains significant, the average cost of treating all conditions attributable to HPV was about $180 per male newborn. Invasive cancer accounted for the majority of these costs.
... Some studies undertaken in regions where the risk of HPV infection is high, have shown a U-shaped age specific HPV prevalence curve, with high rate at young and old ages [Pham et al., 2003;Baseman and Koutsky, 2005;Clifford et al., 2005;IARC, 2007b]. However, the prevalence was highest in 25-29 years age group (31.8%) and lowest in women older than [Pham et al., 2003]. ...
... However, the prevalence was highest in 25-29 years age group (31.8%) and lowest in women older than [Pham et al., 2003]. Increased acquisition due to age-related sexual behaviors, increased detection of HPV due to age or menopause related changes of the cervicovaginal epithelium, and age-related immune depression leading to increased reactivation of latent infections have been suggested as the causes of the second peak in older ages [Baseman and Koutsky, 2005;IARC, 2007b]. The low prevalence in older women in Turkey may be due to the low number of sexual partners in their sexual life and the low persistence of the virus because of low infection rate in their youth. ...
... According to the results of the current study, the prevalence of HPV increased significantly as the number of sexual partners increased. It is compatible with the previous studies [Burk et al., 1996;Deacon et al., 2000;Wang et al., 2003;Baseman and Koutsky, 2005]. Number of sex partners of the male partner is also positively associated with HPV prevalence of women [Burk et al., 1996], but the participants in the present study could not be questioned on this issue because of cultural problems. ...
... El tipo carcinogénico de infección por VPH es la causa de cáncer de cuello uterino, que es uno de los cánceres más comunes entre las mujeres en todo el mundo. La tasa de recolección de VPH es alta, especialmente entre los jóvenes sexualmente activos (Baseman & Koutsky, 2005). ...
... Las estimaciones informadas de la infección incidente por VPH entre las mujeres inicialmente negativas alcanzaron hasta el 60 % de positividad durante un período de seguimiento de 5 años (Baseman & Koutsky, 2005 ...
... ). Los modelos de comportamiento sexual entre los grupos de edad y las poblaciones son importantes para la circulación del VPH y del riesgo de infección, incluido el número de parejas sexuales de por vida(Baseman & Koutsky, 2005;Bosch et al., 2008).El VPH 16 es el tipo más común y el VPH18, el segundo con algunas diferencias regionales menores. Además, en todo el grupo de lesiones cervicales, el VPH 16 siempre ha sido el tipo más común, representando el 50-55 % de los casos de neoplasias de cuello uterino invasivo, lo que indica claramente que este tipo de virus tiene las ventajas biológicas de transmisión, persistencia y transformación(Bosch et al., 2008).La tasa de exposición de las mujeres jóvenes es muy alta y suele incluir varios tipos. ...
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Introduction: human papillomavirus causes cancers in women around the globe. Objective: To determine the prevalence of human papillomavirus in obstetrics and gynecology patients at the Regional Hospital of Lambayeque. Methods: Descriptive study, cross sectional. 187 patients’ samples were analyzed between April and May 2019. Human papillomavirus DNA samples were extracted using the Salting Out method. The Polymerase Chain Reaction technique was used to amplify the viral DNA, using the primers PC04 / GH20 and MY09 / MY11. Descriptive statistics and bivariate analysis were used. Results: a mean of 45 years was found, a mean of a sexual partner and 2 vaginal deliveries, 23 patients with cervical lesions, a history of STIs (5), hormonal contraceptives (135), condom use (177), smoker (22). It was found that 53 had a positive result (29.94 %) and 124 patients were negative for the test (70.06 %), they were infected with the human papillomavirus. No statistical correlation was found for human papillomavirus and age, age of first sexual intercourse, promiscuity, number of vaginal deliveries, cervical lesions, history of sexually transmitted infections (STIs), use of hormonal contraceptives, use of condoms, and smoking. Conclusion: there is a high percentage of the human papillomavirus in patients who are cared for in the OB / GYN area.
... cHSIL is the most commonly known premalignant neoplasia, affecting approximately 1-2% of all women worldwide each year [3]. Development of these lesions is causally related to a persistent infection with high risk human papillomavirus (hrHPV) [4][5][6][7]. Human papilloma virus (HPV) infections are the most common sexually transmitted pathogens worldwide with an estimated life-time risk of 80% [4][5][6]. While about 80% of hrHPV infections are cleared by the immune system within 18 months, a small proportion of women fail to control viral infection [5,8,9]. ...
... Development of these lesions is causally related to a persistent infection with high risk human papillomavirus (hrHPV) [4][5][6][7]. Human papilloma virus (HPV) infections are the most common sexually transmitted pathogens worldwide with an estimated life-time risk of 80% [4][5][6]. While about 80% of hrHPV infections are cleared by the immune system within 18 months, a small proportion of women fail to control viral infection [5,8,9]. ...
... Human papilloma virus (HPV) infections are the most common sexually transmitted pathogens worldwide with an estimated life-time risk of 80% [4][5][6]. While about 80% of hrHPV infections are cleared by the immune system within 18 months, a small proportion of women fail to control viral infection [5,8,9]. Persistent hrHPV infections develop in approximately 10% of the infected women and are associated with the development of cervical low-grade squamous intraepithelial lesions (cLSILs), cHSILs, and their subsequent progression into invasive squamous Table 1. ...
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Cervical high-grade squamous intraepithelial lesions (cHSILs) develop as a result of a persistent high-risk human papilloma virus (hrHPV) infection. The natural course of cHSIL is hard to predict, depending on a multitude of viral, clinical, and immunological factors. Local immunity is pivotal in the pathogenesis, spontaneous regression, and progression of cervical dysplasia; however, the underlying mechanisms are unknown. The aim of this review is to outline the changes in the immune microenvironment in spontaneous regression, persistence, and responses to (immuno)therapy. In lesion persistence and progression, the immune microenvironment of cHSIL is characterized by a lack of intraepithelial CD3+, CD4+, and CD8+ T cell infiltrates and Langerhans cells compared to the normal epithelium and by an increased number of CD25+FoxP3+ regulatory T cells (Tregs) and CD163+ M2 macrophages. Spontaneous regression is characterized by low numbers of Tregs, more intraepithelial CD8+ T cells, and a high CD4+/CD25+ T cell ratio. A ‘hot’ immune microenvironment appears to be essential for spontaneous regression of cHSIL. Moreover, immunotherapy, such as imiquimod and therapeutic HPV vaccination, may enhance a preexisting pro-inflammatory immune environment contributing to lesion regression. The preexisting immune composition may reflect the potential for lesion regression, leading to a possible immune biomarker for immunotherapy in cHSILs.
... The high-risk type potentially develops into a cancerous lesion at a later time. 1 Condylomata accuminata is frequently found in the genital and anal region in adults but rarely found in a female's urethra. 2 According to a meta-analysis study in 2010, from 1 million women from 59 countries, the prevalence of genital HPV ranges from 1.6% to 41.9%. 3,4,5,6 A three-year study (2008)(2009)(2010)(2011) in H. Adam Malik Hospital Medan reported CA in 41 women (53.9%) with an age range of 15-25 years. ...
... More than 40 types of HPV can infect human anogenital, and 15 of which are highrisk types (type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82) that cause cervical cancer, 3 probable high-risk types (type 26, 53, and 66), 12 lowrisk types (type6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and Cp6108), and 3 undetermined (type 34, 57, and 83).1 The incubation period for CA is three weeks to eight months. ...
Article
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Background: Condylomata accuminata (CA) is a sexually transmitted infection caused by the Human Papillomavirus (HPV), which has more than 40 subtypes classified into high and low risks. The incidence of coinfection involving HPVs in genitalia varies between 2%–71%. Coinfection events increase in immunosuppressed patients. Purpose: To know the types of HPV in CA lesions and the risk factors of a high and low-risk HPV coinfection. Case: A 45-year-old woman presented with genital warts appeared three weeks before. The patient had a breast cancer history and undergone chemotherapy. The examination revealed multiple papules with verrucous surface, firm borders, with whitish color around the urethra and on the vaginal wall. Acetowhite test was positive. The biopsy examination showed squamous epithelium arranged to form papils and foci suspected as koilocytes suggesting CA. The Human Immunodeficiency Virus (HIV) rapid test, VDRL (Venereal Disease Research Laboratory) and TPHA (Treponema Pallidum Haemagglutination) examinations showed non-reactive results. The HPV deoxyribonucleic acid (DNA) genotyping test showed positive results for HPV type 56 (High-Risk Genotypes) and HPV type 6 (Low-Risk Genotypes). She was treated with electrosurgery and consulted to the urology department. Discussion: Coinfection of HPVs might cause a persistent HPV infection for a longer duration, as well as the risk of developing into cancerous lesion. The mechanism of high-risk and low-risk HPV coinfection in immunosuppressed individuals might be due to faster replication of the virus or reactivation of a latent infection. Conclusion: Coinfection of 2 types of HPV could happen in immunosuppression condition such as in patient undergone chemotherapy.
... 3,4 HPV infection occurs soon after sexual debut, and about 80-90% of HPV infections are transitory and clear by early life. 5 If HPV persists, it can lead to a range of benign and malignant lesions in both sexes, 6 including genital warts, 7 oropharyngeal, anal, penile, 8,9 cervix, vulva, and vaginal cancers. 10,11 70-80% of sexually active women will become infected with HPV at some point in their lives. ...
... 10,11 70-80% of sexually active women will become infected with HPV at some point in their lives. 8,12 Young women in their 20s have the highest prevalence of HPV infections, 12,13 although men are at continual risk of contracting new infections throughout their lives. 14 Cervical cancer is the sixth most commonly occurring cancer in women, accounting for 1.7% of all cancers. ...
Article
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Background: Human papillomavirus (HPV) infections are sexually transmitted and most frequently associated with cervical cancer in women, but they are also a public health concern in men. There is rising evidence that HPV’s role in other cancers, such as anal, vulva, vaginal, penis, head, and neck cancers. The present study aimed to understand the factors associated with HPV and cervical cancer knowledge levels of university students before and after an educational intervention. Methods: An Institutional-based cross-sectional study was conducted from October to November 2018. A total of 638 study participants were selected using a simple random multistage sampling technique. A pretested questionnaire was used, consolidated the data, and analyzed with SPSS version 23. Bivariate and multivariate logistic regression analyses were performed to identify which variables were associated with the knowledge levels. Results: Six hundred thirty-eight study participants with a 100% response rate, and the mean age was 21.07 years (±SD, 1.96). Initial awareness of various broad categories was 4.09, and after the intervention, it increased to 23.4, with an average increase of 19.31 at 99% CI, p≤0.001 significance level. Before the educational intervention, students with <21 years of age [6.16, 95% CI: (2.21–17.18)] and ≤2.5 CGPA [3.44, 95% CI: (1.51–7.81)] were less knowledgeable over other counterparts. After educational intervention, the year of study was significantly associated with increased knowledge of overall and different broad categories of cervical cancer and HPV. Year of study, 1st-year students [AOR: 0.27, 95% CI: (0.14–0.51)] over third years and above are less knowledgeable. First-year students and CGPA ≤2.5 were less improved awareness over others. Conclusion: The educational intervention improved more than fourfold increase knowledge on cervical cancer and HPV, and the year of study was a key factor associated with overall improvement. This study suggests that educational intervention effectively strengthens our understanding of the spread of HPV and cervical cancer disease burden. Keywords: Amhara, cancer, pre and posttest
... отметили, что это заболевание становится все более распространенным среди молодых людей, с частотой возникновения 3,5 случая у лиц в возрасте до 50 лет [4]. Риск заражения ВПЧ на протяжении жизни составляет от 50 до 80 % [5]. Подсчитано, что среди людей, контактирующих с ВПЧ, у 90 % не возникнут аногенитальные бородавки, несмотря на то, что они способны передавать болезнь [6]. ...
... Целью данной работы является демонстрация метода пластики кожно-фасциальным лоскутом обширного дефекта промежности после удаления гигантской опухоли Бушке-Лёвенштейна. 4,5). ...
Article
The article considers the possibility of surgical treatment of a patient with giant Buschke–Löwenstein condyloma and the possibility of a reconstructive plastic component. The positive aspects of the surgical technique with a reconstructive plastic component are presented. The question of closing a wound defect after extensive vulva resections and performing plastic techniques has always caused ambiguous disputes among various authors, and has led to the complication of the plastic component, as well as a decrease in indications or refusal of this type of operation.
... Nearly all (99.7%) of all cervical cancer cases [3] and 70% of all oropharyngeal cancer are linked to HPV infection [4]. Added to this, 33,700 new cases of cancer are attributed to HPV annually [5]. ...
... In the shared component model, the spatial variation in vaccination is separated into a common component for both sexes and a sex-specific component. The logit of the vaccination probability for each sex is logit(p ik ) = η ik , 5 where the log odds η ik is specified for each sex as ...
Article
Background: Human papillomavirus (HPV) is the most common sexually transmitted infection within the United States (US). Despite clinical agreement on the effectiveness and widespread availability of the prophylactic HPV vaccine, vaccination coverage in the US is suboptimal and varies by geographic region and area-level variables. The goals of this article were to model the variation in vaccination rates among boys and girls within ZIP Codes in Virginia, determine whether neighborhood sociodemographic variables explain variation in HPV vaccination, and identify areas with significantly depressed vaccination coverage. Methods: We used Bayesian hierarchical spatial regression models with statewide immunization registry data to consider the correlation in vaccination among boys and girls, as well as the spatial correlation in vaccination for each sex. Results: The results showed low vaccination coverage in our birth cohort (28.9% in girls and 23.8% in boys) relative to the national level (56.8% and 51.8%, respectively). Several area-level variables were significantly and positively associated with vaccination coverage, including population density, percentage of Hispanic population, and average number of vehicles. In addition, there were several areas of significantly lowered vaccination coverage, including predominantly rural ones, and overall large geographic disparities in HPV vaccination. Conclusions: Determining the geospatial patterning and area-level factors associated with HPV vaccination within a prescribed geographic area helps to inform future planning efforts. Impact: The results of this study will help inform future planning efforts for geographically targeted interventions and policies, as well as drive new research to implement clinical and community strategies to increase HPV vaccination.
... 18,19 HPV is a small, circular, double-stranded DNA virus that includes more than 120 known subtypes. 16 High-risk human papilloma virus encode a series of early (E1-E7) and late (L1 and L2) proteins. High-risk human papilloma virus E6 and E7 early proteins are oncoproteins that stimulate cell-cycle progression, cellular transformation, and cancer development. ...
... E6 and E7 are 2 major oncogenes that have been shown to be constitutively expressed leading to initial establishment and subsequent progression in cervical cancer. 33 A DNA spike-in control was designed to assess the amplification efficiency process of the E6 gene of HR-HPV type 16. This spike-in control is an 80-nucleotide long pair (Supplementary Table 1), which includes 3 segments with the middle sequence representing a 38-bp-long Drosophila melanogaster sequence that ...
Article
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Numerous risk factors for breast cancer (BC) have been identified. High-risk human papilloma virus (HR-HPV) is the etiological agent of cervical cancer and in some cases of head and neck cancer, specifically oropharyngeal cancer, but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study, all women above the age of 18 visiting the oncology clinic at Al-Azhar university hospital and Ain Shams specialized hospital between the period of February 2017 and March 2018 were invited to participate. We determined the prevalence of HR-HPV genotypes 16, 18, and 31 in breast tissue samples from 72 women with treatment-naïve BC and 15 women with benign breast lesions (BBL) by quantitative real-time PCR (qRT-PCR) and primer sets targeting the E6 and E7 regions. High-risk human papilloma virus DNA was detected in 16 of 72 (22.2%) BC cases (viral load range = 0.3-237.8 copies/uL) and 0 of 15 women with BBL. High-risk human papilloma virus was detected in 14 of 16 (87.5%), 2 of 16 (12.5%), and 0 of 16 (0%) for genotypes 16, 18, and 31, respectively. Forty-three age-matched healthy Egyptian women were enrolled as controls for assessment of local risk factors that can be used to initiate a strategy of BC prevention in Egypt. Assessment of the risk factors demonstrated that low education level, passive smoking, lack of physical activity, family history of cancer, and use of oral contraception were significant risk factors for BC. In conclusion, our results lead us to postulate that HR-HPV infection may be implicated in the development of some types of BC in Egyptian women. In addition, identification of local risk factors can support practical prevention strategies for BC in Egypt.
... It is one of the most prevalent sexually transmitted infections in the world. About 50-80% of sexually active women acquire infection by at least one type of HPV during their lifetime [5,6]. Most cases of cervical cancer are caused by HPV type 16 and 18 [7]. ...
... For all questions, the significance test indicated that Kappa-Cohen's coefficient was significantly different from zero, suggesting that the measurements were consistent (repeatable). In the case of one question (1) there was very good repeatability, in the case of five (3,4,5,6,8) good repeatability, and in the case of two (2, 7) moderate repeatability. The Cramer's V coefficient in all cases was significant different to zero, and indicated the high-to-moderate relationship between responses (Table 1). ...
Article
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Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students’ knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25–59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.
... It is associated with human papilloma virus (HPV) infection, which is mostly transmitted sexually. This means of transmission explains why it is frequently associated with sexually transmitted infections, especially HIV, syphilis, justifying systematic screening [3,4]. HIV infection increases the risk of HPV transmission, causing extensive condylomatous lesions, favoring degeneration to dysplasia and cancer by modifying local and tissue immunity, especially when associated with HPV type 16, and also increases the risk of unfavorable evolution of HPV lesions [5,6]. ...
... The peak of occurrence differs by geographic area, being 20-25 years in the USA and Asia and 40-45 years in the Middle East region [4,12,13,15]. HPV type 16 is the most commonly distributed serotype in the world and mostly causes asymptomatic, precancerous lesions and cancers [15,16]. ...
Article
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Background Buschke–Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke–Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients. Case presentation We report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ‘’butterfly wing’’ structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm³) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke–Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection. Conclusion Buschke–Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.
... Cervical cancer is the fourth most common malignancy among women, in the light of a report using the GLOBOCAN 2018 database, there were 569,847 new cases of cervical cancer among 311,365 deaths globally in 2018. 1 Persistent human papillomavirus (HPV) infection, especially high-risk HPV (HR-HPV), is a major cause of precancerous lesions and cervical cancer. 2 It has been estimated that more than 50-80% of sexually active women will be infected with one or more types of genital HPV in their lifetime. 3 The emergence and application of HPV preventive vaccines have been recognized as a major advancement and the most effective intervention for the control of cervical lesions. ...
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Human papillomavirus (HPV) infection is the main cause of female precancerous lesions and cervical cancer. The development and application of HPV prophylactic vaccines have been recognized as a major effective intervention for the control of cervical lesions. However, the infection rate and clinical characters of non-9-valent vaccine covered HPV subtypes are still worth studying. In this retrospective study, we included patients diagnosed and treated in the Department of Gynecology of Shanghai General Hospital between January 2017 and February 2021. The clinical features of non-9-valent vaccine covered HPV subtypes were explored in 2179 patients who have normal results, 338 patients with cervical intraepithelial neoplasia 1 (CIN1), and 153 patients with ≥CIN2. Univariate analysis showed that compared to the normal cervix group, age ≥50, pregnancy ≥5, delivery ≥3, menopause, no condom use, and cervical transformation zone type III were risk factors for CIN1 or ≥CIN2 (p < 0.05). Thirty-one percent of CIN1 and 26% of ≥CIN2 were attributed to HPV51, HPV53, HPV56, and HPV68. Multivariate analysis revealed that HPV53, HPV81, age, menopause, cervical transformation area and involved glands were independent risk factors for ≥CIN2 group compared to the CIN1 group (p < 0.05). Additionally, among the 14 non-9-valent vaccine covered HPV subtypes, the infection rates of HPV53, 56, 51, and 68 were higher in this study. In conclusion, our study demonstrated the distribution and pathogenic risk of non-9-valent vaccine covered HPV subtypes in cervical lesions. These findings might supply a foundation for optimizing cervical cancer prevention in the post-vaccine era.
... Timely detection and treatment can prevent progression of precancerous lesions to cancer, preserving life and fertility. Oncogenic human papillomavirus (HPV) types are present in 95-100% of cervical cancer specimens and cause most cases of cervical cancer [2]. The Latin America and Caribbean (LAC) region is home to just 9% of the world population but bears approximately 16% of the world cervical cancer mortality [3,4]. ...
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Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology.”
... Persistent infections with human papillomavirus (HPV) are associated with development of clinical disease, including anogenital or oropharyngeal cancers (in case of high-risk HPV type infections) and anogenital or laryngeal warts (in case of low-risk HPV type infections) [1,2]. From 2006 onward, 3 vaccines targeting different combinations of HPV types have been registered, which were initially licensed and offered according to a 3-dose (3D) schedule (recommended schedule: 0, 1, and 6 months). ...
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Background: In the Netherlands, the bivalent HPV vaccine (2vHPV) has been offered to preadolescent girls via the National Immunization Program (NIP) in a two-dose (2D) schedule since 2014. The current study estimates vaccine effectiveness (VE) against HPV infections up to four years post-vaccination among girls eligible for routine 2D immunization. Methods: A cohort study (HAVANA2) was used in which participants annually filled out an online questionnaire and provided a vaginal self-sample for determination of HPV by the SPF10-LiPA25 assay, able to detect 25 HPV types. VE against incident type-specific infections and pooled outcomes was estimated by a Cox proportional hazards model with shared frailty between the HPV types. Results: In total, 2027 girls were included in the study, 1098 (54.2%) of whom were vaccinated with two doses. Highest incidence rate was 5.0/1000 person-years (HPV51) among vaccinated participants and 9.1/1000 person-years (HPV74) among unvaccinated participants. Adjusted pooled VE was 84.0% (95%CI, 27.0-96.5%) against incident HPV16/18 infections and 86.5% (95%CI, 39.5-97.08%) against cross-protective types HPV31/33/45. Conclusion: Four years post-vaccination, two doses of 2vHPV vaccination were effective in the prevention of incident HPV16/18 infections and provided cross-protection to HPV31/33/45. Our VE estimates rival those from three-dose schedules, indicating comparable protection by 2D schedules.
... However, the dynamics of the natural evolution of cin is hard to ascertain, especially because most of HPV infections are transient and the exposure to co-factors may vary according to age groups, affecting the precancerous lesion risks of persistence and progression 8 . The infection is transmitted at early ages after the first sexual intercourse, being widespread among 25 to 30 year old women, and a second peak has been reported among women over 55 years of age 16 . ...
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Introdução: Neoplasia de Itraepitelial Cervical (NIC ) quando não tratada progride para câncer, persiste como NIC ou regride para um tecido normal. Objetivo: Determinar o padrão de evolução natural das lesões precursoras do câncer cervical e avaliar o papel de cofatores sobre o risco de desenvolvimento dessa neoplasia numa coorte de mulheres do Rio de Janeiro, Brasil. Método: Foi feito um estudo exploratório em 227 mulheres com NIC referidas a partir do Centro de Patologia Cervical, de 1998 2000. A evolução das NIC foi verificada em pacientes que foram deixadas sem tratamento por apresentarem limitações clínicas, que foram seguidas por dois anos com exames citológicos. Resultados citológicos foram classificados como: Lesão de Baixo Grau (LBG), Lesão de Alto Grau (LA G). Probabilidade e risco de regressão, persistência e progressão das lesões pré-cancerosas foram determinados usando test (L-R:95%) de Kaplan Meier e regressão de Cox proporcional. Resultados: A probabilidade de regressão da lesão foi: 46% (LBG), 72,8% (LAG). As LAG apresentaram maior probabilidadde de progressão para câncer (7,1%) e persistência (43,1%) do que LBG. Mulheres <30 anos eram mais propensas a regredir (79,9%) do que as mulheres mais velhas. Mulheres≥50 eram mais prováveis de apresentar lesão persistente (43,3%) do que as mulheres mais jovens (31,8%). Conclusão: Mulheres < 30 anos no diagnóstico de LBG eram mais propensas a regredir do que as mulheres mais velhas. Mulheres com≥50 anos com HSIL eram mais sujeitas a ter lesões persistentes e progredirem, em comparação as mais jovens.
... El VPH 16 es el tipo viral más común detectado en cáncer oral-orofaríngeo en un 90 %-95 % de los tumores positivos para VPH (22)(23)(24). Por otro lado, diferentes trabajos muestran que factores asociados al virus, como la persistencia de infección, la carga viral, la expresión continua de las oncoproteínas E6 y E7 y la integración del ADN viral dentro del genoma de la célula hospedera y la inactivación del gen viral E2 junto a la acumulación de mutaciones oncogénicas, que conllevan a la progresión de lesiones preneoplásicas a cáncer (25). ...
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Antecedentes: En Colombia, el carcinoma escamocelular orofaríngeo (CEO) puede afectar tanto a hombres como a mujeres. Cerca del 30 % tiene como causa la infección con el virus del papiloma humano (VPH) y el 70 % se debe al consumo excesivo de tabaco y alcohol. La historia natural de la enfermedad del CEO es similar a la del cáncer cervical. Se ha observado una asociación positiva entre Chlamydia trachomatis y VPH. A partir de esa evidencia, se podría hipotetizar que, para el CEO, las bacterias orales tendrían alguna asociación positiva con el VPH. Objetivo: Exponer algunas experiencias y avances sobre el CEO en la Pontificia Universidad Javeriana de Bogotá, Colombia. Hallazgos: En este grupo de investigación se realizó primero una descripción del papel del VPH en CEO (frecuencia, tipos virales de alto riesgo e integración viral) en muestras de pacientes con cáncer en Colombia. Un segundo estudio consistió en una revisión sistemática de la literatura en la que se buscó identificar posibles bacterias asociadas al desarrollo del CEO. En un último estudio se evaluó la frecuencia de bacterias orales asociadas a procesos carcinogénicos y su posible coinfección con VPH en pacientes con CEO e incluyó una comparación con personas sanas. Conclusión: En este manuscrito se presentan los resultados propios más relevantes que permiten comprobar la hipótesis formulada.
... The HPV infection is asymptomatic in the majority of women, and most cases resolve within two years 7 . Some studies reported that infection spontaneously resolves in 50-90% of HPV-positive women in one year 8,9 . Nonetheless, 10-15% of all HPV-infected women may have persistent infection 7 and consecutively, increased risk of cancers, and other benign diseases. ...
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Introduction: Cervical cancer is common cancer and ranked in fourth place in both incidence and mortality worldwide. It is 3rd most common female cancer in Malaysia with a lifetime risk of 1 in 116. Infection with high-risk oncogenic human papillomavirus (HPV) is recognized as one of the substantial risk factors for the development of cervical cancers. Methods: It was a cross-sectional study conducted to determine the prevalence of HPV infection and its subtypes among women with various degrees of abnormal smears, who were seen in the colposcopy clinic of Sarawak General Hospital within six months’ period from January to June 2018. We recruited 56 participants. There were 23 each for an atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) and 10 high- grade squamous intraepithelial lesion (HSIL). DNA was extracted, and HPV genotypes were determined via polymerase chain reaction (PCR) using two primer pairs MY09/MY11 and GP5+/GP6+. Results: The age ranged from 23 to 56 years, with a mean age of 42.96 years. HPV was detected in 20 out of 56 (35.7%). There were 6 high-risk oncogenic HPVs (18, 51, 52, 56, 58, 68) detected in participants and the most prevalent subtypes were 18, 52, and 58 (20% each). Four low-risk HPVs detected were 6, 53, 70, and 84. There was a significant association between the severity of cervical lesions and HPV positivity (P < 0.004). HSIL had the highest positive predictive value to have HPV infection as 70% compared to 43.4% of LSIL and 9.3% of ASC-US. Conclusion: Distribution of HPV subtypes from women with abnormal smears from Sarawak indicated a high prevalence of HPV 18, 52, and 58. We also identified HPV 70, which has never been reported in West Malaysia. These findings could contribute valuable information for HPV vaccination strategies, particularly for Sarawakian women.
... 1−3 The infection progressed by the fact that the high-and low-risk genotypes of HPV infect not only the cervix but also head, neck, vagina, penis, anus, vulva, and oropharynx, resulting in cervical cancer, skin cancer, mucosa verrucous hyperplasia, and orophayngeal cancer. 4,5 The high-risk human papillomaviruses include HPV types 31,35,18,16,33,39,51,56, and 59 from the genera alpha categorized to cause cancer, whereas the types 11,6,42,44,61,54,72, and 70 belong to the low-risk HPV types causing warts and cysts. 2,6 The genome of the human papillomavirus is ∼8 kilobase pairs in size, which encodes a total of eight proteins, among which two are present in the late region and six are present in the early region. ...
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The most prevalent and common sexually transmitted infection is caused by human papillomavirus (HPV) among sexually active women. Numerous genotypes of HPV are available, among which the major oncoproteins E6 and E7 lead to the progression of cervical cancer. The E7 oncoprotein interacts with cytoplasmic tumor suppressor protein PTPN14, which is the key regulator of cellular growth control pathways effecting the reduction of steady-state level. Disrupting the interaction between the tumor suppressor and the oncoprotein is vital to cease the development of cancer. Hence, the mechanism of interaction between E7 and tumor suppressor is explored through protein–protein and protein–ligand binding along with the conformational stability studies. The obtained results state that the LXCXE domain of HPV E7 of high and low risks binds with the tumor suppressor protein. Also, the small molecules bind in the interface of E7–PTPN14 that disrupts the interaction between the tumor suppressor and oncoprotein. These results were further supported by the dynamics simulation stating the stability over the bounded complex and the energy maintained during postdocking as well as postdynamics calculations. These observations possess an avenue in the drug discovery that leads to further validation and also proposes a potent drug candidate to treat cervical cancer caused by HPV.
... HPV includes a group of deoxyribonucleic acid (DNA) viruses that are one of the most common sexually transmitted infections worldwide [5]. HPV infects the lower, basal layer epithelial cell, causing warts and cervical cancer [6,7]. ...
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Background Oropharynx is the anatomical site with the highest human papillomavirus (HPV) infection in head and neck. Many studies on HPV prevalence and p16INK4a positivity in oropharyngeal cancer have been published in recent years. We aimed to update the global burden estimates of oropharyngeal cancer attributable to HPV with the latest data and estimate global burden of tonsillar cancer and base of tongue cancer attributable to HPV by region and country. Methods We calculated the number of new cancer cases using the Cancer Incidence in Five Continents Volume XI (CI5XI) and country-specific population in 2012 issued by the United Nations. Estimates of HPV prevalence and p16INK4a positivity were obtained from literature search and pooled analyses where necessary. Results Globally the number of oropharyngeal cancer and tonsillar cancer attributable to HPV were 42,000 and 20,000 in 2012, corresponding to AFs of 42.7% and 52.7%. The number of cancer cases attributable to HPV among males was about 4-fold greater than that among females. For both oropharyngeal cancer and tonsillar cancer, AFs were higher in more developed countries. Among HPV positive oropharyngeal cancer cases, 86.7%, 87.8%, and 92.5% could have been prevented by bivalent (2v), quadrivalent (4v), and nonavalent (9v) HPV vaccines. Conclusions It is worth considering the inclusion of HPV immunization in males, especially in the regions where oropharyngeal cancer is highly prevalent.
... The risk of HPV infection during a lifetime is striking, as most sexually active persons will acquire the infection at some point [108]. The HPV infection can be cleared and only exist transiently, but if persistent, it can be oncogenic [109], with subsequent risk of developing OPSCC [42]. ...
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Squamous cell carcinoma of unknown primary (SCCUP) is a challenging diagnostic subgroup of oropharyngeal squamous cell carcinoma (OPSCC). The incidence of SCCUP is increasing in parallel with the well-documented increase in OPSCC and is likewise driven by the increase in human papillomavirus (HPV). The SCCUP patient often presents with a cystic lymph node metastasis and undergoes an aggressive diagnostic and treatment program. Detection of HPV in cytologic specimens indicates an oropharyngeal primary tumor origin and can guide the further diagnostic strategy. Advances in diagnostic modalities, e.g., transoral robotic surgery and transoral laser microsurgery, have increased the successful identification of the primary tumor site in HPV-induced SCCUP, and this harbors a potential for de-escalation treatment and increased survival. This review provides an overview of HPV-induced SCCUP, diagnostic modalities, and treatment options.
... Human papillomaviruses (HPV) are a large family of epitheliotropic DNA tumor viruses [1]. Approximately 80% of sexually active women are infected with at least one HPV subtype at some point in their lifetimes [2]. Continuous infection with a high-risk HPV subtype is the main cause of cervical cancer [3]. ...
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Background Human papillomavirus (HPV) vaccines have been proven effective against cervical cancer. However, HPV vaccination is not included in the Chinese immunization program. This study aimed to assess the cost-effectiveness of incorporating different HPV vaccines into immunization programs at the Chinese national and provincial levels. Methods The Papillomavirus Rapid Interface for Modeling and Economics model was used to estimate the possible cost and social and economic benefits of adopting various HPV vaccination immunization strategies in 31 provinces in Mainland China in 2019. Demographic and regional economic data were obtained from the national and provincial Statistical Yearbook. The cost of vaccines was gathered from the centralized procurement information platform of all Chinese provinces. Treatment costs, epidemiological data, and other model parameters were obtained from published literature. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted both provincially and nationally. Deterministic sensitivity analyses were used to explore model uncertainty. Results The net cost of vaccinating with the domestic bivalent HPV vaccine was the lowest. At the national level, after bivalent or quadrivalent HPV vaccination, the number of cases and deaths averted due to cervical cancer were 12,545 and 5109, respectively, whereas the 9-valent HPV vaccine averted 28,140 cases and 11,459 deaths. HPV vaccines were cost-effective at a national level (maximum cost US$ 18,165 per DALY gained.) compared to the 3 times GDP per capita (US$ 30,837). Bivalent HPV vaccines were cost-effective in all 31 provinces. Imported quadrivalent and 9-valent HPV vaccines were cost-effective in 29 provinces, except Heilongjiang and Gansu. The univariate sensitivity analysis showed that the results were robust when the model parameters were changed, and that the discount rate was the main factor affecting the baseline results. Conclusions This study provides evidence that the inclusion of HPV vaccination in the immunization program would be cost-effective at a national level and in most provinces. Provinces with a higher population have more prevented cases, deaths, and DALYs . The economics of HPV vaccination at the provincial level differs from that at the national level, and provinces with an inability to pay should seek help from state subsidies.
... However, not all infections cause tumor development due to the oncogenic potential of different types of HPV [2][3][4][5]. For instance, high-risk HPV types 16 and 18 are reported with the greatest frequency in cervical cancer [4,6,7]. The oncogenic potential of high-risk HPV is due to E6 and E7 oncoprotein production, which initiates a series of alterations associated with cell transformation through the inactivation of p53 and pRB, respectively [4,8,9]. ...
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The oncogenic potential of high-risk HPVs is focused on producing the E6 and E7 oncoproteins responsible for disrupting the control of the cell cycle. Epidemiological studies propose the presence of the N29S and H51N variants of the HPV16 E7 protein as a significant association with cervical cancer. It has been suggested that changes in the amino acid sequence of E7 variants may affect the oncoprotein 3D structure; however, this remains unknown. Analysis of the structural differences of the HPV16 E7 protein and its variants (N29S and H51N) was performed through homology modeling and structural refinement by molecular dynamics simulation. We propose for the first time a 3D structure of the E7 reference protein and two of its variants (N29S and H51N) and conclude that the mutations induced by the variants in N29S and H51N have a significant influence on the 3D structure of the E7 protein of HPV16, which could be related to the oncogenic capacity of this protein.
... Çoğu HPV enfeksiyonları asemptomatik ve geçici olmakla birlikte semptomatik enfeksiyon genital (çoğunlukla HPV 6 ve 11 serotipi) veya servikal, penil ve anal siğillere neden olurken bazı çeşitleri de yüksek dereceli lezyonlara ve sonuç olarak HPV ilişkili kanserlere sebep olmaktadır. 2013 yılında 530.000 yeni invazif servikal kanser olgusunun tanılandığı tahmin edilmekte ve 270.000 kadının bu hastalık yüzünden hayatını kaybettiği belirtilmektedir (1). ...
... One of those is human papillomavirus (HPV). HPV infections are significantly associated with cancer of the male and female anogenital mucosa (7,8) and some adverse effects on reproductive functions (9,10). Most of these consequences are caused by the inability of the immune system to spontaneously clear HPV: in particular, high-risk HPV (HR-HPV) types are more likely to persist than low-risk HPV types (11)(12)(13). ...
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A comprehensive literature review was performed to determine the relationship between HPV infection and infertility and the eventual role of the 9-valent vaccine for infertility prevention. The search was extended from January 1997 through July 2021. Data collected from selected articles focused on three main topics: statistical associations between HPV prevalence and assisted reproductive technology (ART) outcome, association between HPV and characteristics of semen, and associations between HPV and miscarriage. Articles that identified HPV genotypes were selected for this review to study the possible role of the 9-valent vaccine in infertility prevention. To date, there is no agreement on the implication HPV female infection has on the fertility and miscarriage rate. Although it can be stated that HPV prevalence among couples with infertility undergoing ART treatment is consistent, it does not seem to affect the performance of oocytes. Otherwise, HPV infection affects sperm parameters, in particular spermatozoa motility. When an association can be found, most cases of HR-HPV involved are those included in the 9-valent vaccine. The correlation between HPV male infection both with asthenozoospermia and increased risk of pregnancy loss could recommend the extension of anti-HPV vaccination to adolescent males along with cancer prevention. Despite the fact that the relation between 9-valent HPV genotypes involved in female infection and miscarriage/infertility is not clear, the impact of this virus on health reproduction is evident. Considering this, the importance of HPV vaccination in adolescent females is confirmed. A vaccine efficacy study could be useful to confirm the importance of primary prevention for couple reproductive health.
... HPV infection which is sexually transmitted to both male and female is a global epidemic. Most of the HPV infections are asymptomatic and transient, however, symptomatic infection may result in genital (most commonly associated with HPV serotypes 6 and 11) or cervical, penile, anal warts, and several can lead to high-grade lesions and eventually to HPV-associated cancers.It is estimated that about 530.000 new cases of invasive cervical cancer were diagnosed worldwide in 2013, and an estimated 270.000 women died of this disease (1). ...
... The HPV is one of the most common sexually transmitted infections (STIs) around the world. It has been estimated that most sexually active females are infected with at least one of the HPV types worldwide (8,9). Furthermore, there are about 40 different genotypes of this virus were introduce as an STI while 14 types of all them known as high-risk genotypes including 33, 31, 18, 35, 39, 45, 51, 52, 56, 59, 67, and 73 (10-13). ...
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Background and Objectives: The human papillomavirus (HPV) is associated with more than 70% of the cervical neoplasm. The current study aims to evaluate the distribution of HPV genotypes in suspected women cytological specimens from Tehran, Iran. Materials and Methods: In the current cross-sectional study, HPV genotype prevalence was investigated in 433 subject women. DNA extraction was performed by High Pure Viral Nucleic Acid kit. A semi-automatically hybriSpot 24™ (HS24) setting was used for HPV typing and data interpreted by hybriSoft™ software according to instructions. Results: Pathologic data showed 181 (41.8%) had non-malignant lesions, 212 (49%) had inflammation and 40 (9.2%) reported LSIL in primary Pap-smear result. HPV was found in 143 (33%) specimens and the most comment high-risk and low-risk HPV types were HPV-16 and -6, respectively. Also, 62 (43%) were co-infected with multiple genotypes includes, 34 (24%) cases had co-infection with two HPV types, 17 (12%) cases had co-infection with three HPV types, 6 (4%) cases had co-infection with four HPV types and 5 (3%) cases had co-infection with five HPV types. There was statistically different domination on high-risk genotype in most of the co-infected samples (p
... High risk HPV are responsible for one third of virus-induced cancers which account for about 5% of human cancers [2]. Among the high risk subgroup, HPV-Prevalence of infection by HPV-16 varies across populations, genders and habit attributes with incident infection as high as 60% been detected [5]. The immune system is usually capable of clearing the virus in 6-18 months following an infection. ...
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Objective Human papillomavirus (HPV) gained momentum as a potential etiological factor for many types of cancers. Therefore, the aim of this study was to assess the prevalence of HPV-16 infection among Sudanese patients diagnosed with Squamous Cell Carcinoma (SCC) and Salivary Gland Carcinoma. A descriptive, hospital-based study was conducted. 150 formalin-fixed paraffin-embedded blocks were collected. Results The study population included a total of 150 patients aged between 18 to 87 years with a mean age of 48.8 ± 11.9 years. Based on gender, females constituted 46.7% while males constituted 53.3%. The 150 patients were classified into 40 (26.0%) esophageal, 30 (20.0%) nasopharyngeal, 18 (12.0%) conjunctival, 18 (12.0%) tongue 12 (8.0%) laryngeal, 8 (5.3%) lip, 6 (4.0%) oropharyngeal, 6 (4.0%) mucoepidermoid, and 6 (4.0%) adenoid cystic, and 6 (4.0%) myoepithelial carcinomas. Odds ratio for male and female diagnosed with carcinoma was 1.025 [0.439–2.394, 95% CI]. Molecular detection of HPV-16 revealed a prevalence of 26 (17.3%) patients were positive for HPV-16. According to cancer diagnosis, esophageal SCC patients showed a high proportion of HPV-16; 14/40 (35.0%). A statistically significant difference was seen for the distribution of HPV-16 positive patients based on cancer diagnosis, P value 0.001.
... [1][2][3][4] Common warts, also known as verruca vulgaris, are small cutaneous growths that frequently occur over the hands and fingers, which is associated with Human papillomavirus (HPV) type-2, while patients with acquired immunodeficiency syndrome, other types of the virus can coexist, such as HPV type-57. [5][6][7][8][9] Common wart can overlie critical structures of the hand, including extensor tendons and the extensor expansion. 10 This peculiar topography can interfere with specific therapeutic modalities, including cryotherapies. ...
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Background: Common warts frequently occur over the hands and may overlie critical structures, including the extensor expansion of the digits, for which cryotherapy can lead to manual disability. Aims and Objectives: We aim to implement big data to infer knowledge on the interest of web users regarding the dorsal expansion-related manual disability in verrucae vulgaris patients managed with cryotherapy. Materials and Methods: We mapped the interest of users of the surface web in connection with five topics: cryosurgery, extensor digitorum muscle, human papillomavirus, manual disability, and verruca vulgaris. We retrieved longitudinal data [2004-2019] concerning the spatio-temporal variations of interest in these topics, using Google Trends. We are also reporting a case of interest while analyzing it using the Bradford Hill criteria. Results: Sixty-four nations contributed to the spatial (geographic) map, including ten countries from the Middle East and the north of Africa (15.63%). There was high temporal variability concerning cryosurgery 29.61 (+/- 0.94), extensor digitorum muscle 64.43 (+/- 0.86), human papillomavirus 0.01 (+/- 0.01), manual disability 2.89 (+/- 0.13), and verruca vulgaris 9.39 (+/- 0.20). Conjoint inference, via Post-Hoc testing and neural networks [machine learning], assigned the highest synaptic weight [effect size] to “cryosurgery” and “extensor digitorum muscle”, thus indicating that these topics are of prime interest for web users, including anatomists and dermatologists. Conclusions: We are conveying two messages: 1) Dermatologists are encouraged to collaborate with data scientists to realize the importance of big data for evidence-based dermatology. 2) Physicians should exercise extra caution in managing patients with verrucae vulgaris using cryotherapy.
... have been described and clustered within 5 genera: alpha-, beta-, gamma-, mu-, and nu-HPV. High-risk alpha(α)-HPVs are associated with the development of several tumors, including the uterine cervix and the head and neck [27]. Its oncogenic potential occurs due to the expression of viral oncoproteins that interact and block the activities of host cell cycle regulatory proteins [25,26]. ...
Article
Background: Chagasic megaesophagus (CM) as well as the presence of human papillomavirus (HPV) has been reported as etiological factors for esophageal squamous cell carcinoma (ESCC). Objective: We assessed the prevalence of HPV DNA in a series of ESCCs associated or not with CM. Data obtained were further correlated to the pathological and clinical data of affected individuals. Methods: A retrospective study was performed on 92 formalin-fixed and paraffin-embedded tissues collected from patients referred to 3 different hospitals in São Paulo, Brazil: Barretos Cancer Hospital, Barretos, São Paulo; Federal University of Triângulo Mineiro, Uberaba, Minas Gerais; and São Paulo State University, Botucatu, São Paulo. Cases were divided into 3 groups: (i) 24 patients with CM associated with ESCC (CM/ESCC); (ii) 37 patients with ESCC without CM (ESCC); and (iii) 31 patients with CM without ESCC (CM). Detection of HPV DNA was assessed in all samples by a genotyping assay combining multiplex polymerase chain reaction and bead-based Luminex technology. Results: We identified a high prevalence of high-risk HPV in patients in the CM group (12/31, 38.8%) and CM/ESCC (8/24, 33.3%), compared to individuals in the ESCC group (6/37, 16.3%). The individuals in the groups with cancer (ESCC and CM/ESCC) had a higher frequency of HPV-16 (4/9, 44.5% and 2/8, 25.0%). The other types of high-risk HPVs detected were HPV-31, 45, 51, 53, 56, 66, and 73. We also observed in some samples HPV coinfection by more than one viral type. Despite the high incidence of HPV, it did not show any association with the patient's clinical-pathological and molecular (TP53 mutation status) characteristics. Conclusion: This is the first report of the presence of HPV DNA in CM associated with ESCC. HPV infection was more presence in megaesophagus lesions. Further studies are needed to confirm and better understand the role of persistent HPV infection in patients with CM.
... It is one of the most prevalent sexually transmitted diseases, with over half Vaccines 2021, 9,1231 3 of 19 of sexually active individuals contracting HPV during their life [36]. Despite the existence of over 200 HPV types, 70% HPV-related pathologies are due to infection with HPV types 16,18,6, and 11 [37,38]. ...
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Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husband's positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husband's approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.
... Human papillomavirus (HPV), a sexually transmitted DNA virus belonging to the Papovaviridae family, has been con rmed as the essentially causative agent for cervical cancer (8). It is estimated that most sexually active adults have been infected by at least one HPV Genotype (9). If the infection with the highrisk HPV strains persists which then could be a well-established cause of cervical cancer (10). ...
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In this study, a total of 301,880 woman were recruited from 4 different regions of China. The overall prevalence of HPV was 18.01 %. The high-risk HPV infection rate was 79.14%, the low-risk HPV infection rate was 12.56 %, and the mixed HPV infection rate was 8.30%. The most common 4 HR HPV subtypes were HPV-52, 16, 58 and 53, which accounted for 20.49 %, 19.93 %, 14.54 % and 10.01 %. In LR HPV genotype, HPV-6 ranked the highest (28.17 %), followed by HPV-81 (9.09 %) and HPV-11 (3.78 %). HPV genotype subgroup analysis also showed that single-type infections had the highest prevalence rate (77.26 %) among HPV positive individuals. Among muti-infection genotype, double infection was the most common with frequencies of 76.04 %. This large report showed that the overall prevalence of HPV was high in China, whose distribution exhibits different patterns across different particular age and regions. Viral genotypes HPV 53, 6 were frequently detected in this population, which is worth of significant clinical attention.
... It is well established that the most critical risk factor for cervical cancer is having experienced a persistent infection with one of the high-cancer-risk versions of HPV [6]. Persistent infection can lead to developing precancerous lesions that, if undetected and untreated, can progress to invasive cervical cancer. ...
Article
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In Japan, government subsidies for human papillomavirus (HPV) vaccination of girls aged 13–16 commenced in 2010. By early 2013, vaccination had become a widely accepted national immunization program. However, in June of 2013, the Ministry of Health, Labor, and Welfare (MHLW), the government’s lead agency, suspended its recommendation for vaccination in response to reports of adverse vaccine events. The rate of HPV vaccination quickly dropped from 70% to almost zero, where it has lingered for eight years. In 2020, a new 9-valent HPV vaccine was licensed in Japan. The momentum seemed to be building for the resumption of HPV vaccinations, yet Japanese mothers remain widely hesitant about vaccinating their daughters, despite the well-proven safety and efficacy of the HPV vaccines. The Japanese government and our educational and medical institutions must work harder as a team to inform our parents and their children about the life-saving benefits of the HPV vaccine, and at the same time, we must respond to all their concerns and questions. The vaccine hesitancy of unvaccinated women born in 2000 and thereafter is a natural consequence of the suspension of the government‘s recommendation. We must also take every possible measure to reduce the significant risk for cervical cancer these women have.
... However, not all infections cause tumor development due to the oncogenic potential of different types of HPV [2][3][4][5]. For instance, high-risk HPV types 16 and 18 are reported with the greatest frequency in cervical cancer [4,6,7]. The oncogenic potential of high-risk HPV is due to E6 and E7 oncoprotein production, which initiates a series of alterations associated with cell transformation through the inactivation of p53 and pRB, respectively [4,8,9]. ...
Article
Full-text available
The oncogenic potential of high-risk human papillomavirus (HPV) is predicated on the production of the E6 and E7 oncoproteins, which are responsible for disrupting the control of the cell cycle. Epidemiological studies have proposed that the presence of the N29S and H51N variants of the HPV16 E7 protein is significantly associated with cervical cancer. It has been suggested that changes in the amino acid sequence of E7 variants may affect the oncoprotein 3D structure; however , this remains uncertain. An analysis of the structural differences of the HPV16 E7 protein and its variants (N29S and H51N) was performed through homology modeling and structural refinement by molecular dynamics simulation. We propose, for the first time, a 3D structure of the E7 reference protein and two of its variants (N29S and H51N), and conclude that the mutations induced by the variants in N29S and H51N have a significant influence on the 3D structure of the E7 protein of HPV16, which could be related to the oncogenic capacity of this protein.
... 19 OSP can appear at any age but is found most frequently in patients between 30 to 50 years old. 19,20 Clinically, OSP is manifested as a soft, non-painful tumor with a color varying from white to pink. 21 ...
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Objective: The aim of our retrospective study is to compare the long-term recurrence rate of the benign oral squamous papilloma (OSP) with different laser-assisted treatments and conventional procedures (use of scalpels) aiming to suggest the most suitable surgical protocol showing the lowest recurrence rate. Background: A retrospective multicenter DATA collection between 1985 and 2019 covering 781 OSP cases concerning different surgical protocols used for the treatment of OSP was done and included the use of different laser wavelengths (neodymium-doped yttrium-aluminum-garnet [Nd:YAG], carbon dioxide [CO2], and Diode 980 nm) and the conventional surgeries using the scalpel. The age, sex, and the oral location of the OSP were noted. Methods: Three different surgical protocols were selected in our study: protocol 1 regrouped surgical procedures performing the excision of OSP with an in-depth safety margin of 1 mm and just at the base of the tumor with reduced excision of the grossly normal marginal mucosa around the tumor (0-1 mm). Protocol 2 and 3 were similar to protocol 1, but with an additional excision of 1-2 mm and ≥3 mm of the grossly normal marginal mucosa, respectively, for group 2 and 3. All laser-treated OSP wounds were left without sutures. In the conventionally treated OSP, sutures were regularly performed. Follow-up was done after 15 days and at 1, 6, and 18 months. The three included wavelengths were Nd:YAG (1064 nm), CO2 laser (10,600 nm), and diode laser (980 nm). Results: After 18 months of follow-up, the highest success rate was obtained with protocol 3 (100% with Nd:YAG, 99% with CO2, 98.4% with diode, and 99% with the scalpel), which was significantly higher than the values of protocol 2 (96.6% with Nd:YAG, 91% with CO2, 96% with diode, and 95% with the scalpel) and the protocol 1 (38% with Nd:YAG, 29% with CO2, 33% with diode, and 30% with the scalpel). The oral locations of OSP were 30% on palates, 30% on the tongue, 16% on cheek, 14% on lips, and 10% on other locations. Conclusions: The lowest recurrence rate was observed when a minimum of three millimeters (≥3 mm) of grossly normal aspect mucosa around the OSP was included in the excisions. The laser wavelengths and the use of scalpel did not show any significant difference in terms of recurrence.
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The article presents the advantages of screening cervical cancer based on the detection of oncogenic strains of human papillomavirus compare to traditional cytological screening using the PAP test. Self sampling using Aprovix's Qvintip tool (Sweden) allows to increase the percentage of women participating in national population screening programs, which will lead to an improvement in the incidence and mortality rates of the female population from cervical cancer. Keywords: cervical cancer screening, human papillomavirus, Self sampling method.
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The gold standard in the diagnosis and treatment of proctological diseases is the exploration of the anal canal and distal rectum under anaesthesia (EUA), routinely performed as day case surgery. In selected cases it can be conducted as an outpatient exploration (OE) during a specialist surgical consultation. In the outpatient setting it is possible and safe to perform rubber band ligation, sclerotherapy and infrared coagulation for the treatment of haemorrhoidal disease, excision and incision of thrombosed external haemorrhoids, abscess drainage, setonage and fistulotomy also in case of perianal Crohn’s disease, anal warts and skin tags removal. In terms of patients’ satisfaction and success rate OE is comparable to EUA. All procedures can be performed under local anaesthesia. Pain control after the procedure is provided by oral pain killers.
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Background: Many women are known to contract human papilloma virus (HPV) infection in their lifetime but only a few develop cervical cancer. One of the major factors that contribute to development of cervical cancer is HPV persistence. Several other factors including viral load have been implicated in cervical cancer development. This work therefore intends to investigate the persistence of cervical HPV infection among cohort of women in Awka, Nigeria.Methodology: A cohort of 58 women with normal Papanicolaou (Pap) test but positive HPV DNA selected from a population of 410 women at baseline were followed up over a period of 6 months from April to October 2015. Cervical specimens collected were subjected to HPV DNA test and viral quantification using TaqMan Real Time PCR and cervical cytology. Risk factors were obtained using semi structured interviewer administered questionnaires. Variables were analysed using descriptive statistics and T-test on IBM SPSS statistics version 21.0 and EPI INFOTM 7.0Results: At the 6-month follow up, cervical HPV infection persisted in 29 women, representing 50% of the women followed up. Among the 29 women, 7 (24.1%) developed abnormal Pap smear (Low grade Squamous Intraepithelial Lesion). Factors significantly associated with persistence at bivariate analysis of HPV include previous sexually transmitted infection (STI) (p=0.005), HIV positivity (p=0.04), HIV positivity but no anti-retroviral drugs (p=0.014), HPV 16 infection (p<0.0001) and age less than 40 years (p<0.0001). At multinomial logistic regression, only age above 17 years at first sexual intercourse (p=0.003, CI=0.012-0.392) and multiple lifetime sexual partners (p=0.021, CI=0.20-0.726) were statistically significant.Conclusion: High risk HPV infection, in addition to other factors peculiar to an individual may influence HPV persistenceKey words: cervical cancer, human papillomavirus, persistence, cytology, risk factors, infection French Title: Persistance de l'infection cervicale par le papillomavirus humain parmi une cohorte de femmes à Awka, Nigéria Contexte: De nombreuses femmes sont connues pour contracter une infection au virus du papillome humain (VPH) au cours de leur vie, mais seules quelques-unes développent un cancer du col de l'utérus. L'un des principaux facteurs qui contribuent au développement du cancer du col de l'utérus est la persistance du VPH. Plusieurs autres facteurs, y compris la charge virale, ont été impliqués dans le développement du cancer du col de l'utérus. Ce travail vise donc à étudier la persistance de l'infection cervicale au VPH parmi la cohorte de femmes à Awka, au Nigeria. Méthodologie: Une cohorte de 58 femmes avec un test de Papanicolaou (Pap) normal mais un ADN HPV positif sélectionné parmi une population de 410 femmes au départ ont été suivis sur une période de 6 mois d'avril à octobre 2015. Les échantillons cervicaux collectés ont été soumis à l'ADN HPV. test et quantification virale à l'aide de la PCR en temps réel TaqMan et de la cytologie cervicale. Les facteurs de risque ont été obtenus à l'aide de questionnaires semi-structurés administrés par les intervieweurs. Les variables ont été analysées à l'aide de statistiques descriptives et d'un test T sur IBM SPSS statistics version 21.0 et EPI INFOTM 7.0 Résultats: Au suivi de 6 mois, l'infection cervicale au VPH persistait chez 29 femmes, soit 50% des femmes suivies. Parmi les 29 femmes, 7 (24,1%) ont développé un test Pap anormal (lésion squameuse intraépithéliale de bas grade). Les facteurs significativement associés à la persistance lors de l'analyse bivariée du VPH comprennent les antécédents d'infection sexuellement transmissible (IST) (p=0,005), la positivité au VIH (p=0,04), la positivité au VIH mais pas d'antirétroviraux (p=0,014), l'infection au VPH 16 (p<0,0001) et moins de 40 ans (p<0,0001). Lors de la régression logistique multinomiale, seuls les âges supérieurs à 17 ans lors du premier rapport sexuel (p=0,003, IC=0,012-0,392) et les multiples partenaires sexuels à vie (p=0,021, IC=0,20-0,726) étaient statistiquement significatifs. Conclusion: Une infection au VPH à haut risque, en plus d'autres facteurs propres à un individu, peut influencer la persistance du VPH Mots clés: cancer du col de l'utérus, papillomavirus humain, persistance, cytologie, facteurs de risque, infection
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This paper aimed to investigate the characteristics of female HPV infection in the Shangcheng District, Hangzhou city, China. The retrospective study was designed to analyze the HPV prevalence rate of 22,382 women receiving physical examinations from 2016 to 2020 in the Shangcheng District of Hangzhou city in China. A commercial kit was designed to detect the HPV genotypes. Trends were examined for age-specific groups (≤ 30 years, 31–44 years, 45–54 years, 55–64 years, ≥ 65 years). A receiver operating characteristic (ROC) analysis was used to assess the correlation of age classification in high risk HPV (HR-HPV) infection. 22.41% (5015/22,382) of samples were HPV positive, 91.28% (4578/5015) of HPV positive women were infected by HR-HPV. The most prevalent HR-HPV genotypes were 16, 52, 18, 58, 56, and 51. The trend of HPV prevalence showed the significant differences in age-specific groups (χ2 = 164.70, P < 0.001). Moreover, the areas under ROC curve (AUC) was 0.712 in 55–64 years group which showed a strong contribution of age classification for HR-HPV infection. This study provided baseline data on the prevalence characteristics of HPV infection and the critical age group of HR-HPV prevalence rate was 55–64 y among the samples receiving physical examinations.
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Background: Social question-and-answer (Q&A) sites have become an important venue for individuals to obtain and share human papillomavirus (HPV) vaccine knowledge. Objective: This study aims to examine how different features of an HPV vaccine–related answer are associated with users’ response behaviors on social Q&A websites. Methods: A total of 2953 answers and 270 corresponding questions regarding the HPV vaccine were collected from a leading Chinese social Q&A platform, Zhihu. Three types of key features, including content, context, and contributor, were extracted and coded. Negative binomial regression models were used to examine their impact on the vote and comment count of an HPV vaccine–related answer. Results: The findings showed that both content length and vividness were positively related to the response behaviors of HPV vaccine–related answers. In addition, compared with answers under the question theme benefits and risks, answers under the question theme vaccination experience received fewer votes and answers under the theme news opinions received more votes but fewer comments. The effects of characteristics of contributors were also supported, suggesting that answers from a male contributor with more followers and no professional identity would attract more votes and comments from community members. The significant interaction effect between content and context features further showed that long and vivid answers about HPV vaccination experience were more likely to receive votes and comments of users than those about benefits and risks. Conclusions: The study provides a complete picture of the underlying mechanism behind response behaviors of users toward HPV vaccine–related answers on social Q&A websites. The results help health community organizers develop better strategies for building and maintaining a vibrant web-based community for communicating HPV vaccine knowledge.
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Background Persistent infection with high-risk human papillomavirus (HR-HPV) is the main leading cause of cervical precancerous lesions and cervical cancer. This study aims to explore the epidemiological characteristics of HR-HPV genotypes and their correlation with the ThinPrep cytological test (TCT) results among women in Chongqing, in China. Methods In this retrospective study, cervical exfoliations of 14,548 women who visited Chongqing university cancer hospital were collected for detecting HR-HPV genotypes and TCT. Results Overall, the rate of HR-HPV infection was 14.26%. The three most common HR-HPV genotypes are HPV52 (4.39%), HPV58 (2.21%), and HPV16 (1.94%). In this study, the positive rate of cervical TCT was 4.54%. Atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells that could not exclude high-grade squamous intraepithelial lesion (ASU-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells of undetermined significance (AGC) were 2.99%, 0.20%, 0.92%, 0.29%, and 0.14%, respectively. Among the several types of cytological lesions, the HR-HPV infection rates of ASC-US, ASC-H, LSIL, HSIL, and (AGC) were 24.82%, 41.38%, 64.18%, 95.24%, and 23.81%, respectively. Conclusions HPV52, HPV 58, and HPV16 are the most common infection subtypes in Chongqing. When implementing HPV vaccine programs in Chongqing, HPV58 and HPV52 should be attached importance as HPV16 and HPV18.
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Objective: This study aims to compare the efficacy of the potassium-titanyl-phosphate (KTP) laser and cold steel surgery in treating oropharyngeal papilloma. Methods: Between 2017 and 2020, we enrolled 242 patients with oropharyngeal papilloma who were treated with either the KTP laser (n = 160) or cold steel surgery (n = 82). Patient charts were reviewed for demographic data (age and gender), pathology, anatomical location of lesions, operative duration, pain rating, residual disease, and recurrence. Results: The oropharyngeal papillomas were successfully removed in all patients, except one with a significant pharyngeal reflex. There was no significant difference in the average time for lesion resection between KTP laser and cold steel group (18.11 ± 13.96 s vs 19.43 ± 16.91 s, P > .05). However, all patients who underwent cold steel surgery experienced bleeding during the operation and required postoperative observation (about 20 min), making the total procedure time longer than that of the KTP laser procedure, which did not cause any intraoperative bleeding or require postoperative observation. After KTP laser treatment, the pain rating was .49 ± .98, whereas after cold steel surgery, it was .74 ± 1.12 ( P = .058). Twenty-five samples were sent for human papillomavirus (HPV) testing, and one tested positive for both HPV 6 and 11 strains, while another tested positive for HPV 16. No residual disease or recurrence was observed at the treatment sites after a long period of follow-up (M = 15.35 ± 10.79 mo; range = 6-39 mo). Conclusion: The KTP laser provided a better hemostasis effect and a good surgical field of vision during the operation, allowing the surgeon to complete the procedure in less time. No significant difference in terms of pain rating, incision recovery, and postoperative recurrence between the KTP laser treatment and cold steel surgery.
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Background Data regarding human papillomavirus (HPV) prevalence, its associated risk factors and women's knowledge about this disease before HPV vaccine approved are limited in Shanghai, China. Therefore, we investigated these questions among females in Shanghai aimed to provide comprehensive data to guide HPV vaccination and present the biopsychosocial risk factors that impact on high-risk HPV infection and evaluate the level of knowledge and awareness of this disease among women aged 21-65 years old. Methods 6619 (aged from 21 to 65) women from different communities volunteered to participate in the HPV screening and finish questionnaires from December 2016 to December 2017 in Department of Obstetrics and Gynecology of nine hospitals in Shanghai. Data was analyzed using sample logistic regression to assess biopsychosocial risk factors that impact on high-risk HPV infection and knowledge of HPV infection. Results A total 632 (9.5%) cases were positive for high-risk HPV test, 22.6% of them were HPV 16/18 infection, 77.4% of them were non HPV16/18 infection. 40 potential risk factors may related to high-risk HPV infection, and there were 19 factors’ P valve<0.1 from single factor logistic analysis. Finally, multivariable regression revealed education level, type of vaginitis, history of Hyperlipidemias, family history of cancer, number of pregnancy, number of sex partners were independent risk factors for high-risk HPV infection (P<0.05). When stratified by education level, women who finished graduate school had significantly greater knowledge of cervical cancer, cervical screening and the relationship between HPV and cervical cancer than other groups (P<0.05). Conclusion The prevalence rate of high-risk HPV was a little lower than other regions in China and other countries, which may be related to regions, races, living habits and economy. A less reported finding is that history of vaginitis and the history of hyperlipidemias in our study were related to HPV infection. Majority of the participants had poor knowledge regarding cervical cancer, cervical screening and the relationship between HPV and cervical cancer. Hence, these results should be served as a wakeup call for government to increase the knowledge and awareness via the media and doctors. This article is protected by copyright. All rights reserved.
Introduction Women living with human immunodeficiency virus (HIV) have an increased risk of persistent human papillomavirus infection (HPV) of developing cervical cancer precursors and are, therefore, considered at higher risk for cervical cancer. Despite the higher risk, screening for cervical cancer is extremely low among HIV-positive women in India. Objectives Given the limited usefulness of cytology-based screening programs, the current study retrospectively evaluated the comparative performance of visual inspection with 5% acetic acid (VIA), conventional cytology, and human papillomavirus (HPV) testing among HIV-positive women attending the cancer screening clinic at the tertiary cancer center. Materials and Methods Retrospective analysis of 291 HIV-positive women attending cervical cancer screening services in a tertiary cancer center in Mumbai was undertaken. All underwent simultaneous screening with VIA, Pap cytology, and HPV DNA testing, followed by diagnostic colposcopy and histopathology. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect cervical intraepithelial neoplasia (CIN) 2/3 on histology were estimated. Results The screen positivity rate for cervical cancer screening by VIA, high-risk HPV DNA, and Pap cytology was 35.7, 34.4, and 6.2% respectively. At the CIN2+ disease threshold, the sensitivity, specificity, PPV, and NPV estimates were 80.00% (59.30–93.17), 68.42% (62.46–73.96), 19.23% (15.46–23.67), 97.33% (94.30–98.77) for VIA; 80.00% (68.78–97.45), 70.68% (64.81–76.08), 22.00% (18.22–26.32), 98.43% (95.58–99.45) for HPV DNA; and 64.00% (42.52–82.03), 98.12% (95.67–99.39), 76.19% (56.13–88.89), 96.67% (94.50–98.00) for cytology (HSIL cutoff). Conclusion The diagnostic performance of VIA and HPV DNA was comparable and better than cytology indicating that VIA as a cost-effective cervical cancer screening test can be incorporated within the services under sexually transmitted diseases /HIV testing and counseling centers within the country.
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Cervical cancer remains a major public health problem, ranking as the fourth most common cause of cancer incidence and mortality in women worldwide. Wide variations in cervical cancer incidence and mortality were observed with highest incidence rates in Sub Saharan Africa and with 85% of deaths occurring in developing regions of the world. Non-existent or inadequate screening in public health care settings and limited access to the standard treatment options explains the large geographic variation in cervical cancer rates. Persistent infection with high-risk Human papillomavirus (HPV) types is the major risk factor for cervical cancer. High parity, long-term use of oral contraceptive pills, tobacco consumption, co-infection with other sexually transmitted agents, lifestyle factors such as multiple sexual partners, younger age at first sexual intercourse, immunosuppression, and diet have been identified as the co-factors most likely to influence the risk of acquisition of HPV infection and its further progress to cervical carcinogenesis. Differential screening rates and changes in epidemiological patterns have contributed to decreasing trends in cervical cancer in some developed regions of the world. Lower rates were also observed in North Africa and the Middle East, which may be attributed to cultural norms and conservative sexual behaviors. Across world regions, HPV prevalence was highest in women younger than 35 years of age, declining to a plateau in middle age and showed significant association between national age standardized incidence rates and corresponding estimates of HPV prevalence. The five most common HPV types in HPV-positive women worldwide were HPV16, HPV18, HPV31, HPV58, and HPV52, representing 50% of all HPV infections with HPV-16 and HPV-18 infections accounting for about 70% of the total infection burden. Tracking changing trends in the cervical cancer epidemiological patterns including HPV genotypes will immensely contribute toward effective prevention and control measures for cervical cancer elimination.
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Background: Social question-and-answer (Q&A) sites have become an important venue for individuals to obtain and share human papillomavirus (HPV) vaccine knowledge. Objective: The present study aims to examine how different features of an HPV vaccine answer are associated with users’ response behaviors on social Q&A sites. Methods: A total of 2,953 answers and 270 corresponding questions regarding the HPV vaccine were collected from a leading Chinese social Q&A platform, Zhihu. Three types of key features, including content, context, and contributor, were extracted and coded. Negative binomial regression models were employed to examine their impacts on the vote and comment count of an HPV vaccine answer. Results: The findings showed that both content length and vividness were positively related to response behaviors of HPV vaccine answers. In addition, compared to answers under the question theme “benefits and risks,” answers under the question theme “vaccination experience” received fewer votes and answers under the theme “news opinions” received more votes but fewer comments. The effects of contributors’ characteristics were also supported, suggesting that answers from a male contributor with more followers and no professional identity would attract more votes and comments from community members. The significant interaction effect between content and context features further showed that long and vivid answers about HPV vaccination experience are more likely to receive users’ votes and comments than those about benefits and risks. Conclusions: The study provides a complete picture of the underlying mechanism behind users’ response behaviors towards HPV vaccine answers on social Q&A sites. The results help health community organizers develop better strategies for building and maintaining a vibrant online community for communicating HPV vaccine knowledge.
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Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the risk associated with the various HPV types has not been adequately assessed. We pooled data from 11 case-control studies from nine countries involving 1918 women with histologically confirmed squamous-cell cervical cancer and 1928 control women. A common protocol and questionnaire were used. Information on risk factors was obtained by personal interviews, and cervical cells were collected for detection of HPV DNA and typing in a central laboratory by polymerase-chain-reaction-based assays (with MY09/MY11 and GP5+/6+ primers). HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent) and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The most common HPV types in patients, in descending order of frequency, were types 16, 18, 45, 31, 33, 52, 58, and 35. Among control women, types 16, 18, 45, 31, 6, 58, 35, and 33 were the most common. For studies using the GP5+/6+ primer, the pooled odds ratio for cervical cancer associated with the presence of any HPV was 158.2 (95 percent confidence interval, 113.4 to 220.6). The odds ratios were over 45 for the most common and least common HPV types. Fifteen HPV types were classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82); 3 were classified as probable high-risk types (26, 53, and 66); and 12 were classified as low-risk types (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108). There was good agreement between our epidemiologic classification and the classification based on phylogenetic grouping. In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.
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Human papillomavirus (HPV) has been associated with cervical intraepithelial neoplasia, but the temporal relation between the infection and the neoplasia remains unclear, as does the relative importance of the specific type of HPV, other sexually transmitted diseases, and other risk factors. We studied prospectively a cohort of 241 women who presented for evaluation of sexually transmitted disease and had negative cervical cytologic tests. The women were followed every four months with cytologic and colposcopic examinations of the uterine cervix and tests for HPV DNA and other sexually transmitted diseases. Cervical intraepithelial neoplasia grade 2 or 3 was confirmed by biopsy in 28 women. On the basis of survival analysis, the cumulative incidence of cervical intraepithelial neoplasia at two years was 28 percent among women with a positive test for HPV and 3 percent among those without detectable HPV DNA: The risk was highest among those with HPV type 16 or 18 infection (adjusted relative risk as compared with that in women without HPV infection, 11; 95 percent confidence interval, 4.6 to 26; attributable risk, 52 percent). All 24 cases of cervical intraepithelial neoplasia grade 2 or 3 among HPV-positive women were detected within 24 months after the first positive test for HPV. After adjustment for the presence of HPV infection, the development of cervical intraepithelial neoplasia was also associated with younger age at first intercourse, the presence of serum antibodies to Chlamydia trachomatis, the presence of serum antibodies to cytomegalovirus, and cervical infection with Neisseria gonorrhoeae. Cervical intraepithelial neoplasia is a common and apparently early manifestation of cervical infection by HPV, particularly types 16 and 18.
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Oral contraceptive (OC) use was examined as a risk factor for cytological abnormalities of the cervix among 1964 women receiving Papanicolaou smears at three hospitals in the Washington, D.C., area. A single pathologist classified cytological results from all women as normal (n = 1423), atypia (n = 314), low grade squamous intraepithelial lesion (SIL; n = 208), or high grade SIL (n = 19). Women in each of the three abnormal groups were compared to women with normal cytological diagnoses. A subset of 579 patients, including most of the women with low or high grade SIL and a matched group of controls, was tested for human papillomavirus (HPV) by type-specific Southern blot hybridization to examine the effects of OC use while taking into account the effects of HPV infection. OC use was found to be unrelated to risk of atypia or low grade SIL but was associated with an elevated risk of high grade SIL that increased with longer duration of use (relative risk = 4.6, 95% confidence interval = 1.1-18.1 for greater than or equal to 5 years of use). HPV infection was associated, as expected, with risk of low and high grade SIL but not with atypia. Taking the HPV results into consideration did not alter the OC findings. There was no evidence that OC use synergistically increased the risk of cervical neoplasia among HPV-infected women, although small numbers prevented a reliable evaluation for high grade SIL. OC use did appear to increase the detection of HPV types 16/18, but the etiological importance of this finding is unclear.
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From 1950 through 1978, condyloma acuminatum was diagnosed in 746 residents of Rochester, Minn (246 male and 500 female subjects). With the number of cases increasing almost every year until 1975, the mean annual incidence rate reached 106.5 per 100,000 population in the period 1975 through 1978, apparently the highest reported to date. Among age groups, the rate was highest in the 20- through 24-year-old group. Female patients contracted the infection at a higher rate and at a younger age than male patients. Anal condyloma occurred in one third of the male subjects studied and recurrent condyloma in 30% of the male subjects. More female than male patients had lesions at multiple locations.
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Thirty-nine patients with condylomas (12 women and 27 men) attending a dermatology clinic were tested for genital human papillomavirus (HPV) DNA and for seroprevalence to HPV type 6 (HPV6) L1 virus-like particles. The L1 consensus PCR system (with primers MY09 and MY11) was used to determine the presence and types of HPV in sample specimens. All 37 (100%) patients with sufficient DNA specimens were positive for HPV DNA, and 35 (94%) had HPV6 DNA detected at the wart site. Three patients (8%) had HPV11 detected at the wart site, and one patient had both HPV6 and -11 detected at the wart site. Thirteen additional HPV types were detected among the patients; the most frequent were HPV54 (8%) and HPV58 (8%). Baculovirus-expressed HPV6 L1 virus-like particles were used in enzyme-linked immunosorbent assays to determine seroprevalence among the patients with warts. Seronegativity was defined by a control group of 21 women who were consistently PCR negative for HPV DNA. Seroprevalence was also determined for reference groups that included cytologically normal women who had detectable DNA from either HPV6 or HPV16 and women with HPV16-associated cervical intraepithelial neoplasia. Among the asymptomatic women with HPV6, only 2 of 9 (22%) were seropositive, compared with 12 of 12 (100%) female patients with warts. A similar trend in increased HPV6 seropositivity with increased grade of disease was found with the HPV16 DNA-positive women, whose seroprevalence increased from 1 in 11 (9%) in cytologically normal women to 6 in 15 (40%) among women with cervical intraepithelial neoplasia 1 or 3. However, only 4 of 25 (16%) male patients were seropositive. No factors examined, such as age, sexual behavior, or a history of warts, were found to definitively account for the gender difference in seroresponse.
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Cervicovaginal lavage samples from 124 human immunodeficiency virus type 1 (HIV-1)-seropositive and 126 HIV-1-seronegative women were collected monthly for 8 months and tested for human papillomavirus (HPV) DNA. The estimated prevalence of HPV was 42.8% in HIV-1-seropositive and 13.4% in -seronegative women (P < .00l). There was no significant difference in HPV DNA detection in HIV-1-seropositive women with CD4 cell counts of <300/mm3 (50% HPV-positive), 300–499/mm3 (36.4% HPV-positive), or ⩾500/mm3 (40.5% HPV-positive). However, HIV-1-seropositive women who were more immunocompromised, as indicated by lower CD4 cell counts, were more likely to shed HPV persistently. The quantity of HPV DNA detected in cervicovaginal lavage samples was similar in HIV-1-seropositive and -seronegative women. This study further defined the characteristics of HPV infections in HIV-1-infected women.
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Risk factors for cervicovaginal human papillomavirus (HPV) infection were investigated in 604 college women. HPV was detected in 168 (27.8%) ofthe subjects by L1 consensus primer polymerase chain reaction, Southern blot hybridization, or both. Significant independent risk factors for HPV (P < .05) included age (odds ratios [DRs]: 2.6 for 21-23 years old and 1.6 for >23, vs. ⩽0;20), ethnicity (DRs: 3.2 for black, 2.2 for Hispanic, vs. white/other), number of lifetime male vaginal sex partners (DRs: 4.5 for 2, 5.8 for 3 or 4, 10.3 for ⩾5, vs. 1), living with smokers (OR: 1.9), male partner's number of lifetime sex partners (DRs: 2.1 for 2 or 3, 3.1 for 4-10, 2.7 for ⩽11, vs. 1), duration of sexual relationship for > 12 months (OR: 0.6), and male partner currently in college (OR: 0.6). These data demonstrate that the predominant risk factors for genital HPV infection in young women are related not only to their own sexual behaviors but also to those of their male partners.
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To study the temporal relationship between serum antibody response and human papillomavirus type 16 (HPV-16) infection, a cohort of 325 university women were scheduled for examinations at 4-month intervals. At every examination, interviews were completed, cells were obtained for polymerase chain reaction–based testing and for Pap screening, and serum was obtained for testing with a HPV-16 capsid-capture ELISA. Seroreactivity was associated with detection of HPV-16 DNA and with increased numbers of sex partners. The median time to seroconversion was 8.3 months among women with incident HPV-16 infections. Within 16 months following HPV-16 DNA detection, 93.7% of women with prevalent and 67.1% of women with incident infections seroconverted. After seroconversion, antibody responses were maintained during follow-up among HPV-16 DNA–positive women. Women who seroconverted were 5.7 times (95% confidence interval = 2.4–13.4) more likely to have squamous intraepithelial lesions associated with the detection of HPV-16 DNA than were women who did not seroconvert.
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Human papillomavirus (HPV) is the main cause of cervical neoplasia. Because few population-based studies have investigated the prevalence of type-specific infection in relation to cervical disease, we studied a high-risk population, estimating the prevalence of HPV infection and the risk associated with various HPV types. We screened 9175 women in Guanacaste, Costa Rica, to obtain a referent standard final diagnosis, and tested 3024 women for more than 40 types of HPV with a polymerase chain reaction-based system. Among women with normal cytology, HPV infections peaked first in women younger than 25 years, and they peaked again at age 55 years or older with predominantly non-cancer-associated types of HPV and uncharacterized HPV types. Low-grade squamous intraepithelial lesions (LSILs) (n = 189) decreased consistently with age. The prevalence of high-grade squamous intraepithelial lesions (HSILs) (n = 128) peaked first around age 30 years and again at age 65 years or older. Seventy-three percent of LSILs were HPV positive, with HPV16 being the predominant type (16% of positive subjects). HPV was found in 89% of HSILs and 88% of cancers, with HPV16 being strongly predominant (51% and 53% of positive subjects). Virtually all HSILs and cancers had cancer-associated HPV types, with high odds ratios (ORs) and attributable fractions around 80%. Risk for HPV16 was particularly high (OR for HSILs = 320, 95% confidence interval [CI] = 97-1000; OR for cancer = 710, 95% CI = 110-4500). We confirm the early decline of HPV infection with age but note increased prevalence after menopause, which could be related to a second peak of HSILs, an observation that warrants further investigation. At least 80% of HPVs involved in cervical carcinogenesis in this population have been characterized. Polyvalent vaccines including the main cancer-associated HPV types may be able to prevent most cases of cervical disease in this region.
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HPV infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians’ offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. Using a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than clinically apparent infection.
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To assess long‐term trends in the prevalence of oncogenic human papillomavirus (HPV) infection, we performed a cross‐sectional serosurvey of the seroprevalence of the major oncogenic HPV type, HPV16, among 3,512 pregnant women undergoing population‐based serological screening at the first trimester of pregnancy in the same catchment area in Stockholm, Sweden, during 1969, 1983 or 1989. The overall HPV16 seroprevalence rates were 16% in 1969, 22% in 1983 and 21% in 1989. Seroprevalence was significantly increased, comparing both 1969 vs. 1983 (p = 0.0005) and 1969 vs. 1989 (p = 0.008). By comparison, the previously reported herpes simplex 2 (HSV‐2) seroprevalence in the same women increased from 17% in 1969 to 32% in 1983 and 33% in 1989, whereas the seroprevalence rates of HSV‐1 were the same (69% in 1969, 63% in 1983 and 68% in 1989). Odds ratios for HPV16‐positive women to also be HSV‐2‐positive were 1.8 in 1969 (p < 0.005), 1.1 in 1983 (p = NS) and 1.0 in 1989. Our results suggest that both HSV‐2 and HPV16 became more generally spread in the Swedish population between 1969 and 1983 but that the spread has been stable during the 1980s. Int. J. Cancer 76:341–344, 1998.© 1998 Wiley‐Liss, Inc.
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The risk of cervical neoplasia for women with normal Papanicolaou smears was calculated for those whose smears were human papillomavirus (HPV) positive and those whose smears were HPV negative. Data on 347 cases and controls were analyzed in a population-based, nested case-control study. Cases (n = 77) were women who participated in the Utrecht screening program (1976-1984) in the Netherlands and who developed cervical intraepithelial neoplasia 3 or microinvasive or invasive squamous cervical cancer after having a negative smear (1980-1986). Controls (n = 270) were matched on age (±5 years) and follow-up period. DNA was isolated from the Papanicolaou smears and was tested for the presence of HPV DNA by using the ultrasensitive broad-spectrum, general short-fragment polymerase chain reaction. HPV was found in 55 (71%) of the baseline smears of the 77 cases and in 31 (11%) of those of the 270 controls. The age-adjusted odds ratios for developing cervical intraepithelial neoplasia or microinvasive or invasive cervical cancer were 19.2 (95 percent confidence interval (Cl): 10.3, 35.7) for HPV positivity in general, 5.4 (95% CI : 1.5, 19.5) for infection with low-risk HPV genotypes, 24.0 (95% Cl: 12.4, 46.4) for high-risk HPV genotypes, and 104.8 (95% Cl: 29.5, 372.7) for HPV type 16.
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Incidence data on human papillomavirus (HPV) infection are limited, and risk factors for transmission are largely unknown. The authors followed 603 female university students in Washington State at 4-month intervals between 1990 and 2000. At each visit, a sexual and health questionnaire was completed and cervical and vulvovaginal samples were collected to detect HPV DNA. At 24 months, the cumulative incidence of first-time infection was 32.3% (95% confidence interval: 28.0, 37.1). Incidences calculated from time of new-partner acquisition were comparable for enrolled virgins and nonvirgins. Smoking, oral contraceptive use, and report of a new male sex partner—in particular, one known for less than 8 months before sex occurred or one reporting other partners—were predictive of incident infection. Always using male condoms with a new partner was not protective. Infection in virgins was rare, but any type of nonpenetrative sexual contact was associated with an increased risk. Detection of oral HPV was rare and was not associated with oral-penile contact. The data show that the incidence of HPV associated with acquisition of a new sex partner is high and that nonpenetrative sexual contact is a plausible route of transmission in virgins. cohort studies; incidence; papillomavirus, human; sexual abstinence; sexual partners; sexually transmitted diseases
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To clarify the role of human papillomavirus (HPV) in penile cancer we evaluated the prevalence of HPV DNA in different histological subtypes of penile carcinoma, dysplasia, and condyloma using a novel, sensitive SPF10 HPV polymerase chain reaction assay and a novel genotyping line probe assay, allowing simultaneous identification of 25 different HPV types. Formalin-fixed, paraffin-embedded tissue samples were collected from the United States and Paraguay. HPV DNA was detected in 42% cases of penile carcinoma, 90% cases of dysplasia, and 100% cases of condyloma. There were significant differences in HPV prevalence in different histological cancer subtypes. Although keratinizing squamous cell carcinoma and verrucous carcinoma were positive for HPV DNA in only 34.9 and 33.3% of cases, respectively, HPV DNA was detected in 80% of basaloid and 100% of warty tumor subtypes. There was no significant difference in HPV prevalence between cases from Paraguay and the United States. In conclusion, the overall prevalence of HPV DNA in penile carcinoma (42%) is lower than that in cervical carcinoma (∼100%) and similar to vulvar carcinoma (∼50%). In addition, specific histological subtypes of penile cancer—basaloid and warty—are consistently associated with HPV, however, only a subset of keratinizing and verrucous penile carcinomas is positive for HPV DNA, and thus these two tumor groups seem to develop along different pathogenetic pathways.
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High parity has long been suspected of being associated with an increased risk of cervical cancer, but previous analyses of this association have not taken the strong effect of human papillomavirus (HPV) into account. To assess the role of reproductive factors in the progression from HPV infection to cancer, we did a pooled analysis including only HPV-positive women. We pooled data from eight case-control studies on invasive cervical carcinoma (ICC) and two on in-situ carcinoma (ISC) from four continents. 1465 patients with squamous-cell ICCs, 211 with ISCs, 124 with adenocarcinomas or adenosquamous ICCs, and 255 control women, all positive for HPV DNA by PCR-based assays, were analysed. We calculated pooled odds ratios by means of unconditional multiple logistic regression models, and adjusted them for sexual and non-sexual confounding factors. The 95% CI were estimated by treating the odds ratio as floating absolute risk. We found a direct association between the number of full-term pregnancies and squamous-cell cancer risk: the odds ratio for seven full-term pregnancies or more was 3.8 (95% CI 2.7-5.5) compared with nulliparous women, and 2.3 (1.6-3.2) compared with women who had one or two full-term pregnancies. There was no significant association between risk of adenocarcinoma or adenosquamous carcinoma and number of full-term pregnancies. High parity increases the risk of squamous-cell carcinoma of the cervix among HPV-positive women. A general decline in parity might therefore partly explain the reduction in cervical cancer recently seen in most countries.
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Use of oral contraceptives could increase risk of cervical cancer; however the effect of human papillomavirus (HPV), the main cause of cervical cancer, is not usually taken into account. We aimed to assess how use of oral contraceptives affected risk of cervical cancer in women who tested positive for HPV DNA. We pooled data from eight case-control studies of patients with histologically confirmed invasive cervical carcinoma (ICC) and from two studies of patients with carcinoma in situ (ISC). Information about use of oral contraceptives was obtained from personal interviews. Effects were estimated as odds ratios, with logistic-regression models adjusted for possible confounders. 1465 of 1561 (94%) patients with ICC, 211 of 292 (72%) with ISC, and 255 of 1916 (13%) controls were positive for HPV DNA. Compared with never-users, patients who had used oral contraceptives for fewer than 5 years did not have increased risk of cervical cancer (odds ratio 0.73; 95% CI 0.52-1.03). The odds ratio for use of oral contraceptives was 2.82 (95% CI 1.46-5.42) for 5-9 years, and 4.03 (2.09-8.02) for use for 10 years or longer, and these risks did not vary by time since first or last use. Long-term use of oral contraceptives could be a cofactor that increases risk of cervical carcinoma by up to four-fold in women who are positive for cervical HPV DNA. In the absence of worldwide information about HPV status, extra effort should be made to include long-term users of oral contraceptives in cervical screening programmes.
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A recombinant vaccinia virus termed pLC201 VV was designed to coexpress the Li and L2 late genes of human papillomavirus type 16 (HPV16). Synthesis of the Li and L2 proteins occurred in cells infected with pLC201VV, and 40-nm virus-like particles with a density of 1.31 g/ml were produced in the nuclei of cells synthesizing both L1 and L2, but not in cells synthesizing either protein alone. Virus-like particles were partially purified from infected cells by sucrose gradient sedimentation and shown to consist of capsomeres similar to HPV and contain glycosylated L1 viral capsid protein. The production of HPV-like particles using recombinant vaccinia virus should be useful for biochemical studies and could provide a safe source of material for the development of a vaccine.
Article
Thesis (Ph. D.)--University of Washington, 1997 Prospective studies were conducted among women attending a University and women presenting to a STD clinic to evaluate an association between risk of cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) and human papillomavirus type 16 (HPV16) variants. CIN 2-3 was histologically confirmed in 9 of 57 HPV16 positive women attending the University and in 10 of 66 HPV16 positive women presenting to the STD clinic. Among university students, those with HPV16 non-prototype-like (NPL) variants were 6.5 (95% CI, 1.6-27.2) times more likely to develop CIN 2-3 than those with prototype-like (PL) variants. A similar association was observed among women presenting to the STD clinic (RR = 4.5; 95% CI, 0.9-23.8).An association between risk of anal intraepithelial neoplasia grade 3 or carcinoma in situ (AIN3/CIS) and HPV16 variants was examined in a cohort of bisexual or homosexual men. Of 589 men, 37% were positive for HPV16, including 33% with PL variants and 4% with NPL variants. AIN3/CIS was histologically confirmed in 22 cases. Among men with HPV16 infection, those with NPL variants were 4.3 times (95% CI = 1.6-11.6) more likely to develop AIN3/CIS than those with PL variants. Additional adjustments for HIV status and CD4 count or the level of HPV16 DNA did not alter risk estimates substantially. Neither a high level of viral DNA nor a prolonged period of DNA detection was associated with HPV16 NPL variants.To verify whether HPV16 variants change over time, sequence variation of variants was examined in consecutive specimens from individuals. Seventy subjects who were repeatedly HPV16 DNA positive, over 2-8 four-monthly visits, showed an identical polymorphism at every visit. Sequencing many clones from each specimen confirmed that one major variant seemed to predominate over time, whereas minor variants appeared more transient.While the data suggest that HPV16 NPL as compared to PL variants are associated with an increased risk of high grade lesions, the biological mechanism relating to this excess risk remains undetermined. In view of the relatively short time followed, it would not be appropriate to generalize our data beyond the observed time period nor to the risk of invasive cancer.
Article
Carcinoma of the cervix has several well–established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission. [J Natl Cancer Inst 83: 997–1003, 1991]
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By a collaborative effort among British cytopathologists, 101 women were identified who had had unsuspected "positive" cervical smears but who, after at least 2 years, had still escaped biopsy through refusal, default, or failure to trace. Of these, 31 still could not be traced; 10 were traced but could not be further examined (8 because they refused); 7 had clinically diagnosed carcinoma of the cervix; and the remaining 53 had further smears and/or biopsies after a mean interval of 5.2 years. In 19 of the 53 the smear had become negative or biopsy showed no lesion. Regression was confined to women aged under 40 at the time of the initial positive smear. In 20 cases biopsy showed dysplasia or carcinoma-in-situ, in 3 microinvasive carcinoma, and in 3 occult invasive carcinoma. Of the 7 women who presented clinically with carcinoma of the cervix, this caused death in 5.
Article
Infection by certain human papillomavirus types is regarded as the major risk factor in the development of cervical cancer, one of the most common cancers of women worldwide. Analysis of the immunogenic and structural features of papillomavirus virions has been hampered by the inability to efficiently propagate the viruses in cultured cells. For instance, it has not been established whether the major capsid protein L1 alone is sufficient for virus particle assembly. In addition, it is not known whether L1, L2 (the minor capsid protein), or both present the immunodominant epitopes required for induction of high-titer neutralizing antibodies. We have expressed the L1 major capsid proteins of bovine papillomavirus type 1 and human papillomavirus type 16 in insect cells via a baculovirus vector and analyzed their conformation and immunogenicity. The L1 proteins were expressed at high levels and assembled into structures that closely resembled papillomavirus virions. The self-assembled bovine papillomavirus L1, in contrast to L1 extracted from recombinant bacteria or denatured virions, also mimicked intact bovine papillomavirus virions in being able to induce high-titer neutralizing rabbit antisera. These results indicate that L1 protein has the intrinsic capacity to assemble into empty capsid-like structures whose immunogenicity is similar to infectious virions. This type of L1 preparation might be considered as a candidate for a serological test to measure antibodies to conformational virion epitopes and for a vaccine to prevent papillomavirus infection.
Article
Carcinoma of the cervix has several well-established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission.
Article
In an investigation conducted in student health clinic patients, the polymerase chain reaction was used to detect human papillomavirus (HPV) DNA, thereby allowing measurement of the prevalence of HPV infection and study of the association between HPV infection and risk factors for cervical cancer. Of 159 women eligible to participate, 105 (66%) provided a specimen of cervical cells for HPV typing, and also answered an interviewer-administered questionnaire which sought information on risk factors for cervical cancer. Nucleic acid extracted from cervical cells was screened with primers for HPV types 6, 11, 16, 18, 33 and with an HPV Consensus primer. Overall, the prevalence of HPV infection was 18.1%, while for HPV-6/11 it was 2.9% and for HPV-16/18 it was 10.5%. There were statistically significant increases in risk of HPV infection with a history of ever having smoked cigarettes (overall, and for HPV-16 alone) and with a history of usually having sexual intercourse during menstrual periods (overall, but not for HPV-16), and these associations were independent of the effects of age at first sexual intercourse and number of sexual partners. The latter 2 variables, as well as the total number of occasions of sexual intercourse, a history of anal intercourse, and a history of ever having used oral contraceptives, were not associated with statistically significant alterations in risk of HPV infection.
Article
HPV infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. Using a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than clinically apparent infection.