Human Papilloma Virus Research - Dangers

Clark LR, Atendido M. Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

PURPOSE: The purpose of this study was to explore the clinical findings, diagnosis, and treatment of group B streptococcal (GBS) vulvovaginitis in a sample of adolescent girls and young women found to have this condition. METHODS: Descriptive retrospective analysis of charts of 13 adolescent girls and young women found to have GBS vulvovaginitis was performed. RESULTS: Of the girls and young women with GBS vulvovaginitis, almost all were found to have a purulent vaginal discharge (n = 12). Three had frank cervicitis and/or vaginitis on examination. Only 1 was diagnosed accurately with GBS vulvovaginitis at the time of the visit and 4 were treated with appropriate antibiotics at the time of the visit. CONCLUSIONS: GBS vulvovaginitis is a poorly diagnosed disease entity in the adolescent and young adult population. Further study is needed in the epidemiology of GBS vaginitis in postpubertal adolescent girls and women to improve the recognition, pathogenesis, and treatment of GBS vaginitis.

J Low Genit Tract Dis. 2005 Jan;9(1):52-4.

Cervicitis decidualis: a rare cause of antepartum hemorrhage.

Oladipo A, Mathew J. Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom.

This report describes the case of a patient with clinically antepartum hemorrhage and a colposcopic lesion resembling invasive cervical cancer. A 28-year-old patient sought treatment at 28 weeks of pregnancy with significant antepartum hemorrhage, clinically thought to be a result of placenta previa or abruptio placenta. Colposcopy showed a lesion resembling an invasive cervical cancer for which a biopsy was taken. Abnormal placentation was ruled out by ultrasound examination of the uterus. Histologic analysis showed a cervical decidual reaction with focal surface ulceration accounting for the cervical growth and hemorrhage. We describe an unusual cause of significant intrapartum hemorrhage attributable to cervical decidual reaction, mimicking abnormal placentation clinically and invasive cervical cancer colposcopically.

Sex Transm Infect. 2005 Feb;81(1):67-72.

Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers.

Pepin J, Labbe AC, Khonde N, Deslandes S, Alary M, Dzokoto A, Asamoah-Adu C, Meda H, Frost E. Department of Microbiology and Infectious Diseases, University of Sherbrooke, Sherbrooke, Canada.

OBJECTIVES: To identify the contribution of Mycoplasma genitalium to the aetiology of cervicitis in sub-Saharan Africa and its relative importance in the overall burden of sexually transmitted infections among female sex workers (FSW). METHODS: The study population consisted of FSW recruited in Ghana and Benin during the initial visit of a randomised controlled trial. A questionnaire was administered, a pelvic examination carried out, and cervical samples obtained for detection of M genitalium, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Clinical signs potentially indicating cervicitis were cervical discharge, pus on the cervical swab, bleeding after sampling, and inflammatory cervix. RESULTS: Among 826 FSW, 26.3% were infected with M genitalium. N gonorrhoeae was strongly and independently associated with each of the four signs of cervicitis (adjusted odds ratios (AOR): 4.1 to 6.0). The AOR for C trachomatis were intermediate (1.3-4.1) and the AOR for M genitalium were lower (between 1.6 and 1.8) but statistically significant (p< or =0.05) for each sign. CONCLUSIONS: M genitalium is weakly associated with signs of cervicitis in west African FSW but is highly prevalent.

Int J Gynecol Cancer. 2005 Jan-Feb;15(1):81-7.

Human papillomavirus (HPV) genotyping by HPV DNA chip in cervical cancer and precancerous lesions.

Lee GY, Kim SM, Rim SY, Choi HS, Park CS, Nam JH. Department of Obstetrics and Gynecology, College of Medicine, Chonnam National University Hospital, 8 Hakdong, Dongku, Gwangju 501-190, Korea.

OBJECTIVES: The human papillomavirus (HPV) is a well-known cause of cervical cancer. HPV tests are used as an adjunct test to decrease the false-negative rate of cytological screening. However, attempts are being made to replace the cytological screening with HPV tests. Therefore, this study was performed to examine the possibility of using HPV tests as screening test. MATERIALS AND METHODS: The results of the tests that were performed at the same time including the ThinPrep cytology, the high-risk group hybrid capture II (HC-II) test, the HPV DNA chip (HD-C) test, and a punch biopsy were compared in 400 women who were referred to us due to abnormal cytology or cervicogram. The accuracy of each test was then evaluated, and the type of virus was investigated using a HD-C test. RESULTS: The positive predictive values detected by the high-risk group HC-II test and HD-C test according to the histological diagnosis outcomes were 56.8 and 53.8%, respectively, for cervicitis; 91.5 and 91.5%, respectively, for cervical intraepithelial neoplasia I (CIN I); 88.1% and 81.0%, respectively, for CIN II; 88.6 and 84.2%, respectively, for CIN III, and 92.5 and 88.7%, respectively, for cancer (in 53 patients). The most prevalent types of HPV according to the HPV tests were types 16, 58, 18, and 52 in which type 16 was detected in the more advanced lesions. The sensitivity was 88.4% for the ThinPrep cytology, 89.9% for the HC-II for the high-risk group, and 86.2% for the HD-C test. CONCLUSION: These results suggest the possibility of using the HC-II and HD-C tests as screening tests, which have a similar sensitivity as the ThinPrep cytology. Nonetheless, randomized controlled trials will be needed before the actual application of the HPV tests as screening tests. Despite the fact that the importance of HPV type 16 in cancer development was confirmed, the prevalence of types 58 and 52 were relatively high compared with those found in other studies, showing a need for further studies on this subject. These HPV types need to be considered in vaccine development.

Am J Epidemiol. 2005 Jan 15;161(2):186-95.

Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women.

Ness RB, Hillier SL, Kip KE, Richter HE, Soper DE, Stamm CA, McGregor JA, Bass DC, Rice P, Sweet RL. University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, Room A530 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.

Douching has been linked to gonococcal or chlamydial cervicitis and pelvic inflammatory disease (PID) in retrospective studies. The authors conducted a 1999-2004 prospective observational study of 1,199 US women who were at high risk of acquiring chlamydia and were followed for up to 4 years. Cervical Neisseria gonorrhoeae and Chlamydia trachomatis were detected from vaginal swabs by nucleic acid amplification. PID was characterized by histologic endometritis or pelvic pain and tenderness plus one of the following: oral temperature >38.3 degrees C, leukorrhea or mucopus, erythrocyte sedimentation rate >15 mm/hour, white blood cell count >10,000, or gonococcal/chlamydial lower genital tract infection. Associations between douching and PID or gonococcal/chlamydial genital infections were assessed by proportional hazards models. The 4-year incidence rate of PID was 10.9% and of gonococcal and/or chlamydial cervicitis was 21.9%. After adjustment for confounding factors, douching two or more times per month at baseline was associated with neither PID (adjusted hazard ratio = 0.76, 95% confidence interval: 0.42, 1.38) nor gonococcal/chlamydial genital infection (adjusted hazard ratio = 1.16, 95% confidence interval: 0.76, 1.78). Frequency of douching immediately preceding PID or gonococcal/chlamydial genital infection was not different between women who developed versus did not develop outcomes. These data do not support an association between douching and development of PID or gonococcal/chlamydial genital infection among predominantly young, African-American women.

Publication Types:
• Multicenter Study

Clin Microbiol Rev. 2004 Oct;17(4):965-81, table of contents.

The molecular mechanisms used by Neisseria gonorrhoeae to initiate infection differ between men and women.

Edwards JL, Apicella MA. Department of Microbiology, The University of Iowa, 51 Newton Rd., BSB 3-403, Iowa City, IA 52242, USA.

The molecular mechanisms used by the gonococcus to initiate infection exhibit gender specificity. The clinical presentations of disease are also strikingly different upon comparison of gonococcal urethritis to gonococcal cervicitis. An intimate association occurs between the gonococcus and the urethral epithelium and is mediated by the asialoglycoprotein receptor. Gonococcal interaction with the urethral epithelia cell triggers cytokine release, which promotes neutrophil influx and an inflammatory response. Similarly, gonococcal infection of the upper female genital tract also results in inflammation. Gonococci invade the nonciliated epithelia, and the ciliated cells are subjected to the cytotoxic effects of tumor necrosis factor alpha induced by gonococcal peptidoglycan and lipooligosaccharide. In contrast, gonococcal infection of the lower female genital tract is typically asymptomatic. This is in part the result of the ability of the gonococcus to subvert the alternative pathway of complement present in the lower female genital tract. Gonococcal engagement of complement receptor 3 on the cervical epithelia results in membrane ruffling and does not promote inflammation. A model of gonococcal pathogenesis is presented in the context of the male and female human urogenital tracts.

Publication Types:
• Review
• Review, Tutorial

Human Papilloma Virus Research - Dangers Associated with Cervicitis Links

Chlamydia Facts - Read about cervicitis and related disorders.

Gonococcal Cervicitis - Learn about this disorder and how to cope with it.