Journal of Lower Genital Tract Disease最新文献

{"title":"Treatment Interventions for Usual-Type Vulvar Intraepithelial Neoplasia: A Systematic Review and Meta-analysis.","authors":"Ana Carolina Simões, Ayane Cristine Sarmento, Antonio Carlos Aquino, José Eleutério-Jr, Isabel Cristina do Val Guimarães, Megan L Falsetta, Ana Katherine Gonçalves","doi":"10.1097/LGT.0000000000000901","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000901","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the efficacy of treatments for usual-type vulvar intraepithelial neoplasia (uVIN).</p><p><strong>Materials and methods: </strong>This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, Embase, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, PsycINFO, and Clinical Trial Databases in July 2024. Clinical trials comparing treatments for uVIN to a placebo or other treatments were included. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and the strength of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Out of 10,306 studies, 8 met the inclusion criteria. A meta-analysis of 2 studies comparing imiquimod 5% to placebo found that 55.3% of women in the imiquimod group experienced total lesion resolution, compared to 0% in the placebo group (risk ratio = 18.21, 95% CI = 2.60-127.69). Cidofovir 1% had a complete response rate of 41%, while imiquimod 5% showed a 42% response. Imiquimod 5% was well-tolerated and showed a trend toward noninferiority to surgical treatments. Ultrasonic surgical aspiration is less scary than CO2 laser vaporization, with similar efficacy. Sinecatechins 10% showed lesion improvement in the best observed clinical response compared to those in the placebo group (p = .002), while indole-3-carbinol and Omiganan were ineffective despite adherence to treatment protocols.</p><p><strong>Conclusions: </strong>Imiquimod 5% is an effective treatment for uVIN with comparable results to surgery. Cidofovir 1% is another effective option. Less invasive treatments are beneficial for multifocal or extensive lesions but combining medical and surgical approaches has not been studied.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alinity m HR HPV Assay: United States Clinical Trial Design and High-Risk Human Papillomavirus Prevalence.","authors":"Mark Stoler, Richard Cullum, Danijela Lucic, Thomas Wright","doi":"10.1097/LGT.0000000000000900","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000900","url":null,"abstract":"<p><strong>Objective: </strong>The Alinity m HR HPV assay is a qualitative molecular assay that simultaneously detects high-risk human papillomavirus (hr HPV) genotypes HPV16, 18, and 45 and reports the 11 other hr HPV genotypes in 2 aggregates as other HR HPV A (HPV31, 33, 52, 58) and other HR HPV B (HPV35, 39, 51, 56, 59, 66, 68). Here, we describe the prevalence of hr HPV genotypes in the Alinity m HR HPV assay US clinical trial population stratified by age, cytology, and cervical disease status.</p><p><strong>Materials and methods: </strong>This study included 11,532 women undergoing routine cervical cancer screening.</p><p><strong>Results: </strong>Overall hr HPV positivity decreased with age. Other HR HPV B genotypes had the highest positivity followed by other HR HPV A, HPV16, HPV45, and HPV18. In the population with ≥atypical squamous cells of undetermined significance cytology, other HR HPV A and other HR HPV B genotypes had the highest positivity rates. HPV16 and other HR HPV A positivity rates were highest in specimens with ≥cervical intraepithelial neoplasia 3 by histology.</p><p><strong>Conclusions: </strong>This analysis of primary screening participants in the Alinity m HR HPV assay US clinical trial demonstrates the benefits of including genotype-specific testing in cervical cancer screening programs.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulvovaginal Candidiasis Caused by Candida krusei (Pichia kudriavzevii), Still a Formidable Challenge.","authors":"Yogitha Sai Vempati, Jack D Sobel","doi":"10.1097/LGT.0000000000000899","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000899","url":null,"abstract":"<p><strong>Objectives: </strong>In recent years, the prevalence of non-albicans Candida vulvovaginitis has risen with Candida glabrata and Candida krusei (Pichia kudriavzevii) being prominent contributors. Candida krusei poses a significant challenge due to its intrinsic resistance to fluconazole, both in vitro and clinically. Practitioners face difficulties managing patients with chronic symptomatic vulvovaginal candidiasis who fail to respond to multiple courses of oral fluconazole and over the counter (OTC) antifungals.</p><p><strong>Methods: </strong>We analyzed retrospectively a cohort of women who had chronic vulvovaginal symptoms seen in our vaginitis clinic between 2017 and 2024. Clinical charts of 11 patients with positive C. krusei vaginal fungal isolates were reviewed. Antifungal susceptibility of isolates was assessed, and treatments, including novel antifungal agents oteseconazole and ibrexafungerp, were evaluated for their efficacy in symptom control.</p><p><strong>Results: </strong>In 10 of 11 patients, symptoms were attributed to C. krusei vaginitis, while in 1 patient, C. krusei was found to be an innocent bystander. Candida krusei vaginal isolates in vitro susceptibility testing demonstrated resistance not only limited to fluconazole but also to miconazole, ketoconazole, and other azole agents. Although itraconazole exhibited in vitro activity, treatment often failed to achieve clinical or mycologic remission. Despite the availability of new antifungal agents, vaginal boric acid emerged as the initial if not definitive treatment method of choice.</p><p><strong>Conclusion: </strong>Determining the antifungal susceptibility profile of C. krusei vaginal isolates may be required in selecting effective antifungal treatment of refractory vaginitis due to non-albicans Candida (NAC).</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASCCP President's Message.","authors":"Michelle J Khan","doi":"10.1097/LGT.0000000000000898","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000898","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifetime Cervical Cancer Screening and Social Determinants of Health in the Canadian Longitudinal Study on Aging.","authors":"Melissa Lavecchia, Amanda Selk, Maura Marcucci, Andra Nica, Parminder Raina, Waldo Jimenez, Julie Mv Nguyen","doi":"10.1097/LGT.0000000000000895","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000895","url":null,"abstract":"<p><strong>Objectives: </strong>In Canada, cervical cancer rates remain well above the World Health Organization target, despite screening and vaccination programs. Modeling reveals that those who have never undergone screening represent one of the highest risk populations. The Canadian Longitudinal Study on Aging (CLSA) prospectively collected health outcomes on >50,000 individuals. We sought to identify the prevalence of Canadian female participants having never undergone cervical cancer screening and the association with social determinants of health.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis from CLSA data. The main outcome was self-report of ever having undergone a Pap smear. Regression analyses evaluated the association between demographic or social determinants of health and self-reported lifetime cervical cancer screening.</p><p><strong>Results: </strong>The population-based sample comprised 22,910 participants aged 45-85, of whom 99.8% had available information on cervical cancer screening (n = 22,720). The prevalence of never having undergone a Pap smear was 14.1%; weighted prevalence, 11.8% (95% CI = 11.0-12.6). The following factors were associated with never having undergone screening: older age(10-year) (OR = 1.5, 95% CI = 1.4-1.6), lower education(low vs. high) (OR = 1.5, 95% CI = 1.2-1.9), lower household income(low vs. high) (OR = 1.7, 95% CI = 1.3-2.3), having a religious affiliation (OR = 1.3, 95% CI = 1.1-1.5), and never being married/lived in common law (OR = 1.5, 95% CI = 1.2-1.9). Notably, not having a family physician was also associated (OR = 2.3, 95% CI = 1.6-3.3). However, among participants who never underwent a Pap smear, 97% reported having a family physician.</p><p><strong>Conclusions: </strong>Our analysis highlights inequities in cervical cancer screening in the Canadian context. These insights are critical in informing a more equitable approach to implementing human papillomavirus (HPV)-based screening.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awards Presented as Part of the ASCCP 2025 Scientific Meeting on Anogenital & HPV-Related Diseases.","authors":"","doi":"10.1097/LGT.0000000000000897","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000897","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASCCP Clinical Guidance Document Standardization.","authors":"Jenna Z Marcus, Christine Conageski, Akiva P Novetsky, David P Chelmow","doi":"10.1097/LGT.0000000000000896","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000896","url":null,"abstract":"<p><strong>Abstract: </strong>The American Society for Colposcopy and Cervical Pathology (ASCCP) provides practice guidance for clinicians caring for patients with lower genital tract conditions. The ASCCP wants to ensure that its library of guidance documents is current, evidence based, and easy for clinicians to use. Guidance documents should present clear, actionable evidence-based management recommendations where the quality of the evidence and the strength of the recommendation are clearly identified. This document explains ASCCP's new standard document types and the processes for their development and maintenance, as well as the process for selecting new topics.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risk of Developing Cervical Cancer in the Elderly; Who Benefits From Screening After the Age of 60?","authors":"Renée M F Ebisch, Celine Buijssen, Nicole C M Visser, Albert G Siebers, Ruud L M Bekkers","doi":"10.1097/LGT.0000000000000893","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000893","url":null,"abstract":"<p><strong>Objectives: </strong>Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.</p><p><strong>Methods: </strong>People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.</p><p><strong>Results: </strong>A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.</p><p><strong>Conclusions: </strong>People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Collected Swabs for Primary HPV Screening in an Underscreened Population in Hawaii.","authors":"Anna Ung, Jonathan Riel, Paris Stowers, Jeffrey Killeen, Singne Brown, Ann Chang","doi":"10.1097/LGT.0000000000000887","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000887","url":null,"abstract":"<p><strong>Objectives: </strong>This study assessed the feasibility and acceptability of Human Papillomavirus (HPV) self-swab collection at a Hawaii-based Federally Qualified Health Center in the United States with low cervical cancer screening rates.</p><p><strong>Methods: </strong>Patients with an indication for cervical cancer screening were approached during their scheduled primary care visit. Consenting participants self-collected a sample for primary HPV testing. After sample collection, participants completed a 5-minute written survey concerning their experience collecting the sample and knowledge of cervical cancer.</p><p><strong>Results: </strong>From August 2023 through May 2024, 20 participants enrolled and completed the study, including 5 participants who had never undergone any prior cervical cancer screening and 7 participants over the age of 65. The HPV analysis confirmed 1 positive result. Most (17 of 20) of the participants described the self-collection process as very easy or easy. Knowledge of HPV and cervical cancer prevalence was low with only 2 of 20 participants (10%) correctly identifying the prevalence of these conditions.</p><p><strong>Conclusions: </strong>Self-swab screening for HPV is feasible with high patient satisfaction in the studied population.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Extended HPV Genotyping for Detecting Endocervical Glandular Neoplasia for Atypical Glandular Cells.","authors":"Fangfang Zhong, Megan L Zilla, Yihua Sun, Xianxu Zeng, Hao Zhang, Jianan Xiao, Xiang Tao, Chengquan Zhao","doi":"10.1097/LGT.0000000000000886","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000886","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the risk of cervical glandular neoplasia with extended high-risk human papillomavirus (hrHPV) genotyping, in patients with atypical glandular cells (AGC) cytology.</p><p><strong>Methods: </strong>Cervical AGC cases with concurrent extended HPV genotyping between October 2017 and October 2023 were retrieved from the archives of Department of Pathology, Obstetrics, and Gynecology Hospital of Fudan University (OGHFU).</p><p><strong>Results: </strong>A total of 497 AGC cases with extended hrHPV genotyping showed an hrHPV-positive rate of 32.0%. The top 4 hrHPV types were HPV18, 16, 52, and 59. A total of 304 cases had histological follow-up. A total of 72 cases (23.7%) had cervical adenocarcinoma in situ/cervical intraepithelial neoplasia3 or worse (AIS/CIN3+) lesions with 43 endocervical carcinoma (EC-ADC), 28 AIS, and 1 CIN3. Cervical AIS/CIN3+ lesions were detected in 50.5% (55/109) of the hrHPV-positive group.Women with HPV18/16/45 positivity had 77.6% cumulative risk of cervical AIS/CIN3 + lesions (52/67), accounting for 94.6% (52/55) of the total hrHPV-associated cervical AIS/CIN3+ lesions. For all 15 other hrHPV types, the overall risk of AIS/CIN3+ was 7.1% (3/42 cases). The sensitivity, specificity, PPV, and NPV of the composite HPV18/16/45 group for detecting endocervical glandular neoplasia was 71.8%, 93.1%, 76.1%, and 91.6%, respectively. Endocervical carcinoma was found in 17 of 195 (8.7%) women with negative hrHPV testing, accounting for 39.5% EC-ADC (17/43) cases.</p><p><strong>Conclusions: </strong>Atypical glandular cells was rarely related to CIN3. Atypical glandular cells was strongly related to AIS and EC-ADC. Women aged 30-49 years had highest risk for AIS/CIN3+ lesions. Although HPV test can be helpful, there were still some cases of HPV-negative endocervical adenocarcinomas. Extended HPV genotyping in AGC cases identified certain HPV types associated with a higher risk of cervical glandular lesions, potentially assisting with risk stratification.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}