Journal of Lower Genital Tract Disease最新文献

{"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":"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":"213-217"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188802/pdf/","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":"OA","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":"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, the authors 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>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":"235-238"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188798/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis to Excision: Estimates for Guideline-Concordant Treatment of High-Grade Cervical Intraepithelial Neoplasia.","authors":"Nerlyne Desravines, Michael R Desjardins, J Stuart Ferriss, Jamie Perrin, Lisa Rahangdale","doi":"10.1097/LGT.0000000000000880","DOIUrl":"10.1097/LGT.0000000000000880","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the proportion of participants with high-grade cervical intraepithelial neoplasia (CIN 2/3) who completed indicated therapeutic procedures.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study of the National Institutes of Health's All of Us database enriched for racial and ethnic minorities historically underrepresented in biomedical research. The study included female participants aged 25 and older with a diagnosis of CIN 2/3 only, excluding invasive malignancy. The authors conducted both univariate and multivariate logistic regression to identify background characteristics associated with guideline-concordant ablative and excisional procedures.</p><p><strong>Results: </strong>Of 1,764 participants with CIN 2/3, only 27.7% of participants underwent a therapeutic procedure in the 12 months following a diagnosis of CIN 2/3. The study found that Hispanic participants had a 1.48 increased odds ratio (OR) (95% CI = 1.18-1.85) of undergoing therapeutic procedures (compared to non-Hispanic). Participants residing in the Midwest had a 2.04 OR (95% CI = 1.6-2.6) of undergoing a therapeutic procedure compared to the Northeast. After adjustment for race, ethnicity, region, and smoking status, Hispanic ethnicity remained associated with therapeutic excision (OR = 2.37, 1.13-4.78). Geography was significant with 2.37 (95% CI = 1.17-3.29) increased odds of therapy completions for Midwest residents but 0.52 (95% CI = 0.27-0.96) decreased odds for Western residents.</p><p><strong>Conclusion: </strong>In this large US national database enriched for racial and ethnic minorities, the authors found that 3 of 4 participants with cervical precancer did not undergo a therapeutic procedure in the 12 months following their first diagnosis. Increased efforts to promote access to and completion of treatment of CIN 2/3 are needed to prevent cancer.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"243-250"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Morpho-Functional Assessment of the Vulvar Vestibule in Patients With Vestibulodynia: A Case-Control Study.","authors":"Filippo Murina, Cecilia Fochesato, Stefania Di Francesco, Dario Recalcati, Giovanna Esposito, Valeria Savasi","doi":"10.1097/LGT.0000000000000904","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000904","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls.</p><p><strong>Materials and methods: </strong>This was a case-control study including 30 women diagnosed with PVD and 30 healthy controls. The following morpho-functional characteristics were considered: (i) vestibular trophism, (ii) vestibular epithelial thickness, (iii) pelvic floor muscle hypertonia, and (iv) vestibular current perception threshold evaluation, at 3 frequencies (2000 Hz, 250 Hz, and 5 Hz). Fisher's exact test and Mann-Whitney U test were used to compare parameters between PVD cases and healthy controls, while Pearson's correlation coefficient was calculated to assess vestibular trophism and epithelial thickness with neurosensitization.</p><p><strong>Results: </strong>PVD patients compared to healthy controls showed higher vestibular trophism health score (6.5 vs 3.0, p < .001), lower epithelial thickness (987.0 vs 1159.0 μm, p < .001), more frequently hypertonia of pelvic floor muscle (p < .001), and lower thresholds at neurosensitization at all three frequencies. A linear negative correlation emerged between vestibular trophism health score and current perception threshold at 5 Hz (r = -0.53, p = .003) and 250 Hz (r = -0.45, p = .013) in PVD cases. No significant correlation emerged for controls and for both groups for current perception threshold at 2000 Hz.</p><p><strong>Conclusions: </strong>This study identified substantial organic differences between PVD patients and healthy controls in critical parameters, such as vestibular trophism, epithelial thickness, pelvic floor muscle hypertonia, and neurosensitization. These findings enhance understanding of the complex and multifactorial mechanisms underlying PVD and highlight potential therapeutic targets for intervention.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477659","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":"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":"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":"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":"Letter to the Editor Regarding \"A Narrative Review of the Vulvar Disease Literature With Images of Women of Color\".","authors":"Debra S Heller","doi":"10.1097/LGT.0000000000000872","DOIUrl":"10.1097/LGT.0000000000000872","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"204"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015407","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":"Lichen Sclerosus in Cancer Patients.","authors":"Amaris N Geisler, Shivani Jain, Kara Long Roche, Deborah J Goldfrank, Alina Markova, Mario E Lacouture, Sarah J Noor","doi":"10.1097/LGT.0000000000000870","DOIUrl":"10.1097/LGT.0000000000000870","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the association between cancer therapies and the development of lichen sclerosus (LS) in a case series of patients.</p><p><strong>Methods: </strong>A retrospective chart review was performed to screen for patients who were diagnosed with LS while undergoing cancer therapy at Memorial Sloan Kettering Cancer Center between 2003 and 2019. Patients were excluded if they had been diagnosed with LS prior to starting cancer therapy. Clinical and treatment characteristics were analyzed.</p><p><strong>Results: </strong>The final study sample included 29 female patients who developed LS in the setting of systemic cancer therapy. Median time to LS onset after cancer therapy initiation was 420 days. Primary tumor types included breast (10, 34.5%), gynecologic (8, 27.6%), gastrointestinal (5, 17.2%), cutaneous (2, 6.9%), lung (2, 6.9%), and hematologic (2, 6.9%). Cancer therapy regimens included hormonal therapy (10, 34.5%), chemoradiation (7, 24.1%), cytotoxic chemotherapy (7, 24.1%), PD-1/PD-L1 inhibitors (3, 10.3%), local radiation (1, 3.4%), and allogeneic stem cell transplant (1, 3.4%). Across all patients, the mean number of treatments for LS was 2.8. Twenty-three (79.3%) patients received the first-line therapy of ultrapotent topical steroids, but 16 (69.6%) required additional topical and systemic treatment. Limitations include retrospective design and referral bias.</p><p><strong>Conclusions: </strong>Breast cancer was the most common primary tumor among patients in this study. The most common cancer therapy regimen was hormonal therapy. Most patients required an escalation in therapy to manage their LS. For patients undergoing cancer treatment, concomitant LS management can present unique challenges due to the biological mechanism of some anticancer therapies and the pathophysiology of LS. There is limited data to guide treatment of LS for this population. Some of the patients included in this analysis had progression of LS and recurrence of cancer while undergoing management of both conditions, necessitating close follow-up.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"186-189"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257101","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}