Alternatives to surveillance for persistent human papillomavirus after a positive cervical screen: A systematic review and meta-analysis.
Eur J Obstet Gynecol Reprod Biol
; 302: 332-338, 2024 Oct 01.
Article
em En
| MEDLINE
| ID: mdl-39369502
ABSTRACT
OBJECTIVES:
In 2021, the World Health Organisation (WHO) updated its guidelines for cervical screening from cytology testing to primary high-risk human papillomavirus (HR-HPV) testing. This change in testing has effectively led to a 'new disease' as women are now aware of having a virus that induces changes that can cause cancer, which they would have been unaware of previously. While current management involves a 'watch and wait' approach and no active treatment, the anxiety associated with having HR-HPV may prompt some women to seek 'treatments' outside the screening programme. â to identify potential treatment options available for women with persistent HR-HPV and/or low-grade cervical intraepithelial neoplasia (CIN), i.e. ≤CIN 1. â to determine the clinical effectiveness of these treatments, namely by ⦠HR-HPV clearance rate, and/or ⦠CIN regression.METHODS:
We searched MEDLINE, PubMed, EMBASE, Web of Science and the Cochrane Library. We included cohort studies and randomised controlled trials (RCTs) only. Records (n = 2135) were screened in Rayyan by two independent reviewers. Quality assessment was conducted using the ROBINS-I tool and the ROB-2 tool.RESULTS:
12 studies (four cohort studies and eight RCTs) were included six oral medications, two topical medications, one vaccination, and three non-surgical device treatments. Meta-analysis revealed that some therapeutic interventions, including vaginal gels, photodynamic therapy, and some oral medications, may lead to earlier resolution of persistent HR-HPV and regression of low-grade CIN when compared with natural clearance.CONCLUSION:
This review can better inform discussions with HR-HPV+ women and answer their questions about alternatives to surveillance.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
Eur J Obstet Gynecol Reprod Biol
Ano de publicação:
2024
Tipo de documento:
Article