Prospective follow-up of 2,065 young unscreened women to study human papillomavirus incidence and clearance.

Human papillomavirus (HPV) is a necessary factor in the development of cervical intraepithelial neoplasia and cervical cancer. However, HPV is also a very common sexually transmitted virus and many women clear their infection. To study HPV incidence and clearance, 2,065 women, aged 18-29 years, were followed for 12 months and were asked to provide a self-collected cervico-vaginal sample and fill-out a questionnaire every 3 months. For HPV DNA detection, the SPF10 -DEIA LiPA25 system was used. Incidence rates of any-type high-risk HPV and low-risk HPV were 17.0 per 1,000-person months, and 14.3 per 1,000-person months, respectively. HPV types 16, 52, 51 and 31 had the highest type-specific incidence rates. HPV incidence was increased in singles, and women having a new relationship. A higher number of lifetime sex partners, and a higher frequency of sexual contacts in the past 3 months was associated with an increased HPV incidence. The overall clearance of the newly detected type-specific high-risk HPV infections and low-risk HPV infections was 61.2% and 69.0%, respectively. Having a sexual relationship compared to being single, and a higher sexual age both positively influenced the clearance of any-type high-risk HPV. Among the women infected with HPV 16, the women who had a co-infection had a lower proportion of clearance of HPV 16. In conclusion, in this young Dutch study population, HPV incidence rates are not related to age and comparable to other western countries. Clearance was only independently related to factors associated with sexual behavior, either past or current.

The role of individually targeted information to reduce anxiety before colposcopy: a randomised controlled trial.

OBJECTIVE: We investigated whether providing targeted information on an individual level by mail and by phone reduces anxiety in women referred to the colposcopy clinic. DESIGN: Randomised controlled trial. POPULATION: Women referred to the colposcopy clinic. METHODS: Between December 2007 and April 2010, 169 patients with abnormal smear results were randomised into two study arms. Group A received individually targeted information about the diagnosis and procedure by mail and phone. Group B received the standard folder about colposcopies alone. Patients were requested to fill out a questionnaire prior to their first colposcopy appointment. MAIN OUTCOME MEASURES: The questionnaire included the hospital anxiety and depression scale (HADS), and the Spielberger state-trait anxiety inventory (STAI), as well as a short self-administered questionnaire. RESULTS: Twenty women were excluded from further analyses after randomisation, leaving 149 women for evaluation. The median STAI state anxiety score was high (50.0), but there was no significant difference in median STAI state anxiety and HADS anxiety scores between both groups. However, knowledge about human papillomavirus and the colposcopy procedure did significantly increase in group A (P = 0.004). CONCLUSIONS: Anxiety levels before primary colposcopy are surprisingly high, and are not reduced following individually targeted information given before colposcopy.

Universal human papillomavirus genotyping by the digene HPV Genotyping RH and LQ Tests.

BACKGROUND: High-risk (hr)HPV testing plays an important role in primary cervical cancer screening. Subsequent hrHPV genotyping might contribute to better risk stratification. The majority of hrHPV tests do not include identification of individual hrHPV genotypes. OBJECTIVES: The digene HPV Genotyping RH Test (strip-based) and LQ Test (xMAP-based) allow genotyping of GP5+/6+ amplimers, but their probes target a region in the L1 ORF, which is also amplified by other broad-spectrum hrHPV assays, e.g., the Roche Amplicor HPV Test (Amplicor) and the Roche Linear Array. The goal was to test whether the RH Test and LQ Test can be used as an universal hrHPV genotyping test. STUDY DESIGN: Self-collected cervico-vaginal specimens (n=416) from an epidemiologic study were analyzed with Amplicor. The amplimers obtained were also tested with the RH Test and LQ Test for identification of 18 HPV types, including the 13 hrHPVs targeted by Amplicor. RESULTS: 197 specimens were positive by Amplicor, in which the RH Test and LQ Test identified one of the 13 hrHPVs in 94.4% and 98.0%, respectively. In 219 specimens remaining negative by Amplicor, the RH Test and LQ Test, performed on the Amplicor amplification products, still detected one of the 13 hrHPVs in 3.7% and 5.5%, respectively, and include identification of HPV53, 66, and 82. Overall, the RH and LQ Tests demonstrated high concordance with Amplicor for hrHPV detection (κ=0.908 and κ=0.923, respectively). CONCLUSIONS: The digene HPV Genotyping RH and LQ Tests can be directly used for amplimers generated by the Amplicor HPV Test.

[Use of oral contraceptives and increased risk of cervical cancer]. / Pilgebruik en een verhoogde kans op cervixcarcinoom.

A recently published meta-analysis and a large cohort study showed independently that use of oral contraceptives (OC) leads to an increased relative risk (RR) of cervical cancer. This RR increased with the duration of OC use and was 1.90 after 5 years or more (95% CI: 1.69-2.13). The increased RR decreased after cessation of OC use and was normal again Io years later. Longstanding OC use enhances human papillomavirus (HPV) transcription and decreases HPV clearance, resulting in more frequent persistence of HPV, an increase of cervical intraepithelial neoplasia, and an increased RR of cervical cancer. The increase in cervical cancer by OC is, however, associated with a fully compensatory decrease in the incidence of other malignancies, in particular ovarian cancer and endometrial cancer. Based on these findings, there are no reasons to discourage the use of OC by women in the Netherlands.

Young adults and acceptance of the human papillomavirus vaccine.

OBJECTIVES: To determine whether young Dutch adults had ever heard of human papillomavirus (HPV) and whether they would accept vaccination, and to assess the factors influencing their decision. STUDY DESIGN: Cross-sectional survey. METHODS: Six hundred participants aged 18-25 years were recruited from two university departments and one non-university technical college. RESULTS: One hundred and six (17.7%) participants had heard of HPV and 536 (94%) had heard of cervical carcinoma. Women had significantly more knowledge of cervical carcinoma than men. A medical education, knowledge of HPV, knowledge of cervical cancer and knowledge of the cervical screening programme were not significantly associated with acceptance of HPV vaccination, whereas gender and age did show a significant relationship. In total, 61% of the female participants and 48% of the male participants were willing to accept a 'catch-up' HPV vaccination. CONCLUSIONS: This study found that average knowledge levels of HPV and cervical cancer were low. Despite this lack of knowledge, a small majority of the study population would accept a 'catch-up' HPV vaccination. Women and younger participants were significantly more willing to accept HPV vaccination. However, in these subgroups, acceptance of HPV vaccination seems to be affected by other, still unidentified, factors. These factors could be evaluated in a more qualitative orientated study. An educational campaign is needed to cover knowledge about HPV and cervical carcinoma, and beliefs and behaviours associated with the acceptance of vaccination.

Can screening for retinopathy of prematurity be reduced?

BACKGROUND: As screening for retinopathy of prematurity (ROP) is costly, time-consuming for the ophthalmologist and discomforting for the neonate, the minimum number of infants should be screened for ROP, without missing infants with severe ROP, at risk for threshold ROP. OBJECTIVES: To develop a diagnostic screening guideline for ROP that would safely reduce the number of ROP screening funduscopies in our department. METHODS: Data of 275 infants admitted between 1996 and 2000 and screened for ROP according to our Dutch National guideline were studied. Significant risk factors for ROP were calculated, using logistic regression analysis and used to develop a guideline. The discriminative power of the guideline was evaluated using the area under the curve for the receiver operating characteristic curve. RESULTS: Significant risk factors for ROP were: gestational age, birth weight and number of erythrocyte transfusions within the first 4 weeks of life. The combination of these 3 factors resulted in the highest area under the curve: 0.793. Using these 3 factors, a diagnostic screening guideline for ROP was developed: if birth weight + 2 x (gestational age - 20) - 6 x erythrocyte transfusion value within the first 4 weeks of life >or=34, no screening for ROP is necessary. Using this guideline, 22.2% of the infants of the study group could have been excluded from screening; 3.8% of the infants with ROP stages 1-2 would have been missed. CONCLUSION: In our department, ROP screening can be safely reduced using our diagnostic screening guideline.