RESUMO
This study investigates the incidence and clearance of cervical and anal high-risk human papillomavirus (hrHPV) infection in kidney transplant recipients (KTRs) compared to immunocompetent controls. During 2016-2017, we enrolled 125 female KTRs and 125 female controls. Liquid-based cervical and anal cytology samples collected at enrollment and follow-up were tested for human papillomavirus (HPV) DNA using the CLART HPV2 test. All participants answered a questionnaire on lifestyle and sexual behavior at both examinations. KTRs had an increased age-adjusted risk of incident cervical hrHPV infection compared to controls (hazard ratio [HR] = 3.6, 95% CI = 1.2-11.2). Probability of cervical hrHPV clearance at 18 months was lower among KTRs (8.3%) than controls (66.7%). There was no statistically significant difference in anal hrHPV incidence between KTRs and controls (HR = 0.9, 95% CI = 0.4-2.0). Clearance of anal hrHPV was similar between KTRs and controls at 18 months. During the total follow-up, a lower anal hrHPV clearance, although not statistically significant, was observed among KTRs (HR = 0.3, 95% CI = 0.06-1.2). KTRs had higher incidence of cervical hrHPV and lower probability of clearance, especially of cervical hrHPV infections, than controls. Our findings support that KTRs are at increased risk of HPV infection and point to the need for targeted HPV prevention strategies, such as cervical cancer screening.
Assuntos
Transplante de Rim , Papillomaviridae , Infecções por Papillomavirus , Humanos , Feminino , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Transplante de Rim/efeitos adversos , Estudos Prospectivos , Incidência , Pessoa de Meia-Idade , Seguimentos , Fatores de Risco , Papillomaviridae/isolamento & purificação , Adulto , Dinamarca/epidemiologia , Prognóstico , Estudos de Casos e Controles , Transplantados/estatística & dados numéricos , Falência Renal Crônica/cirurgia , Complicações Pós-Operatórias/epidemiologia , DNA Viral/análise , DNA Viral/genética , Canal Anal/virologia , Papillomavirus HumanoRESUMO
Anal cancer risk is increased in certain risk groups including people living with HIV (PLWH), especially in men who have sex with men, but also in organ transplant recipients and women with a history of cervical or vulva dysplasia or cancer. High-resolution anoscopy (HRA) is a tool to diagnose anal high-grade squamous intraepithelial lesions (HSIL), and HRA-guided treatment of anal HSIL has been shown to reduce the risk of anal cancer in PLWH. The purpose of this review is to increase the awareness of HRA but also of tertiary prevention by digital anal rectal examination.
Assuntos
Neoplasias do Ânus , Infecções por HIV , Infecções por Papillomavirus , Minorias Sexuais e de Gênero , Masculino , Humanos , Feminino , Homossexualidade Masculina , Fatores de Risco , Endoscopia , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/etiologia , Neoplasias do Ânus/prevenção & controle , Canal Anal/patologia , Infecções por Papillomavirus/patologiaRESUMO
BACKGROUND: Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)-related anogenital (pre)cancers, including anal high-grade intraepithelial lesions and cancer. Previous studies on anal high-risk HPV (hrHPV) among KTRs are sparse. METHODS: In a cross-sectional study, we included 247 KTRs and 248 controls from a dermatology department and 5 nephrology departments in Denmark during 2016-2017. All participants provided an anal cytobrush sample that was tested for HPV DNA. Participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of anal hrHPV in KTRs compared with controls and risk factors for anal hrHPV in KTRs. RESULTS: The anal hrHPV prevalence was higher in female KTRs (45.5%) than in controls (27.2%). Female KTRs had almost 3-fold higher adjusted odds of anal hrHPV than controls (adjusted OR, 2.87 [95% confidence interval, 1.57-5.22]). In contrast, among men we did not observe increased prevalence or odds of anal hrHPV in KTRs compared with controls (prevalence, 19.4% vs 23.6%; adjusted OR, 0.85 [95% 95% confidence interval, .44-1.64]). Among hrHPV-positive KTRs, 63% and 52% of men and women, respectively, were infected with hrHPV types covered by the nonavalent HPV vaccine (type 16, 18, 31, 33, 45, 52, or 58). Current smoking, >10 lifetime sexual partners, history of genital warts, and among men having had receptive anal sex were risk factors for anal hrHPV in KTRs. CONCLUSIONS: Female KTRs had an increased risk of anal hrHPV compared with immunocompetent controls. Our findings indicate that pretransplant HPV vaccination should be considered to prevent anal high-grade intraepithelial lesions and cancer caused by anal hrHPV infection in KTRs. CLINICAL TRIALS REGISTRATION: NCT03018327.
Assuntos
Doenças do Ânus , Transplante de Rim , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Feminino , Humanos , Masculino , Canal Anal , Estudos Transversais , Homossexualidade Masculina , Transplante de Rim/efeitos adversos , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Genital warts (GWs) are a risk factor for subsequent human papillomavirus (HPV)-related anogenital cancers. In this register-based, prospective cohort study, we estimated the risk of GWs in renal transplant recipients (RTRs) compared with a nontransplanted cohort. In a nationwide database, we identified first-time RTRs in Denmark during 1996 to 2015. For each RTR, 50 age- and sex-matched nontransplanted individuals were selected from the population registry. Information on GWs, sociodemographic characteristics, HPV vaccination, and other causes of immunosuppression was retrieved from registries. We estimated the cumulative incidence of GWs and used Cox regression to estimate hazard ratios (HR) of GWs in RTRs vs non-RTRs. We included 3268 RTRs and 162 910 non-RTRs without GWs 1 year before baseline. RTRs had higher hazard of GWs than non-RTRs (HR = 3.30; 95% confidence interval, 2.76-3.93, adjusted for sex, age, education, and income). The increased hazard of GWs compared with non-RTRs was more pronounced in female than in male RTRs. Although not statistically significant, the hazard tended to be higher in RTRs with functioning grafts compared with RTRs on dialysis after graft failure. The hazard of GWs was increased <1 year after transplantation and remained increased during ≥10 years. In conclusion, RTRs had substantially higher risk of GWs than non-RTRs.
Assuntos
Condiloma Acuminado/complicações , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Transplantados , Adulto , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/epidemiologia , Dinamarca/epidemiologia , Feminino , Transplante de Coração , Humanos , Terapia de Imunossupressão , Imunossupressores/uso terapêutico , Incidência , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto JovemRESUMO
Ano-genital warts are in general considered as benign lesions, as they are mostly caused by the non-oncogenic HPV types 6 and 11. In this review, there is a focus on the problematic issues, that these lesions and their treatments can cause. Both topical and ablative treatments are associated with side effects, and the varying effect of the treatments combined with an uncertain timeline to clearance are known to cause psychological distress. Vaccination against HPV-6 and -11 has been shown to reduce the incidence of this troublesome infection substantially in both women and men in countries with high vaccine coverage.
Assuntos
Condiloma Acuminado , Algoritmos , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/patologia , Condiloma Acuminado/terapia , Feminino , Humanos , Masculino , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus/administração & dosagemAssuntos
Terapia a Laser , Rinofima/cirurgia , Humanos , Lasers de Gás , Masculino , Rinofima/patologiaRESUMO
BACKGROUND: Besides being a causative agent for genital warts and cervical cancer, human papillomavirus (HPV) contributes to 40-85% of cases of anal, penile, vaginal and vulvar cancer and precancerous lesions. HPV types 16 & 18 in particular contribute to 74-93% of these cases. Overall the number of new cases of these four cancers may be relatively high implying notable health care cost to society. The aim of this study was to estimate the incidence and the health care sector costs of anal, penile, vaginal and vulvar cancer. METHODS: New anogenital cancer patients were identified from the Danish National Cancer Register using ICD-10 diagnosis codes. Resource use in the health care sector was estimated for the year prior to diagnosis, and for the first, second and third years after diagnosis. Hospital resource use was defined in terms of registered hospital contacts, using DRG (Diagnosis Related Groups) and DAGS (Danish Outpatient Groups System) charges as cost estimates for inpatient and outpatient contacts, respectively. Health care consumption by cancer patients diagnosed in 2004-2007 was compared with that by an age- and sex-matched cohort without cancer. Hospital costs attributable to four anogenital cancers were estimated using regression analysis. RESULTS: The annual incidence of anal cancer in Denmark is 1.9 per 100,000 persons. The corresponding incidence rates for penile, vaginal and vulvar cancer are 1.7, 0.9 and 3.6 per 100,000 males/females, respectively. The total number of new cases of these four cancers in Denmark is about 270 per year. In comparison, the total number of new cases cervical cancer is around 390 per year. The total cost of anogenital cancer to the hospital sector was estimated to be 7.6 million Euros per year. Costs associated with anal and vulvar cancer constituted the majority of the costs. CONCLUSIONS: Anogenital cancer incurs considerable costs to the Danish hospital sector. It is expected that the current HPV vaccination program will markedly reduce this burden.
Assuntos
Neoplasias do Ânus , Custos Hospitalares/estatística & dados numéricos , Neoplasias Penianas , Neoplasias Vaginais , Neoplasias Vulvares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ânus/economia , Neoplasias do Ânus/epidemiologia , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/economia , Neoplasias Penianas/epidemiologia , Sistema de Registros , Neoplasias Vaginais/economia , Neoplasias Vaginais/epidemiologia , Neoplasias Vulvares/economia , Neoplasias Vulvares/epidemiologia , Adulto JovemRESUMO
Diagnosing gonorrhoea from extra-genital as well as genital sites is important in managing this sexually transmitted disease. In this study we evaluated a screening procedure for Neisseria gonorrhoeae (GC) from all sample sites in a low-prevalence setting. A total of 69,252 specimens submitted for Chlamydia trachomatis testing were also examined for GC on the BD Viper™ platform using the BD Probetec ET system. In order to avoid false-positive results all GC BD reactive samples were re-tested using a PCR method with the porA pseudogene as target. Using this method we screened 170% more samples for GC than in the previous year, in the same population, and diagnosed more than twice as many GC-positive episodes. The BD system can be used successfully to screen extra-genital as well as genital specimen types for GC in a low-prevalence area if it is combined with a validated confirmatory PCR test.
Assuntos
Colo do Útero/microbiologia , Gonorreia/diagnóstico , Programas de Rastreamento/métodos , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Reto/microbiologia , Uretra/microbiologia , Dinamarca , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Proteínas de Fímbrias/genética , Fímbrias Bacterianas/genética , Gonorreia/microbiologia , Humanos , Masculino , Neisseria gonorrhoeae/genética , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase , Porinas/genética , Valor Preditivo dos Testes , Kit de Reagentes para DiagnósticoRESUMO
INTRODUCTION: A recent qualitative study shows that genital warts can reduce the quality of life of heterosexual patients considerably. This follow-up study seeks to elucidate the illness perception among men who have sex with men (MSM). The aim is to examine the extent to which minority cultural conditions and factors affect the experiences of these patients. MATERIAL AND METHODS: This study was based on qualitative interviews with six Danish MSM. Along with the study among heterosexual patients, a literature review identified the important questions to be presented to the participants. RESULTS: Many MSM worry about being stigmatized in the homosexual "scene" and thereby losing their affiliation to a significant social group as well as their chances of finding sex and love. Most participants had suffered from genital warts for several years - which added to the negative psycho-sexual and social effects of the disease. These participants' fears of developing anal cancer corresponded to the concerns of female genital warts patients about cervical cancer. CONCLUSION: Ano-genital HPV infection is common among MSM. However, these men will not benefit to the same extent as heterosexual men from the herd immunity effect of HPV vaccination of girls. MSM may have particular pathological pictures as well as concerns that should be addressed when communicating with these patients and taken into account when considering HPV vaccination of boys.
Assuntos
Condiloma Acuminado/psicologia , Homossexualidade Masculina/psicologia , Qualidade de Vida , Feminino , Humanos , Masculino , Comportamento Sexual , Isolamento Social , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The new quadrivalent vaccine against human papillomavirus (HPV) can prevent a large number of cervical cancer cases and most cases of genital warts. Genital warts are among the most common sexually transmitted diseases in Denmark and constitute a considerable burden to the health care system as well as to the individual patient. The aim of this study is to examine the ways in which genital warts may affect the patient's quality of life. The results are important in relation to treatment as well as counselling of patients suffering from genital warts. The results are particularly relevant to decisions concerning the introduction of HPV vaccination of men as well as women. MATERIAL AND METHODS: A qualitative research design was applied using focus group interviews with male and female genital wart patients aged 18-30 years. The study was based on a literature review which identified the important issues and questions presented to the participants. RESULTS: The participants in the study have a significantly lowered quality of life due to their genital warts. The disease negatively affects them psychologically, socially and in their sex and love life in particular. The course of treatment is a burden because of the uncertain time-line and the varying effectiveness. There is much need for more information and communication about the disease and its psycho-sexual aspects. CONCLUSION: The development of a quadrivalent HPV vaccine is a milestone in the prevention of both cervical cancer and genital warts. The knowledge of genital warts is limited despite the prevalence of the disease and its severe effects on the patient's quality of life. This study indicates that HPV vaccination of both sexes would have a marked positive effect on the mental burden associated with the disease.
Assuntos
Condiloma Acuminado/psicologia , Qualidade de Vida , Adolescente , Adulto , Cognição , Condiloma Acuminado/prevenção & controle , Condiloma Acuminado/virologia , Efeitos Psicossociais da Doença , Feminino , Grupos Focais , Humanos , Masculino , Vacinas contra Papillomavirus/uso terapêutico , Comportamento Sexual , Comportamento Social , Inquéritos e QuestionáriosRESUMO
Methotrexate (MTX) is used in the treatment of malignant and non-malignant diseases. This case report describes impotence as a seldom but possible overlooked adverse effect to MTX treatment. A 58 year-old man was treated for erythrodermia with a weekly dose of 7.5 mg MTX. He developed erective impotence nine months after initiation of treatment. Two weeks after discontinuation of MTX the impotence subsided, but when MTX treatment was reintroduced, the impotence returned after two months. Only a few other cases of impotence associated with MTX have been described previously.