HPV cervical infections and serological status in vaccinated and unvaccinated women.

Understanding genital infections by Human papillomaviruses (HPVs) remains a major public health issue, especially in countries where vaccine uptake is low. We investigate HPV prevalence and antibody status in 150 women (ages 18 to 25) in Montpellier, France. At inclusion and one month later, cervical swabs, blood samples and questionnaires (for demographics and behavioural variables) were collected. Oncogenic, non-vaccine genotypes HPV51, HPV66, HPV53, and HPV52 were the most frequently detected viral genotypes overall. Vaccination status, which was well-balanced in the cohort, showed the strongest (protective) effect against HPV infections, with an associated odds ratio for alphapapillomavirus detection of 0.45 (95% confidence interval: [0.22;0.58]). We also identified significant effects of age, number of partners, body mass index, and contraception status on HPV detection and on coinfections. Type-specific IgG serological status was also largely explained by the vaccination status. IgM seropositivity was best explained by HPV detection at inclusion only. Finally, we identify a strong significant effect of vaccination on genotype prevalence, with a striking under-representation of HPV51 in vaccinated women. Variations in HPV prevalence correlate with key demographic and behavioural variables. The cross-protective effect of the vaccine against HPV51 merits further investigation.

Natural history, dynamics, and ecology of human papillomaviruses in genital infections of young women: protocol of the PAPCLEAR cohort study.

INTRODUCTION: Human papillomaviruses (HPVs) are responsible for one-third of all cancers caused by infections. Most HPV studies focus on chronic infections and cancers, and we know little about the early stages of the infection. Our main objective is to better understand the course and natural history of cervical HPV infections in healthy, unvaccinated and vaccinated, young women, by characterising the dynamics of various infection-related populations (virus, epithelial cells, vaginal microbiota and immune effectors). Another objective is to analyse HPV diversity within hosts, and in the study population, in relation to co-factors (lifestyle characteristics, vaccination status, vaginal microbiota, human genetics). METHODS AND ANALYSIS: The PAPCLEAR study is a single center longitudinal study following 150 women, aged 18-25 years, for up to 2 years. Visits occur every 2 or 4 months (depending on HPV status) during which several variables are measured, such as behaviours (via questionnaires), vaginal pH, HPV presence and viral load (via qPCR), local concentrations of cytokines (via MesoScale Discovery technology) and immune cells (via flow cytometry). Additional analyses are outsourced, such as titration of circulating anti-HPV antibodies, vaginal microbiota sequencing (16S and ITS1 loci) and human genotyping. To increase the statistical power of the epidemiological arm of the study, an additional 150 women are screened cross-sectionally. Finally, to maximise the resolution of the time series, participants are asked to perform weekly self-samples at home. Statistical analyses will involve classical tools in epidemiology, genomics and virus kinetics, and will be performed or coordinated by the Centre National de la Recherche Scientifique (CNRS) in Montpellier. ETHICS AND DISSEMINATION: This study has been approved by the Comité de Protection des Personnes Sud Méditerranée I (reference number 2016-A00712-49); by the Comité Consultatif sur le Traitement de l'Information en matière de Recherche dans le domaine de la Santé (reference number 16.504); by the Commission Nationale Informatique et Libertés (reference number MMS/ABD/AR1612278, decision number DR-2016-488) and by the Agence Nationale de Sécurité du Médicament et des Produits de Santé (reference 20160072000007). Results will be published in preprint servers, peer-reviewed journals and disseminated through conferences. TRIAL REGISTRATION NUMBER: NCT02946346; Pre-results.

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in asymptomatic patients under 30 years of age screened in a French sexually transmitted infections clinic.

BACKGROUND: An increasing prevalence of sexually transmitted infections (STI) has been noted in France over the past decade. Asymptomatic carriage may be high in patients infected with Chlamydia trachomatis attending free and anonymous screening centres (CDAG) and information, diagnosis and screening centres for STI (CIDDIST). In these centres, systematic C. trachomatis detection is recommended in women ≤25 years and in men ≤30 years. OBJECTIVES: This study aimed at estimating the prevalence of C. trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in asymptomatic patients younger than 30 years attending a CDAG-CIDDIST. MATERIAL AND METHODS: A free systematic screening for C. trachomatis, N. gonorrhoeae and M. genitalium was offered to asymptomatic subjects under 30 years attending the Montpellier CDAG-CIDDIST from April to August 2009. Pathogens were identified by PCR in first void urine samples. RESULTS: Of the 1381 subjects included (53.8% women and 46.2% men), 105 (42.9% men and 57.1% women) tested positive for C. trachomatis (7.6%, 95% CI [6.3;9.13]); eight (seven men and one woman) tested positive for M. genitalium (0.58% [0.2;1]) of whom two were infected with C. trachomatis ; five (two men and three women) tested positive for N. gonorrhoeae (0.36% [0.1;0.8]) of whom three were infected with C. trachomatis. CONCLUSION: This study confirmed the need for C. trachomatis screening in all patients under 30 years. Our results did not support a systematic screening for N. gonorrhoeae and M. genitalium in urine samples in this kind of facility.

Treatment of early stages of mycosis fungoides with narrowband ultraviolet B. A clinical, histological and molecular evaluation of results.

BACKGROUND: Narrowband ultraviolet B (UVB) phototherapy is increasingly used in mycosis fungoides (MF). OBJECTIVE: We report on the results obtained in a prospective series of early MF patients receiving this therapeutic regimen. METHODS: In total, 22 patients were treated. Therapeutic results were evaluated on clinical, histological and molecular levels. Patients were then submitted to a clinical follow-up. RESULTS: The cumulative number of treatments ranged from 22 to 48 (mean: 29). A complete clinical remission (CCR) was obtained in 18/22 patients, and a partial clinical remission in 4 cases. Complete or partial histological responses were achieved in 9/15 (all in CCR) and 4/15 patients, respectively. The molecular response was evaluated in 12 patients, and a disappearance of the dominant T cell clone in the skin was obtained in only 3 cases. After 4-48 months of follow-up (mean 20.1 months), 7/18 patients in CCR (39%) relapsed. CONCLUSION: Narrowband UVB phototherapy is a well-tolerated treatment of early-stage MF, and its efficiency is maximal in very early stages (Ia). Even though clinical results seem very similar to PUVA through indirect and tentative comparisons with historical series, relapses tend to occur earlier than with PUVA, especially when an incomplete histological or molecular response was achieved.