Self-Perception of HIV Risk and Interest in Pre-Exposure Prophylaxis in a General Obstetrics and Gynecology Clinic Population.

Background: Pre-exposure prophylaxis (PrEP) for HIV is underutilized, particularly among attendees of obstetrics and gynecology (Ob/Gyn) clinics. Lack of self-perception of HIV risk is a barrier to PrEP utilization, and a lack of understanding of community risk factors for HIV may contribute to that lack of self-perception of risk. Methods: Attendees of general Ob/Gyn clinics in New Orleans completed a survey assessing HIV knowledge, self-perception of HIV risk, and interest in PrEP. They reviewed a brief written educational intervention on demographic and behavioral risk factors for HIV and availability of PrEP. HIV knowledge, self-perception of HIV risk, and interest in PrEP were reassessed after the intervention. Results: One-hundred seventy individuals completed the survey. Eighty-five participants (50%) expressed initial interest in PrEP. Self-perception of risk of HIV acquisition was associated with interest in PrEP. Ten of 11 (90.9%) respondents who had high self-perceived risk of HIV were interested in PrEP, compared with 75 of 159 (47.2%) of those who had low self-perceived risk (p = 0.01). The association remained significant in a multivariate analysis. After the intervention, the number of those who perceived themselves to be at risk of HIV increased from 11 to 25 individuals (p < 0.01) and 20 of these (80%) were interested in PrEP. Knowledge of HIV risk factors increased (p < 0.01). The intervention did not significantly alter interest in PrEP. Conclusions: Self-perception of HIV risk was associated with interest in PrEP. A brief written educational intervention increased knowledge of HIV risk factors and increased self-perception of risk of HIV. The intervention did not translate to increased interest in PrEP.

Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy.

OBJECTIVE: The most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for endocervical curettage (ECC). This document provides updated guidelines for use of ECC among patients referred for colposcopy. METHODS: Consensus guidelines for the use of ECC were developed in 2012. To update these guidelines in concordance with the 2017 Colposcopy Standards process, an expert workgroup was convened in 2021. Literature had been previously reviewed through 2011, before the 2012 guideline. Literature from the years 2012-2021 and data from the NCI Biopsy study were reviewed, focusing on the additional yield of ECC. RESULTS: Endocervical curettage is recommended for patients with high-grade cytology, human papillomavirus 16/18 infection, positive results on dual staining for p16/Ki67, for those previously treated for known or suspected cervical precancer or considering observation of cervical intraepithelial neoplasia grade 2, and when the squamocolumnar junction is not fully visualized at colposcopy. Endocervical curettage is preferred for all patients aged older than 40 years. Endocervical curettage is acceptable for all nonpregnant patients undergoing colposcopy but may be omitted when a subsequent excisional procedure is planned, the endocervical canal does not admit a sampling device, or in nulliparous patients aged younger than 30 years, with cytology reported as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion regardless of whether the squamocolumnar junction is fully visualized. Endocervical curettage is unacceptable in pregnancy. CONCLUSIONS: These guidelines for ECC add to the 2017 consensus recommendations for colposcopy practice in the United States.

Association of Diet Quality and Dietary Components with Clinical Resolution of HPV.

Nutrient deficits have been repeatedly linked to cervical human papillomavirus (HPV) persistence, cervical neoplasia, and cervical cancer in case-control studies. This study sought to examine the relationship between overall diet quality and dietary components with the spontaneous resolution of cervical HPV over one year. A prospective observational cohort study was performed. Women with low-grade cervical cytology and/or positive HPV test completed a 24-hour dietary recall, from which the Healthy Eating Index (HEI)-2010, a score of overall diet quality, and scores in dietary categories were calculated. Participants were managed clinically according to national management guidelines. Those whose subsequent testing demonstrated normalization of cytology and/or HPV testing ("HPV resolution") were compared to those whose abnormalities persisted or progressed ("HPV non-resolution"). Twenty-six women were included in the HPV resolution group and 38 in the non-resolution group. They were observed for a median of 428 and 412 day, respectively (p = 0.09). There was no difference in overall diet quality between the groups. Intake of total and whole fruit, and seafood/plant protein were associated with HPV resolution in a logistic regression model (all p < 0.05). These findings could have important implications for the counseling and management of individuals with HPV infection of the cervix.

Factors Associated with Initiation of HPV Vaccination Among Young Women and Girls in Urban and Suburban New Orleans.

Vaccination coverage against human papilloma virus (HPV) in the United States remains low. This study aimed to identify factors associated with initiation of HPV vaccination among young women and girls in New Orleans, Louisiana. The study was conducted in Pediatrics and Obstetrics & Gynecology clinics in New Orleans between 2014 and 2017. Surveys were administered to women ages 18 through 26, and guardians of girls ages 12 through 17. Demographics, health history, sources of medical information, knowledge of HPV and HPV vaccination, opinions on vaccination, expected support for vaccination, and systems-level barriers were assessed. Participants self-reported discussion of the vaccine with a healthcare provider, and whether they or their child had been vaccinated. Participants were predominantly black and low-income. Among young adults, 61/121 (50%) had received any doses of the HPV vaccine; 71/94 (75%) of girls had received it (p < 0.01). In both groups, knowledge of the HPV vaccine, believing the vaccine was available from their usual healthcare provider, and having discussed the vaccine with their provider were associated with increased odds of vaccination. Among young adults, additional factors associated with vaccination were younger age, distance from a healthcare center, knowledge of HPV, and expectation of support from parents. Among guardians, holding negative views on vaccination was associated with decreased odds of vaccination. Discussion of the vaccine with a healthcare provider was the factor most strongly associated with initiation of HPV vaccination in both groups. The results provided actionable items to increase HPV vaccination uptake in these populations.

Interest in Pre-exposure Prophylaxis (PrEP) for HIV is Limited Among Women in a General Obstetrics & Gynecology Setting.

Pre-exposure prophylaxis (PrEP) is an important tool for reducing the risk of HIV acquisition, but identifying eligible and interested female patients remains difficult. We collected 144 surveys at urban Obstetrics & Gynecology clinics in Louisiana to assess interest in PrEP. Study participants were predominantly African-American (61.8%) and 45.1% had incomes of less than $20,000 per year. 84.7% of participants estimated their risk of HIV acquisition to be low. Initial interest in PrEP was moderate at 37.5% of the population. Number of partners, condom use, and self-perceived risk of HIV acquisition were associated with initial interest. After receiving more information about side effects and compliance requirements, only four of 144 (7.8% of initially interested, 2.8% of total) women remained interested in using PrEP. Concern about side effects was the major barrier to persistent interest. Further study is needed to determine how best to identify PrEP candidates in Obstetrics & Gynecology settings.

Etonogestrel Subdermal Implant-Associated Regression of Endometrial Intraepithelial Neoplasia.

BACKGROUND: Endometrial intraepithelial neoplasia is a precursor lesion to endometrial adenocarcinoma. Total hysterectomy is the preferred management, but systemic or locally acting progestin therapies are acceptable alternatives. The use of the etonogestrel subdermal implant for treatment of endometrial intraepithelial neoplasia has not been studied. CASE: A 36-year-old woman, G2P2002, with obesity presented with abnormal uterine bleeding. Her endometrial specimen demonstrated endometrial intraepithelial neoplasia. She declined both hysterectomy and conventional medical management. The etonogestrel implant was offered as an alternative to no treatment. After etonogestrel implant insertion, serial biopsies showed regression of endometrial intraepithelial neoplasia. Sixteen months after implant insertion, biopsy showed inactive and atrophic endometrium. CONCLUSION: The etonogestrel subdermal implant should be considered for further study for the treatment of endometrial intraepithelial neoplasia in women who decline surgical management.

Absence of viruses in amniotic fluid of women with PPROM: a case series.

Preterm premature rupture of membranes (PPROM) and preterm birth are strongly linked to intrauterine inflammation. Bacterial infection is often not identified as the cause. The objective was to examine the amniotic fluid of women with PPROM for viral genomic content, and to correlate with the presence of bacterial infection and markers of intrauterine inflammation. A case series of 13 women with PPROM is presented. Amniocentesis was performed in each of these women. DNA/RNA isolated from amniotic fluid was tested using polymerase chain reaction (PCR) for the presence of herpes simplex virus (HSV)-1 and -2, adenovirus, adeno-associated virus-2 (AAV-2), cytomegalovirus (CMV), parvovirus B19, human papilloma viruses (HPV), and enteroviruses. Maternal and neonatal hospital course and laboratory information, including results of amniotic fluid inflammatory marker testing and bacterial culture, were determined from the medical record. All amniotic fluid samples were negative for HSV-1 and HSV-2, adenovirus, AAV-2, CMV, parvovirus B19, HPV, and enteroviruses. Six of the 13 fluid samples (46%) had positive bacterial cultures, including culture for atypical organisms. In a small series of women, viral infection as assessed by the presence of viral genomic content in the amniotic fluid was not associated with PPROM.

Influenza-like illness in hospitalized pregnant and postpartum women during the 2009-2010 H1N1 pandemic.

OBJECTIVE: To estimate characteristics and outcomes of pregnant and immediately postpartum women hospitalized with influenza-like illness during the 2009-2010 influenza pandemic and the factors associated with more severe illness. METHODS: An observational cohort in 28 hospitals of pregnant and postpartum (within 2 weeks of delivery) women hospitalized with influenza-like illness. Influenza-like illness was defined as clinical suspicion of influenza and either meeting the Centers for Disease Control and Prevention definition of influenza-like illness (fever 100.0°F or higher, cough, sore throat) or a positive influenza test. RESULTS: Of 356 women meeting eligibility criteria, 35 (9.8%) were admitted to the intensive care unit (ICU) and four (1.1%) died. Two hundred eighteen women (61.2%) were in the third trimester and 10 (2.8%) were postpartum. More than half (55.3%) were admitted in October and 25.0% in November with rapidly decreasing numbers thereafter. Antiviral therapy was administered to 10.1% of the women before hospitalization and to 88.5% during hospitalization. Factors associated with an increased likelihood of ICU admission included cigarette smoking (29.4% compared with 13.4%; odds ratio [OR] 2.77, 95% confidence interval [CI] 1.19-6.45) and chronic hypertension (17.1% compared with 3.1%; OR 6.86, 95% CI 2.19-21.51). Antiviral treatment within 2 days of symptom onset decreased the likelihood of ICU admission (31.4% compared with 56.6%, OR 0.36, 95% CI 0.16-0.77). CONCLUSION: Comorbidities, including chronic hypertension and smoking in pregnancy, increase the likelihood of ICU admission in influenza-like illness hospitalizations, whereas early antiviral treatment may reduce its frequency. LEVEL OF EVIDENCE: II.

Association of polymicrobial growth from urine culture with adverse pregnancy outcomes.

We sought to determine if pyelonephritis and preterm delivery occur more frequently among pregnant women with polymicrobial growth from screening urine culture than among women with negative urine culture. A retrospective cohort study was performed. Three hundred eighty pregnant women with greater than 100,000 colony-forming units per milliliter of polymicrobial growth from urine culture performed at less than 20 weeks of pregnancy were compared with 375 women with negative urine culture. Admissions for pyelonephritis were identified from discharge records. Gestational age at delivery was determined from a research registry. Frequency of pyelonephritis and preterm delivery did not differ between the two groups. Frequencies of pyelonephritis were 0.3% and 0% in women with polymicrobial and negative urine culture, respectively ( P=0.32). Frequencies of preterm delivery were 16.8% and 16% ( P=0.76). Among those with repeat urine cultures, 4.6% in the polymicrobial group and 2.4% of those in the negative initial urine culture group had a positive culture later in the pregnancy ( P=0.21). There is no association between polymicrobial growth from screening urine culture and pyelonephritis or preterm delivery.