Cross-sectional study to assess the need to commence opportunistic screening of women for cervical cancer presenting with sexually transmitted disease in Western India.

This study examines the prevalence of suspected cervical cancer (established through the use of visual inspection with Lugol's Iodine - VILI) among outpatients attending Surat Municipal Institute of Medical Education & Research Hospital, India. A cross-sectional study was conducted on 356 patients; 178 with an established sexually transmitted disease (STD) and 178 patients without. Patients with positive results were investigated with cervical biopsy; out of 356 patients, 21.91% patients with STD and 12.35% patients without STD tested positive for VILI respectively (p = .017). The factors found to be significantly associated with a positive VILI test were STD, marital status, oral contraceptive pill use, a complaint of PV bleeding, white discharge on speculum examination (PS) and cervical erosion on PS. On applying multiple logistic regression, STD, age of patient in years, parity, OC pill use, a complaint of PV bleeding and cervical erosion on PS were found to be significant predictors of VILI positivity among the patients. STD patients are 2.5 times more likely to test positive for VILI than patients without STD. In Indian populations comparable to ours, opportunistic screening should be considered in gynaecology outpatient clinics for women presenting with complaints related to STDs.

Preparation, property of the complex of carboxymethyl chitosan grafted copolymer with iodine and application of it in cervical antibacterial biomembrane.

Cervical erosion is one of the common diseases of women. The loop electrosurgical excisional procedure (LEEP) has been used widely in the treatment of the cervical diseases. However, there are no effective wound dressings for the postoperative care to protect the wound area from further infection, leading to increased secretion and longer healing time. Iodine is a widely used inorganic antibacterial agent with many advantages. However, the carrier for stable iodine complex antibacterial agents is lack. In the present study, a novel iodine carrier, Carboxymethyl chitosan-g-(poly(sodium acrylate)-co-polyvinylpyrrolidone) (CMCTS-g-(PAANa-co-PVP), was prepared by graft copolymerization of sodium acrylate (AANa) and N-vinylpyrrolidone (NVP) to a carboxymethyl chitosan (CMCTS) skeleton. The obtained structure could combine prominent property of poly(sodium acrylate) (PAANa) anionic polyelectrolyte segment and good complex property of polyvinylpyrrolidone (PVP) segment to iodine. The bioactivity of CMCTS could also be kept. The properties of the complex, CMCTS-g-(PAANa-co-PVP)-I2, were studied. The in vitro experiment shows that it has broad-spectrum bactericidal effects to virus, fungus, gram-positive bacteria and gram-negative bacteria. A CMCTS-g-(PAANa-co-PVP)-I2 complex contained cervical antibacterial biomembrane (CABM) was prepared. The iodine release from the CABM is pH-dependent. The clinic trial results indicate that CABM has better treatment effectiveness than the conventional treatment in the postoperative care of the LEEP operation.

Is pornography consumption associated with condom use and intoxication during hookups?

In order to examine whether pornography consumption is associated with risky sexual behaviour among emerging adults, we examined two large samples of those who reported hooking up in the past 12 months (combined n =  1216). Pornography use was associated with a higher likelihood of having a penetrative hookup; a higher incidence of intoxication during hookups for men (but a lower incidence of intoxication during hookups for women); increasing levels of intoxication during hookups for men but decreasing levels of intoxication for women; and a higher likelihood of being in the riskiest category of having a penetrative hookup, without a condom, while intoxicated. For each of these outcomes, our point estimates for Study 2 fell within the 95% confidence intervals from Study 1. Controlling for trait self-control, binge drinking frequency, broader problematic patterns of alcohol use, openness to experience, and attitudes toward casual sex did not change the pattern of results. Implications for interventions to reduce sexual risk are discussed.

Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria.

BACKGROUND: Cervical ectropion (also known as cervical erosion) is a common finding on routine pelvic examination during the fertile years. The decision to treat or not remains controversial. According to studies in support of routine treatment of cervical erosion, there is a possible relationship between squamous metaplasia and squamous cell carcinoma of the cervix. To determine the prevalence of cervical ectropion and associated risk factors among clients with intra-uterine contraceptive devices (IUCDs) attending a family planning clinic of a tertiary health institution in Lagos, Nigeria. METHODS: A 5-year retrospective study was conducted by assessing existing clinic records from years 2007-2011. Clients with IUCDs undergo routine pelvic examination during check-up visits. A total of 628 clients' records were seen within the stated time frame. This study was approved by the ethical committee of the Lagos State University Teaching Hospital (LASUTH) and the collected data were analyzed using SPSS version 19.0. RESULTS: The mean age of the IUCD users was 34.7±6.52 years, while 517 (82.3%) had secondary education. On routine pelvic examination, seventy-nine clients (12.6%) had cervical ectropion. Thirty-nine (6.2%) clients had presented with a history of abnormal vaginal bleeding while 12.1% had vaginal discharge. Treatments offered to cases of cervical ectropion include cervical painting with gentian violet (89.9%) and antibiotics prescription (58.2%). On bivariate analysis, previous hormonal contraceptive use (P=0.041) and vaginal discharge (P<0.001) were significantly associated with developing cervical ectropion. Clients with ectropion were significantly more likely to receive prescriptions for antibiotics (P<0.001). CONCLUSION: Less than one fifth of the clients had cervical erosion. However, routine pelvic examination could aid the detection and control of latent reproductive health problems such as cervical ectropion which may require further investigations for example, pap smears, to exclude potentially lethal conditions and to determine appropriate treatment modality.

Effects of diode laser therapy and stannous fluoride on dentin resistance under different erosive acid attacks.

OBJECTIVE: This in vitro study aimed to evaluate the effect of a low intensity diode laser (λ=808 nm; 60 J/cm2) associated with stannous fluoride on the inhibition of dentin erosion by assessing percentage of superficial hardness loss (%SHL) and calcium release into the acid solution. MATERIALS AND METHODS: Human root dentin slabs were assigned to eight groups (n=10), according to treatments (control, stannous fluoride, diode laser therapy, and the combination of stannous fluoride and laser therapy), and acid challenge (hydrochloridric or citric acid). All slabs were subjected to a previous 2 h acquired pellicle formation; laser and fluoride treatments were performed according to the groups. Subsequently, the slabs were exposed to erosive challenge (0.01 M hydrochloridric acid or citric acid 1% for 60 sec). Additionally, calcium released into the acid solution during erosive challenge was analyzed by photometric test. Data were analyzed by ANOVA followed by Tukey's test (p<0.05). RESULTS: Mean values (±SD) for %SHL of treated groups did not present statistically significant differences, regardless of the erosive challenge. However, in relation to released calcium concentration, groups treated with laser presented statistically significant lower calcium loss under hydrochloridric acid challenge (p<0.001). To groups under citric acid attack, only the combination of treatments (p=0.037) was able to show a protective effect on dentin. CONCLUSIONS: Under the conditions of this study, 808 nm diode laser with or without stannous fluoride could effectively reduce dentin surface loss under both acid exposures. Only calcium concentration analysis was sensitive enough to measure the effects under the tested conditions.

Uterine cervical ectopy during reproductive age: cytological and microbiological findings.

Cervical ectopy is common in adolescents, pregnant women, and those taking high doses of estrogen-containing contraceptives. The majority of cases have spontaneous reversion, but some cases can be persistent. Studies suggested that the adequacy of a Pap smear could be affected and there is an increased risk cervical infections. This study is a cross-sectional study conducted from December 2009 to February 2011 with 457 women with cervical ectopy and 736 without ectopy. Cervical samples were collected in vials for analysis by ThinPrep cytology (Hologic, Marlborough, MA). The Mann-Whitney test and Fisher's exact test (95% CI) were applied. The study was approved by the ethics committee of the Federal University of Ceará. The mean ages of the study group and control group were 28.7 (±14.8) and 33.6 (±7.5) years old, respectively (P < 0.0001). Negative diagnosis for malignancy and intraepithelial lesion was present in 399 (87%) cases and 705 (96%) in the study and control groups, respectively (P < 0.0001). Shift in the flora suggestive of bacterial vaginosis (BV) was observed more frequently in the study group: 74 (16.2%) than in the control group: 86(11.7%) (P = 0.017). The differences among the other morphotypes showed no significance. The smears were atypical in 12.7% (58/457) of the patients from the study group and in 4.2% (31/736) in the control group (P < 0.001; RR = 3 [2.033-4.712]). The association between ectopy and inflammatory cytology, the presence of the shift in the flora suggestive of BV and cytological atypia is evident.

A suppository for treating cervical erosion and its preparation method.

OBJECTIVE: To study a suppository for treating cervical erosion, its preparation method, and to observe its therapeutic effect on cervical erosion in animal models. METHODS: Twenty rats were divided into five groups: blank control group, model group, and three different therapeutic concentration groups. Phenol slurry was injected through the vagina to create cervical erosion animal models. After seven days of drug treatment, the difference of cervical histopathology was observed and compared between different groups. RESULTS: Compared with the control group, the model group showed obvious cervical erosion, inflammatory cell infiltration, vascular dilatation, and congestion. Among the administration group, the high administration group had the least inflammation and cell infiltration in the mucous membrane. CONCLUSIONS: There is a significant effect of therapeutic drugs in rats with cervical erosion, which is related to the concentration of drugs.

Relação entre fatores de risco e lesão precursora do câncer do colo do útero em mulheres com e sem ectopia cervical / Relation between risk factors and cervical cancer precursor lesion in women with and without cervical ectopy

A ectopia cervical, uma condição fisiológica do organismo da mulher, pode favorecer infecções genitais, até mesmo pelo papilomavírus humano, que é o principal fator de risco envolvido na carcinogênese cervical. O objetivo deste estudo foi relacionar alguns fatores de risco para lesão precursora de câncer de colo de útero com resultados de exames citopatológicos de mulheres com e sem ectopia cervical. Foi realizado um estudoobservacional descritivo transversal com mulheres que realizaram exame de rotina em um consultório médico privado no município de São Borja, entre janeiro e junho de 2009. O estudo constou de exame clínico e exame citológico. Pelo exame citológico de Papanicolaou foi determinada a presença de lesões precursoras do câncer de colo deútero, e pela inspeção visual foi identificada a ectopia cervical. Das 57 mulheres, 29 apresentaram ectopia e 28 não apresentaram ectopia. Entre os resultados citológicos com células epiteliais atípicas, 10,7% (3/28) das mulheres sem ectopia e 17,1% (5/29)das mulheres com ectopia apresentaram células epiteliais atípicas. Quando foram relacionados os fatores de risco entre as mulheres com ectopia e sem ectopia, o uso de anticoncepção oral (p = 0,007) e o número de filhos (p = 0,021) estiveram associados com a ectopia cervical.

Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical erosion.

Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs.

Investigación de factores socioculturas que inciden en la problemática de cancer cérvico uterino / ss

Disponer de una experiencia sistematizada sobre tabulación y consistencia de datos de la investigación factores sociales y culturales que inciden en la problemática de cáncer cérvico uterino en mujeres que acuden al Hospital de La Mujer

[Cytogenetic characteristics of the uterine cervical epithelium in inflammatory diseases].

Functional status of epithelial cells at inflammatory cervical pathologies has been studied with the use of cytogenetic method of detection of chromosome nucleolar organizer regions. The highest level of rRNA proliferation and synthesis has been detected in cylindrical epithelial cells using the indexes of compact and transitional nucleolonemic types of nucleolar organizer regions, a higher level--in squamous cells of intermediate type, and the lowest one in squamous epithelium of superficial type.

Painful love-"hispareunia" after sling erosion of the female partner.

INTRODUCTION: Sling erosion/extrusion is a complication after suburethral sling insertion for female stress urinary incontinence that occurs in approximately 6% of patients. Symptoms may include vaginal discharge, infections, postcoital bleeding, and alterations of the sexual function. Little is known about the effect of sling erosion on the sexual function of the male partner. AIM: The aim of this study was to determine male sexual function in partners of women who had undergone sling insertion for stress urinary incontinence and who developed sling erosion postoperatively. MAIN OUTCOME MEASURES: Main outcome measures were the Brief Male Sexual Function Inventory (BMSFI) and visual analog scale (VAS) scores. METHODS: Male partners of patients who presented with sling erosion for various reasons were addressed and asked to fill in the BMSFI and assess sexual pain using the VAS before and 6 months after the sling erosion of their female partners was treated. Participants gave informed consent and those who had undergone prostate surgery during the past 12 months were excluded. For statistical analyses, SPSS version 10.0 (SPSS Inc., Chicago, IL, USA) was used. RESULTS: Thirty-two males were included in the study and produced a full set of data. VAS scores as a measurement for "hispareunia" improved from a median score of 8 before to a median score of 1 after intervention. Some domains of male sexual function (sexual interest, sexual drive, ejaculation, and erection) were significantly improved whereas the strength of erection, problems with ejaculation, and problems with lack of interest were not statistically significantly changed. CONCLUSIONS: Changes of male sexual function and particularly pain after sling insertion in their female partners may be due to sling exposure. Sexual interest and drive may be negatively influenced. Male dyspareunia is a complaint that can be treated effectively by correcting the sling exposure.

Recurrent mesh erosion and retropubic abscess following anterior intravaginal slingplasty.

Anterior intravaginal slingplasty (IVS), which utilizes multifilament polypropylene mesh is associated with significant risk of mesh erosion and infection. A case of mesh erosion occurred at 6 months following retropubic suburethral IVS sling was referred to our clinic. Complete removal of the protruded tape with primary closure of the vaginal defect was performed. However, repeat vaginal erosion was observed 2 years later. The undermined remaining tape further developed a retropubic purulent abscess. Thereafter, complete mesh removal and debridement in the retropubic space was carried out. The retropubic abscess resulted from the remains of the IVS tape. We emphasize that complicated sequel can develop after incomplete removal of IVS tape when tape erosion is encountered.

Prevalence of human papillomavirus genotypes, and mucosal IgA anti-viral responses in women with cervical ectopy.

BACKGROUND: Data on the prevalence of different human papillomavirus (HPV) genotypes and the associated mucosal immune response in women with cervical ectopy are scarce. OBJECTIVE: To assess the prevalence of different HPV genotypes and the mucosal anti-viral immune response in cervical ectopy. STUDY DESIGN: Detection and typing of HPV DNA was determined in 141 women with cervical ectopy, 272 cytologically normal controls and 98 low-grade squamous intraepithelial lesions (LSIL) by PCR and direct sequencing. Mucosal IgA antibodies to HPV16 and HPV18 were evaluated in cervical mucus by ELISA. RESULTS: The prevalence of HPV in cervical ectopy was higher (73.7%) than that observed in control samples (30.5% in endocervix, and 1.8% in exocervix), but similar to the prevalence in LSIL (62.2%). Typing showed that the overall distribution frequency concerned 14 different genotypes, with HPV18 being the most prevalent in cervical ectopy (53.9%), whereas HPV16 predominated in LSIL (38.7%). High-risk HPV genotypes were 2.2 times more frequent in cervical ectopy than in the normal endocervix (p<0.0001). HPV infection in cervical ectopy patients was accompanied by a mucosal IgA-antibody response. Antibody reactivity to HPV18 was significantly higher than the response to HPV16. CONCLUSION: Cervical ectopy is a risk factor for infection with high-risk HPV genotypes, in particular HPV18. Our results emphasize the need of further studies to clarify the oncogenic potential of this virus in cervical ectopy.

Cryotherapy as the treatment modality of postcoital bleeding: a randomised clinical trial of efficacy and safety.

BACKGROUND: Postcoital bleeding is a common gynaecological problem that impacts on a woman's quality of life and sexual function. There is little systematic research into its management. AIMS: To assess the efficacy and side-effects of cryotherapy as treatment for postcoital bleeding. METHODS: A prospective randomised controlled trial was conducted in a tertiary referral hospital in Hong Kong. A total of 85 women who presented with postcoital bleeding were recruited, and randomised to cryotherapy or no treatment. The treatment group received cryotherapy with compressed carbon dioxide through a cryoprobe placed on the cervix, and controls had cryoprobe on the cervix without compressed carbon dioxide flow. All recruited women were followed up two weeks, three months and six months to review their symptoms and response to the treatment. RESULTS: The treatment group had a significantly better long-term cure rate and improvement rate. At six months, the cryotherapy group reported a cure rate of 72.1% while that in the control group the cure rate was 50.0% (P = 0.04). The number needed to treat was 5. The mean improvement rate of the cryotherapy group was 82.88% +/- 35.87 but was only 61.62% +/- 55.30 in the control group (P = 0.04). The results were more significant in women with the defined pathological cervix. Apart from the vaginal discharge at second week follow up in the treatment group, there was no statistical significant difference in side-effects and complications among two groups. CONCLUSION: Our study demonstrated that cryotherapy is a safe and an effective treatment for postcoital bleeding.

[Morphological observation of cone biopsy and hysterectomy specimens of high-grade cervical intraepithelial neoplasia].

OBJECTIVE: To study the histopathological features, growth pattern and distribution on the uterine cervix of high-grade cervical intraepithelial neoplasia (CIN). METHODS: Cone biopsy and hysterectomy specimens of 592 women with high-grade CIN (CIN II or III) were reviewed morphologically. Of all cases, the gross appearance of the external os was recorded, and the frequency of cervical quadrants involved in high-grade CIN was assessed. Two hundred specimens were selected randomly to observe micrographical changes, including the extent, depth, growth pattern and cell types of high-grade CIN and the alteration of stroma surrounding CIN. RESULTS: Of 592 specimens, external os showed smoothness in 46 cases (7.8%), mild erosion in 151 cases (25.5%), moderate or severe erosion in 395 cases (66.7%), hypertrophy in 48 cases (8.1%), and neoplasm in 4 cases (0.7%). High-grade CIN involvement was equally frequent on each quadrant of cervix (P>0.05). Of 200 cases of high-grade CIN reviewed micrographically, the depth of the deepest involved crypt was less than 3 mm in 188 specimens (94.0%), between 3 to 5 mm in 12 specimens (6.0%), and more than 5 mm in none. High-grade CIN with isolated endocervical crypt involvement was detected in 77 cases (38.5%), multiple crypt involvement in 143 cases (71.5%), and confluent crypt involvement in 73 cases (36.5%). High-grade CIN showed explanate in 81.0% (162/200) of cases, endophytic in 49.0% (98/200) of cases, and exophytic in 6. 5% (13/200) of cases. Abrupt transition between CIN and normal epithelia were found in 167 specimens (83.5%), whereas gradual transition in 66 specimens (33.0%). A variety of cell types, but basaloid type predominantly, were observed in high-grade CIN. In 28.5%-45.0% of cases, the stroma surroundin CIN displayed oedema, desmoplastic and lymphocytic responses. CONCLUSIONS: Our data suggest that gross examination is of little importance for diagnoses of CIN. CIN trend to spread horizontally and along the endocervical crypts, and are mainly distributed to a depth less than 3 mm. These data also suggest that there are a variety of cell types of CIN, and stroma responses to CIN may exist in part of high-grade CIN.

Evidence for benefits from treating cervical ectopy: literature review.

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.