Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

School-based HPV Vaccination: The Challenges in a Brazilian Initiative / Vacinação contra o HPV em base escolar: Os desafios de uma iniciativa brasileira

Abstract Objective The present study assesses the implementation and the impact after 2 years of a school-based human papillomavirus (HPV) vaccination program in a Brazilian city. Methods A prospective study assessing the implementation of the program, offering quadrivalent HPV vaccine in two annual doses to girls and boys aged from 9 to 10 years old. The program was started in the city of Indaiatuba, state of São Paulo, Brazil, in 2018, and had authorization from the National Immunization Program. The number of HPV vaccine first doses applied and the coverage in 2018 was calculated and compared to the year 2017. There were described events that have influenced the results. Results The program invited 4,878 children through schools (87.1% of the target population), and 7.5% refused vaccination. Several concurrent events required or competed for health professionals of the vaccination teams. The coverage of the first dose (between 9 and 10 years old) was 16.1% in 2017 and increased to 50.5% in 2018 (p < 0.0001). The first dose in all ages increased 78% in 2018 compared with 2017 (6,636/3,733). Competing demands over the program continued in 2019, and the first dose coverage dropped (26.9%). For 2020, a municipal law instituted school-based vaccination and the creation of dedicated teams for vaccination, and these strategies are waiting to be tested. Conclusion School-based annual HPV vaccination in children between 9 and 10 years old was feasible and increased vaccination coverage, regardless of gender, although the program was vulnerable to competing events.

Resumo Objetivo O presente estudo avalia a implantação de um programa de vacinação contra o papilomavírus humano (HPV) em escolas de uma cidade brasileira e o impacto após 2 anos. Métodos Estudo prospectivo para avaliar a implementação do programa, oferecendo a vacina quadrivalente contra o HPV em duas doses anuais, para meninas e meninos de 9 a 10 anos. O programa foi autorizado pelo Programa Nacional de Imunizações na cidade de Indaiatuba, estado de São Paulo, Brasil, e teve início em 2018. A cobertura anual da primeira dose foi comparada ao ano de 2017, e os eventos que influenciaram os resultados foram descritos. Resultados O programa convidou 4.878 crianças por meio das escolas (87,1% da população-alvo) e 7,5% recusou a vacinação. Vários eventos concorrentes exigiram ou competiram pelos profissionais de saúde das equipes de vacinação. A cobertura da primeira dose (9 a 10 anos) foi de 16,1% em 2017 e aumentou para 50,5% em 2018 (p < 0,0001). A primeira dose em todas as idades aumentou 78% em 2018 em comparação com 2017 (6.636/3.733). As demandas concorrentes sobre o programa continuaram em 2019, e a cobertura da primeira dose caiu (26,9%). Para 2020, uma lei municipal instituiu a vacinação nas escolas e a criação de equipes dedicadas à vacinação, e estas estratégias aguardam para ser testadas. Conclusão A vacinação anual contra o HPV em base escolar nas idades de 9 a 10 anos foi viável e aumentou a cobertura vacinal, independentemente do gênero, embora o programa fosse vulnerável a eventos concorrentes.

Medical students' knowledge of the human papillomavirus (HPV), cervical cancer, and HPV vaccination / Conhecimento dos alunos de medicina sobre papilomavírus humano (HPV), câncer cervical e vacinação contra HPV

Abstract: Introduction: Medical students still have many doubts regarding HPV (Human papillomavirus) and the vaccine against this virus. Objective: The study aimed to assess the University of Brasilia medical students' grasp of knowledge about HPV, its relationship with cancer, and the vaccine against the virus. Methods: A cross-sectional study was undertaken by applying a survey questionnaire on the topics. The evaluation involved 379 respondents, 72.7% of the 521 students from the 1st to the 6th years enrolled in the second semester of 2017. The statistical analyses included differences between means and proportions, effect size measures, and the correlation between the identified indicators. The study was approved by the Ethics Committee in Research on Human Beings of the School of Medicine (1,989,835). Results: The 50-item knowledge score increased progressively with the year attended by the medical students (r= .706, p< .001), and was higher among the sexually-active compared to celibate participants (t = 3.26, df = 275, p = 0.001, d = 0.37), as well as among participants with higher family income compared to those with lower family income (t= 2.91, df= 366, p= .004, d= .35). No significant score differences emerged between participants grouped by gender, sexual behavior, or HPV vaccination status. Furthermore, gender (female; OR= 6.5, p<.001), age range (<24 years; OR= 3.3, p= .001), sexuality (active; OR= 2.7, p= .002), but not overall knowledge were predictors of the wish to be vaccinated among the 297 unvaccinated students. Conclusion: The study revealed a strong correlation of medical students' HPV-related knowledge with medical school year and significantly higher scores among sexually active and higher-income respondents, but there were no essential differences between males and females or between vaccinated and unvaccinated students. Among the latter participants, gender, age, and sexuality, but not knowledge, were the best predictors of the wish to be vaccinated. The findings suggest the need for improving HPV screening and vaccination programs and educational strategies regarding HPV-related diseases.

Resumo: Introdução: Há ainda, entre os estudantes de Medicina, muitas dúvidas com relação ao papilomavírus humano (HPV) e à vacina contra esse vírus. Objetivo: Este estudo teve como objetivo avaliar a compreensão dos estudantes de Medicina da Universidade de Brasília acerca do HPV, da sua relação com o câncer e da vacina contra o vírus. Método: Foi realizado um estudo transversal por meio da aplicação de um questionário teste sobre os temas. A avaliação envolveu 379 respondentes, o que representava 72,7% dos 521 alunos do primeiro ao sexto ano matriculados no segundo semestre de 2017. As análises estatísticas incluíram diferenças entre médias e proporções, medidas de tamanho de efeito e a correlação entre os indicadores identificados. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da Faculdade de Medicina (1,989,835). Resultado: A pontuação de conhecimento de 50 itens aumentou progressivamente com o ano do curso médico (r = 0,706, p <0,001) e foi maior entre os participantes sexualmente ativos em comparação com os celibatários (t = 3,26, df = 275, p = 0,001, d = 0,37), e entre os participantes com renda familiar mais alta em comparação com aqueles com renda mais baixa (t = 2,91, df = 366, p = 0,004, d = 0,35). Nenhuma diferença significativa de pontuação foi observada entre os participantes agrupados por gênero, comportamento sexual ou estado de vacinação contra o HPV. Além disso, sexo (feminino; OR = 6,5, p <0,001), faixa etária (<24 anos; OR = 3,3, p = 0,001) e sexualidade (ativo; OR = 2,7, p = 0,002), mas não o conhecimento geral, foram preditores do desejo de vacinação entre 297 alunos não vacinados. Conclusão: O estudo revelou uma forte correlação entre o conhecimento relacionado ao HPV dos estudantes de Medicina e o ano de estudo, e pontuações significativamente mais altas entre os respondentes sexualmente ativos e de renda superior, mas não houve nenhuma diferença essencial entre homens e mulheres ou entre alunos vacinados e não vacinados. Entre estes últimos, gênero, idade, sexualidade, e não o conhecimento foram os melhores preditores do desejo de vacinação. Os achados sugerem a necessidade de aperfeiçoamento em programas de triagem e vacinação para HPV e nas estratégias educacionais referentes às doenças relacionadas ao vírus.

Prevalencia de los genotipos de HPV en lesiones pre invasoras de alto grado de malignidad y cáncer de cuello uterino en la población del Hospital de Clínicas: Montevideo-Uruguay / Prevalence of HPV genotypes in cervical high risk intraepithelial lesions and cervical cancer in the population of Hospital de Clínicas: Montevideo-Uruguay / Prevalência de genótipos de HPV em lesões pré-invasivas com alto grau de malignidade e câncer de colo do útero na população do Hospital de Clínicas: Montevidéu, Uruguai

El Cáncer de Cuello Uterino (CCU) es un problema de Salud pública a nivel mundial. Su indiscutible asociación con el Virus del papiloma humano (HPV) hace necesario su estudio. El objetivo de este trabajo, es conocer la prevalencia de los diferentes genotipos de HPV, en lesiones pre invasoras de alto grado de malignidad (HSIL) y/o cáncer de cuello uterino. Material y Métodos: Todas las Mujeres que fueron derivadas a pol de TGI del H Clínicas entre enero del 2011 y diciembre de 2012, por un PAP sospechoso de lesión y en las que se confirmó luego un HSIL o cáncer cervical fueron tipificadas. Se recabaron datos de edad, tipo de lesión y genotipificación. La extracción de ADN viral se realizó a partir de muestras cervico vaginales conservadas en medio de transporte comercial (Sacace) mediante el kit QIAamp DNA Mini Kit (QIAGEN). Se buscaron 14 genotipos de alto riesgo. Resultados: Se tipificaron 75 pacientes, 19 con CCU y 56 con HSIL. El HPV 16 fue el más prevalente en un 61,5 % para las infecciones únicas y en un casi 100 % para las múltiples y un 60% para el total de las lesiones, seguido en prevalencia por los HPV 31,33 y 45. El HPV 18 fue muy poco prevalente. Conclusiones: En esta muestra, la prevalencia del HPV 16 está acorde con las publicaciones nacionales siendo el más frecuente. El HPV 18 tiene muy baja prevalencia siendo 2 casos en 75, siempre en infecciones múltiples.

Cervical Cancer (CC) is a public health problem worldwide. Its indisputable association with the Human Papilloma Virus (HPV) makes its study necessary. The objective of this work is to know the prevalence of the different HPV genotypes, in pre-invasive high-grade malignant lesions (HSIL) and / or cervical cancer. Material and Methods: All women who were referred to Low genital tract service in the Hospital de Clinicas between January 2011 and December 2012, for a PAP suspected of injury and in which HSIL or cervical cancer was later confirmed were typified. Data on age, type of lesion and genotyping were collected. The viral DNA extraction was carried out from cervico-vaginal samples preserved in commercial transport medium (Sacace) using the QIAamp DNA Mini Kit (QIAGEN). 14 high-risk genotypes were searched. Results: 75 patients were typified, 19 with CCU and 56 with HSIL. HPV 16 was the most prevalent in 61.5% for single infections and almost 100% for multiple infections and 60% for all lesions, followed in prevalence by HPV 31,33 and 45. The HPV 18 was very rare. Conclusions: In this sample, the prevalence of HPV 16 is in accordance with national publications, being the most frequent. HPV 18 has a very low prevalence, being 2 cases in 75, always in multiple infections.

O câncer cervical é um problema de saúde pública em todo o mundo. E um câncer com uma ligação comprovada com o vírus do papiloma humano. O objetivo é conhecer a prevalência dos diferentes genótipos do HPV em mulheres que apresentam neoplasias pré-invasivas de alto grau e câncer de colo do útero, que foram tratadas e diagnosticadas no Hospital de Clínicas entre janeiro de 2011 e dezembro de 2012. Material e Métodos: o estudo foi realizado em 75 pacientes do Hospital de Clinicas, com diagnóstico histológico de Câncer Cervical e lesões intraepiteliais de alto grau para as quais foi realizado o tipageme do HPV alto risco. Resultados: 75 pacientes foram tipificados, 19 com CCU e 56 com HSIL. O HPV 16 foi o mais prevalente em 61,5% para infecções únicas e quase 100% para infecções múltiplas e 60% para todas as lesões, seguido em prevalência pelo HPV 31,33 e 45. O HPV 18 era muito raro. Conclusões: Nesta amostra, a prevalência do HPV 16 está de acordo com as publicações nacionais, sendo a mais frequente. O HPV 18 tem prevalência muito baixa, sendo 2 casos em 75, sempre em infecções múltiplas.

Estimation of the costs of invasive cervical cancer treatment in Brazil: A micro-costing study / Estimativa dos custos do tratamento do câncer do colo do útero invasivo no Brasil: um estudo de microcustos

Abstract Objective Themain objective of the present study was to estimate the annual treatment costs of invasive cervical cancer (ICC) per patient at an oncology center in Brazil from a societal perspective by considering direct medical, direct nonmedical, and indirect costs. Methods A cost analysis descriptive study, in which direct medical, direct nonmedical, and indirect costs were collected using a microcosting approach, was conducted between May 2014 and July 2016 from a societal perspective. The study population consisted of women diagnosed with ICC admitted to a tertiary hospital in Recife, state of Pernambuco, Brazil. The annual cost per patient was estimated in terms of the value of American Dollars (US$) in 2016. Results From a societal perspective, the annual ICC treatment cost per patient was US $ 2,219.73. Direct medical costs were responsible for 81.2% of the total value, of which radiotherapy and outpatient chemotherapy had the largest share. Under the base-case assumption, the estimated cost to the national budget of a year of ICC treatment in the Brazilian population was US$ 25,954,195.04. Conclusion We found a high economic impact of health care systems treating ICC in a poor region of Brazil. These estimates could be applicable to further evaluations of the cost-effectiveness of preventing and treating ICC.

Resumo Objetivo O objetivo principal do presente estudo foi estimar os custos anuais por paciente do tratamento do câncer do colo do útero (CCU) invasivo em um centro de oncologia no Brasil, sob a perspectiva da sociedade, considerando os custos diretos médicos, diretos não médicos e indiretos. Métodos Foi realizado um estudo descritivo de análise de custos, no qual os custos médicos diretos, não médicos diretos e indiretos foram coletados por meio de uma abordagem de microcustos, realizado entre maio de 2014 e julho de 2016 sob a perspectiva da sociedade. A população do estudo foi composta por mulheres diagnosticadas com CCU invasivo internadas em um hospital terciário em Recife, PE, Brasil. O custo anual por paciente foi estimado emtermos de dólares americanos (US$) para o ano de 2016. Resultados O custo anual do tratamento do CCU invasivo sob a perspectiva da sociedade foi de US$ 2.219,73 por paciente. Os custos médicos diretos foram responsáveis por 81,2% do valor total, dos quais a radioterapia e a quimioterapia ambulatorial tiveram a maior participação. Sob o pressuposto do caso base, o custo estimado para o orçamento nacional de um ano de tratamento do CCU invasivo na população brasileira foi de US$ 25.954.195,04. Conclusão Foi encontrado um alto impacto econômico dos sistemas de saúde para o tratamento do CCU invasivo em uma região pobre do Brasil. Essas estimativas poderão ser aplicáveis emavaliações adicionais do custo-efetividade da prevenção e tratamento do CCU.

Lower genital tract infections in young female juvenile idiopathic arthritis patients

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

Management of atypical squamous cell cases: A prospective study of women seen at a private health service in northeastern Brazil / Conduta em casos de células escamosas atípicas: um estudo prospectivo de mulheres atendidas pelo serviço de saúde privado no nordeste do Brasil

Abstract Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p< 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p< 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p< 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Resumo Objetivo Avaliar a conduta adotada por ginecologistas após resultados citológicos apresentando células escamosas atípicas (ASCs) e os desfechos destes casos em mulheres brasileiras. Métodos Um estudo observacional prospectivo avaliou o manejo clínico inicial do ginecologista nos casos de 2.458 resultados citológicos apresentando ASCs coletados entre janeiro de 2010 e julho de 2016. Os respectivos desfechos citológicos, histológicos e de detecção do papilomavírus humano (HPV) foram comparados entre os subgrupos células escamosas atípicas de significado indeterminado (ASC-US) e células escamosas atípicas não podendo excluir lesão intraepitelial de alto grau (ASC-H). Resultados Nenhuma conduta foi adotada em 36,97% de citologias do tipo ASC-US e 40,5% do tipo ASC-H. A conduta mais escolhida foi a repetição da citologia, inclusive para acompanhamento de ASC-H, o que contraria as diretrizes nacionais. O tempo de realização de uma nova citologia para resultado do tipo ASC-US em mulheres com mais de 30 anos de idade foi de 13,03 meses, também em desacordo com as diretrizes (p< 0,0001). Resultados negativos para lesão intraepitelial ou neoplasia maligna (NILM), tanto citológicos (p = 0,0026) como histológicos (p = 0,0017), foram associados a ASC-US, enquanto que resultados negativos para lesões intraepiteliais escamosas de alto grau (HSILs), citológicos (p< 0,0001) e histológicos, foram associados a ASC-H (p< 0,0001). Dois carcinomas cervicais invasivos foram encontrados durante o acompanhamento para ASC-H e uma associação estatisticamente significante foi estabelecida (p = 0,0341). Um teste de HR-HPV positivo foi associado a ASC-H (p = 0,0075). Conclusão Os dados sugerem que mesmo para uma população de mulheres brasileiras atendidas em clínicas privadas, as recomendações das diretrizes clínicas nacionais para resultados citológicos apresentando ASCs não são seguidas.

A pilot study on the identification of human papillomavirus genotypes in tongue cancer samples from a single institution in Ecuador

The relationship between human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma has been established. However, data from Ecuador is limited. The objective of this study was to characterize HPV infection in Ecuadorian patients with tongue cancer. Fifty-three patients with tongue cancer treated at the tertiary referral center Sociedad de Lucha Contra el Cancer (SOLCA), Guayaquil, between 2006 and 2011 were identified. Linear Array® HPV genotyping was used to identify the presence and types of HPV on formalin-fixed paraffin-embedded biopsy samples from these patients with tongue cancer. HPV was identified in 42% (n=22) and high-risk (HR) HPV in 17% (n=9), with 18 different HPV types identified. The most common types were the HR HPV 33 (14%) and low-risk HPV 67 (14%), followed by the HR HPV 58. More than one HPV type was identified in 27.3% of cases. HPV 33 was frequently associated with other HPV types. No statistically significant differences in gender (P=0.58) and age (P=0.12) were observed between HPV-positive and HPV-negative cases. HPV was identified in almost half of the tongue cancer samples, with subtypes 33 and 67 being the most common. This suggested that HPV played an important role in this disease in the population studied. Given these results, current HPV vaccines may not be as effective in reducing tongue cancer rates in this population.

HPV vacina: conhecer e aceitar para assegurar a eficácia / HPV vaccine: knowledge and acceptance to ensure effectiveness

The new Vaccine technologies against transmissible and non-transmissible diseases, such as cancer, have had an impact on international public health. The human papillomavirus (HPV) vaccine is used on a large scale in immunization programs in more than 58 countries, with resultant efficacy and safety for precursor lesions of cervical cancer, in addition to anogenital lesions. After the introduction of quadrivalent HPV vaccine (6,11,16 and 18) in Brazil in 2014, monitoring the vaccination coverage and the development of HPV prevalence incidence of cervical abnormalities and precancerous lesions must be observed, as well as morbidity and mortality trends from in situ and invasive cancer. Encouraging information, counseling and continuing education is recommended as a strategy to broaden vaccine acceptance in order to sediment its implementation and ensure effectiveness in reducing new cases of cervical cancer in the future.

As novas tecnologias em vacina contra doenças transmissíveis e não transmissíveis como o câncer, tiveram impacto na saúde pública internacional, especificamente a vacina para o papiloma vírus humano (HPV) utilizada em larga escala nos programas de imunização em mais de 58 países, com resultados de eficácia e segurança para lesões precursoras do câncer de colo do útero além de lesões anogenitais. Após a introdução em território Nacional da vacina quadrivalente para o HPV (6,11,16 e 18) desde 2014, ressalta-se a importância do monitoramento da cobertura vacinal e o desenvolvimento de estudos de prevalência de HPV em logo prazo, de incidência de anormalidades cervicais e lesões pré-cancerosas bem como de tendência de morbimortalidade por câncer in situ e invasivo. O incentivo às informações, aconselhamento e educação continuada é recomendado como uma estratégia para ampliar a aceitação da vacina a fim de sedimentar sua implantação e assegurar a eficácia na redução dos novos casos de câncer de colo do útero para o futuro.

Prevalence of Human Papillomavirus Infection and Cervical Cancer Screening among Riverside Women of the Brazilian Amazon / Prevalência da infecção pelo papilomavírus humano e rastreamento do câncer em mulheres ribeirinhas da Amazônia brasileira

Abstract Purpose The aim of this study was to evaluate the overall and type-specific prevalence of human papillomavirus (HPV) infection among females living in riverside communities in the state of Pará, in the Eastern Brazilian Amazon. These communities are inhabited by low-income people, and are accessible only by small boats. Cervical cytology and risk factors for HPV infection were also assessed. Methods Cervical samples from 353 women of selected communities were collected both for Papanicolau (Pap) test and HPV detection. Conventional polymerase chain reaction (PCR) and real-time PCR were used to assess the overall and type-specific prevalence of HPV-16 and HPV-18, the main oncogenic types worldwide. Epidemiological questionnaires were used for the assessment of the risk factors for HPV infection. Results The mean age of the participants was 37 years (standard deviation [SD] ± 13.7). Most were married or with a fixed sexual partner (79%), and had a low educational level (80%) and family monthly income (< U$ 250; 53%). Overall, HPV prevalence was 16.4% (n = 58), with 8 cases of HPV-16 (2.3%) and 5 of HPV-18 (1.4%). Almost 70% of the women surveyed had never undergone the Pap test. Abnormal cytology results were found in 27.5% (n = 97) of the samples, with higher rates of HPV infection according to the severity of the lesions (p = 0.026). Conclusions The infections by HPV-16 and HPV-18 were not predominant in our study, despite the high prevalence of overall HPV infection. Nevertheless, the oncogenic potential of these types and the low coverage of the Pap test among women from riverside communities demonstrate a potential risk for the development of cervical lesions and their progression to cervical cancer, since the access to these communities is difficult and, in most cases, these women do not have access to primary care and public health services.

Resumo Objetivo O objetivo deste estudo foi avaliar a prevalência global e tipo-específica da infecção pelo papilomavírus humano (HPV) entre mulheres que vivem em comunidades ribeirinhas do estado do Pará, Amazônia oriental, Brasil. Estas comunidades são habitadas por pessoas de baixa renda, e são acessíveis somente por meio de pequenos barcos. A citologia cervical e os fatores de risco para a infecção por HPV também foram avaliados. Métodos Amostras cervicais de 353 mulheres de comunidades selecionadas foram coletadas para a análise citológica e para a detecção do HPV. A prevalência global e tipoespecífica dos HPV-16 e HPV-18, principais tipos oncogênicos no mundo, foram avaliadas por meio de reação em cadeia de polimerase (PCR) convencional e PCR em tempo real. Os fatores de risco para a infecção por HPV foram avaliados a partir de questionários epidemiológicos. Resultados A idade média das participantes foi de 37 anos (desvio padrão [DP] ± 13,7). A maioria era casada ou tinha um parceiro sexual fixo (79%) e baixo nível de escolaridade (80%) e de renda familiar mensal (< U$ 250; 53%). A prevalência global do HPV foi de 16,4% (n = 58), com 8 casos de HPV-16 (2,3%) e 5 casos de HPV-18 (1,4%). Aproximadamente 70% das mulheres entrevistadas nunca tinha realizado o exame preventivo de Papanicolau. Os resultados citológicos anormais foram encontrados em 27,5% (n = 97) das amostras, com taxas mais altas da infecção por HPV de acordo com a severidade das lesões (p = 0,026). Conclusões As infecções por HPV-16 e HPV-18 não foram predominantes em nosso estudo, apesar da alta prevalência global da infecção por HPV. No entanto, o potencial oncogênico desses tipos e a baixa cobertura do exame de Papanicolau entre mulheres de comunidades ribeirinhas demonstram um risco potencial para o desenvolvimento de lesões cervicais e sua progressão para o câncer de colo do útero, uma vez que o acesso a essas comunidades é difícil e, na maioria dos casos, estas mulheres não têm acesso aos serviços de atenção primária e de saúde pública.

Conocimientos sobre el virus del papiloma humano y su vacuna en padres de familia de Rivera, Huila en el 2015 / Knowledge of human papillomavirus and its vaccine in parents of Rivera, Huila in 2015

RESUMEN Introducción: la vacuna contra el virus del papiloma humano es la medida preventiva más reciente y controversial para el cáncer de cuello uterino. En 2014 Colombia tuvo una serie de supuestas reacciones adversas ante la vacuna que provocó la caída de su cobertura. Objetivo: describir los conocimientos frente al virus del papiloma humano y su vacuna en los padres de Rivera, Huila. Materiales y método: estudio transversal con muestra por conveniencia de 124 padres de niños menores de 18 años, a través de una encuesta sociodemográfica donde fue medido el conocimiento acerca del virus, su vacuna y el cáncer de cérvix. Análisis cuantitativo por medio de la técnica de frecuencias simples. Resultados: el nivel de conocimiento fue bajo (44,35%); el 43,54% identifican al virus del papiloma humano como agente etiológico del cáncer de cuello uterino; sólo el 7,4% considera útil la vacuna como método preventivo y la vacuna fue aceptada por el 87% de los padres. Conclusiones: El conocimiento del virus del papiloma humano y el cáncer de cuello uterino es bajo y se ve afectado por el desconocimiento de las diferentes estrategias preventivas del cáncer de cuello uterino, así como por la falta de información sobre la acción de la vacuna contra el virus. Sin embargo, la aceptabilidad de la vacuna es alta. MÉD.UIS. 2017;30(1):13-9.

ABSTRACT Introduction: Human Papillomavirus Vaccine is the most recent and controversial step for cervical cancer prevention. During 2014, in Colombia, a series of suspected adverse reactions to the vaccine caused a decline in its coverage. Objective: the aim of this study is to describe the knowledge about Human Papillomavirus and its vaccine from parents of Rivera, Huila. Materials and method: cross-sectional study with a convenient sample of 124 parents whose children were under 18 years old; through a socio-demographic questionnaire, knowledge about issues related to the virus, related to cervical cancer and its vaccine was measured. A quantitative analysis was performed by simple frequency analysis. Results: the level of knowlodge was low (44,35%); 43,54% of the parents identify Human Papillomavirus as an etiological cervical cancer agent, just 7,4% of the parents consider the vaccine as an useful preventive method and the vaccine was accepted by 87% of the parents. Conclusions: the knowledge level of the parents of Rivera, Huila about Human Papillomavirus and cervical cancer is low and it is affected by the ignorance of the different cervical cancer preventive strategies, as well as the lack of information of the action of Human Papillomavirus vaccine. However, the vaccine acceptability is high. MÉD.UIS. 2017;30(1):13-9.

Epidermodisplasia verruciforme / Epidermodysplasia verruciformis

La epidermodisplasia verruciforme (EV) es una genodermatosis rara, caracterizada por el desarrollo de verrugas planas y lesiones similares a pitiriasis versicolor, asociada a infección crónica por Virus Papiloma Humano. Se reporta el caso de EV. Mujer de 49 años con múltiples lesiones verrucosas de larga evolución distribuidas en las cuatro extremidades y antecedente familiar de cuadro similar. Biopsia a los 19 años evidenció verrugas sin atipia. Nuevo estudio histológico informó carcinoma escamoso, decidiéndose extirpación de lesiones. La clínica inicia en edades tempranas, con elevado riesgo de transformación maligna. No existe tratamiento específico. Es esencial la fotoprotección estricta y manejo precoz de lesiones para prevención de progresión a carcinoma.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis, characterized by the development of plane warts and pityriasis versicolor-like lesions, associated with chronic infection caused by the Human Papilloma virus. An EV case is reported. 49 year-old woman with multiple long standing warty lesions distributed on the four limbs and family background of similar cases. Biopsy at 19 years old evidenced warts without atypia. New histological study reported squamous cell carcinoma, deciding the removal of the lesions. The clinic begins at early age, with high risk of malignant transformation. There is no specific treatment. Strict photoprotection and early management of the lesions is essential to prevent the progression to carcinoma.

Vacina como agente de imunização contra o HPV / Vaccines as an agent for immunization against HPV

Considerada uma infecção de alta prevalência em todo o mundo, o papiloma vírus humano (HPV) é um DNA vírus que infecta a mucosa genital e possui grande potencial oncogênico, sendo relacionado ao risco aumentado de lesões do trato genital inferior, como o câncer cervical. Este câncer é responsável pela morte de cerca de 231 mil mulheres por ano no mundo, o que torna o HPV um grande problema para a saúde pública. Sabendo que a maneira mais eficaz e com melhor custo-benefício para controlar uma doença infecciosa é o desenvolvimento de vacinas, duas profiláticas foram desenvolvidas e aprovadas no Brasil, uma bivalente e outra quadrivalente. Essa revisão de literatura se propõe a apresentar as características do vírus HPV, os tipos de vacinas presentes no mercado, suas indicações e contraindicações, seus efeitos adversos, sua eficácia, seus títulos de anticorpos (GMT) e seu custo-efetividade.

Considered a highly prevalent infection throughout the world, the human papillomavirus (HPV) is a DNA virus that infects the genital mucosa and has high carcinogenic potential, being related to an increased risk of lower genital tract lesions, such as cervical cancer. This cancer is responsible for the deaths of about 231,000 women per year worldwide, which means that HPV is a major problem for public health. Knowing that the most effective and cost-effective way to control an infectious disease is the development of vaccines, two prophylactic vaccines have been developed and approved in Brazil, one of which is bivalent and the other is tetravalent. This review of the literature seeks to present the characteristics of the HPV virus, types of vaccines available on the market, their indications and contraindications, their adverse effects, their effectiveness, their geometric mean titer (GMT) and their cost-effectiveness.

Prevalence of cervical squamous intraepithelial lesion high grade according to age from Antônio Pedro University Hospital / Prevalência de lesão intraepitelial escamosa de alto grau do colo uterino de acordo com a faixa etária no Hospital Universitário Antônio Pedro

The targeted population for HPV infection has peak infection at young adults, but studies point to the emergence of a new peak of viral infection and injuries later, probably by changesin sexual behaviour, waning immunity over time or reactivation of latent infection. Whereas the cervical squamous intraepithelial lesion high grade, mainly cervical intraepithelial neoplasia grades III (CIN III) have significant potential for progression to invasive carcinoma, the procedures of choice for the diagnosis and treatment in the target population are essential for the prevention of cervix cancer. Objective: To determine the prevalence of CIN II/III among patients seen in Cervical Pathology Clinic of Gynecology Department at the University Hospital Antonio Pedro from May 1996 to May 2013, relating toage in which this diagnosis was made. Method: It was selected patients referred to the Cervical Pathology Clinic for altered cytology and diagnosed through biopsy guided by colposcopy with CIN II / III. They were segmented into the following age groups: 15 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84 and 85 to 94 years old. Results: Between 25 and 64 years of age, there were 36.5% of patients in these age groups with CIN II/III. However, it was found that 19% of patients younger than 25 years and 14.2% at 64 years also had such a diagnosis. Conclusion: The target population according to Brazilian Ministry of Health would let 16.2% of women with high-grade lesions withouta diagnosis, which corresponds to 11.3% of all high-grade cervical lesions.

A população alvo de infecções pelo HPV tem como pico adultos jovens, porém estudos apontam para um novo pico mais tardio, provavelmente por alterações do comportamento sexual, diminuição da imunidade ou reativação da infecção latente. Considerando que as lesões intraepiteliais escamosas de alto grau do colo uterino, sobretudo a neoplasia intraepitelial cervical grau III (NIC III) tem potencial significativo de progressão para carcinoma invasor,os procedimentos de escolha para diagnóstico e tratamento na população alvo são essenciais para a prevenção do câncer de colo uterino. Objetivo: Verificara prevalência de NIC II/III dentre as pacientes atendidas no Ambulatório de Patologia Cervical do Serviço de Ginecologia do Hospital Universitário Antônio Pedro no período de maio de 1996 a maio de 2013, relacionando com a faixa etária em que este diagnóstico foi realizado. Método: Selecionou-se as pacientes encaminhadas ao Ambulatório de Patologia Cervical por citologia oncótica alterada e diagnosticadas, por meio de biópsia dirigida pela colposcopia, comNIC II/III. Foram segmentadas nas seguintes faixas etárias: 15 a 24, 25 a 34, 35 a 44, 45 a 54, 55 a 64, 65 a 74, 75 a 84 e 85 a 94 anos. Resultados: Entre 25e 64 anos de idade, houve 36,5% de pacientes nestas faixas etárias com NIC II/III. Entretanto, verificou-se que 19% de pacientes com menos de 25 anos e14,2% com mais de 64 anos também apresentavam tal diagnóstico. Conclusão: A população-alvo preconizada pelo Ministério da Saúde deixaria 16,2% dasmulheres com lesões de alto grau à margem de um diagnóstico, o que corresponde a 11,3% de todas as lesões de alto grau do colo uterino.

Conhecimento e atitude de usuários do SUS sobre o HPV e as vacinas disponíveis no Brasil / SUS users? knowledge of and attitude to HPV virus and vaccines available in Brazil / SUS users? knowledge of and attitude to HPV virus and vaccines available in Brazil

OBJETIVO : Analisar o conhecimento de homens e mulheres acerca do HPV e das vacinas e sua intenção de serem vacinados e de vacinarem seus filhos adolescentes. MÉTODOS : Estudo descritivo, de corte transversal, com 286 mulheres (18 a 49 anos) e 252 homens (18 a 60 anos), usuários de cinco unidades básicas de saúde e duas policlínicas do Sistema Único de Saúde, em Campinas, SP, em 2011. Foi realizada entrevista estruturada. Realizou-se análise bivariada e regressão de Poisson para identificar variáveis associadas ao conhecimento sobre HPV e vacinas e à intenção de vacinação. RESULTADOS : Quase 40,0% dos entrevistados referiram ter ouvido falar do HPV e 28,9% mencionaram informações adequadas; a principal fonte de informação foi a mídia (41,7%); 8,6% tinham ouvido falar das vacinas. Depois de informados da existência das vacinas, cerca de 94,0% dos participantes disseram que se vacinariam e/ou vacinariam filhos adolescentes se as vacinas estivessem disponíveis na rede pública de saúde. Escolaridade > 8 anos e ser do sexo feminino estiveram independentemente associados a ter ouvido falar do HPV e das vacinas e a ter conhecimento adequado sobre o vírus. Maior idade associou-se a ter ouvido falar das vacinas. Não houve variáveis associadas à intenção de vacinação. CONCLUSÕES : Os resultados reforçam a necessidade de haver intervenções educativas na população para prover informação adequada sobre o HPV e sobre medidas de prevenção. .

Objetivo : Analizar el conocimiento de hombres y mujeres sobre el VPH y de las vacunas y su intención de ser vacunados y de vacunar sus hijos adolescentes. Métodos : Estudio descriptivo, de corte transversal, con 286 mujeres (18 a 49 años) y 252 hombres (18 a 60 años), usuarios de cinco unidades básicas de salud y dos policlínicas del Sistema Único de Salud, en Campinas, SP – Brasil, en 2011. Se realizó entrevista estructurada. Se utilizó el análisis bivariado y regresión de Poisson para identificar variables asociadas al conocimiento sobre VPH y vacunas y la intención de vacunación. Resultados : Casi el 40,0% de los entrevistados mencionaron haber oído hablar del VPH y 28,9% relataron informaciones adecuadas; la principal fuente de información fueron los medios de comunicación (41,7%); 8,6% habían oído hablar de las vacunas. Después de informados de la existencia de las vacunas, cerca de 94,0% de los participantes dijeron que se vacunarían y/o vacunarían hijos adolescentes si las vacunas estaban disponibles en la red pública de salud. Escolaridad > 8 años y ser del sexo femenino estuvieron independientemente asociados al haber oído hablar del VPH y de las vacunas y tener conocimiento adecuado sobre el virus Mayor edad se asoció al haber oído hablar de vacunas. No hubo variables asociadas a la intención de vacunación. Conclusiones : Los resultados refuerzan la necesidad de haber intenciones educativas en la población para proveer información adecuada sobre el VPH y sobre medidas de prevención .

OBJECTIVE : To investigate knowledge of HPV and HPV vaccines in men and women, users of the Brazilian Unified Health System, and the intention to get themselves and their teenage children vaccinated. METHODS : A descriptive, cross-sectional study with 286 women (18-49 years old) and 252 men (18-60 years old), users of five primary health units and two polyclinics in Campinas, SP, Southeastern Brazil, was carried out. Participants were interviewed in 2011 using a structured questionnaire. Bivariate and Poisson regression analysis were performed to identify variables associated with knowledge of HPV and HPV vaccines, and participants vaccination intentions. RESULTS : Almost 40.0% of the participants reported having heard of HPV and 28.9% mentioned adequate information. The main information source was the media (41.7%). Only 8.6% of the participants had heard of the HPV vaccines. Once the participants were informed of the existence of HPV vaccines about 94% of them said they would get vaccinated and/or vaccinate their teenage children, if the vaccines were available in the public health system. Schooling of over 8 years and being female were the variables independently associated with having heard of HPV, the vaccines and having adequate knowledge of the virus. Advanced age was associated with having heard of HPV vaccines. There were no variables associated with the vaccination intentions. CONCLUSIONS : These results reinforce the need for educational activities that provide the population with adequate information on HPV and preventive measures. .

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE: To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus METHODS: This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay. RESULTS: A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection. CONCLUSIONS: The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus. .

Knowledge and attitudes toward HPV and the HPV vaccines in the Bahamas / Conocimientos y actitudes hacia el VPH y las vacunas contra VPH en las Bahamas

OBJECTIVE: High-risk types of human papillomavirus (HPV) are a necessary, albeit not sufficient, cause for cervical cancer development. In The Bahamas, cervical cancer is one of the leading causes of cancer despite screening and educational efforts. As a vaccine programme is being considered, awareness of HPV-related conditions and its vaccine need to be measured. METHODS: This study design was cross-sectional and carried out at three clinical sites and one community in Nassau, Bahamas. All participants were over the age of 18 years and were invited to answer a (self-administered) questionnaire regarding knowledge and attitudes toward HPV and its vaccines. RESULTS: Of399 participants, 75% were female and 23% male. About 41% had a high school education and 55.4% had some tertiary college education. Forty-six per cent had heard of HPV and 35% heard of the vaccine. The mean number of correct answers about HPV was 2.93 ± 3.17 of 10 questions, while for the vaccine, it was 1.37 ± 1.58 of five questions. Multivariable logistic regression indicated that some college education was associated with more HPV and HPV vaccine knowledge. Seventy-three per cent needed reassurance of the vaccine's safety and efficacy. Sixty-five per cent would vaccinate their daughters and 68% would vaccinate their sons if the vaccine was safe and effective. CONCLUSION: More public education is needed to increase awareness of cervical cancer and HPV-related diseases. Reassurance with respect to vaccine safety and efficacy also needs to be addressed. Since the majority would vaccinate their children, there is the potential for a national vaccination programme to succeed.

OBJETIVO: Los tipos de alto riesgo del virus del papiloma humano (VPH) son una medida necesaria, aunque no constituyen causa suficiente para el desarrollo de cáncer cervical. En las Bahamas, el cáncer de cuello uterino es una de las principales causas de cáncer a pesar de los esfuerzos realizados en términos de pesquizaje y educación. En un momento en que se está considerando la posibilidad de un programa de vacunación, es necesario evaluar el nivel de conciencia con respecto a las condiciones relacionadas con el VPH y su vacuna. MÉTODOS: Se trata de un estudio con un diseño transversal, llevado a cabo en tres clínicas y en una comunidad, en Nassau, Bahamas. Todos los participantes eran mayores de 18 años y fueron invitados a responder un cuestionario autoadministrado sobre conocimientos y actitudes hacia el VPH y sus vacunas. RESULTADOS: De 399 participantes, el 75% eran hembras y el 23% eran varones. Aproximadamente el 41% tenía educación secundaria y el 55,4% tenía algún nivel de educación terciaria. El cuarenta y seis por ciento había oído del VPH, y el 35% había oído hablar de la vacuna. El número promedio de respuestas correctas sobre el VPH fue 2.93 ± 3.17 de 10 preguntas, mientras que para la vacuna, fue 1.37 ± 1.58 de cinco preguntas. La regresión logística multivariable indicó cierta asociación de la educación universitaria con más conocimientos sobre el VPHy la vacuna del VPH. Setenta y tres por ciento necesitaban garantías de seguridad y eficacia en relación con la vacuna. El sesenta y cinco por ciento vacunaría a sus hijas, y el 68% vacunaría a sus hijos varones, si la vacuna fuese segura y efectiva. CONCLUSIÓN: Se requiere más educación pública para aumentar la conciencia sobre el cáncer de cuello uterino y las enfermedades relacionadas con el VPH. Asimismo hay que abordar el problema de las garantías respecto a la eficacia y seguridad de la vacuna. Puesto que la mayoría vacunaría a sus hijos e hijas, existe la posibilidad de que un programa nacional de vacunación tenga éxito.

Prevalence of hrrpes simplex virus type 2 and rsk factors associated with thiss infection in women in southern Brazil / Prevalencia do herpes virus tipo 2 e fatores de risco associados a sua infeccao em mulheres do sul do Brasil

SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2. .

RESUMO O vírus herpes simplex tipo 2 (HVS-2) é uma das infecções mais prevalentes em todo o mundo. Considera-se um co-factor na aquisição do vírus da imunodeficiência humana (HIV) e na persistência do papilomavirus humano (HPV). Este estudo tem como objetivo avaliar a prevalência de HSV-2 usando a reação em cadeia da polimerase (PCR) e fatores associados em pacientes atendidos na Universidade Federal do Rio Grande e em Unidades Básicas de Saúde (UBS) do Rio Grande, Brasil. A prevalência de HSV-2 encontrada neste estudo foi de 15,6%. Entre as 302 mulheres estudadas, 158 haviam recebido assistência na UBS e 144 foram atendidos na FURG. A prevalência de HSV-2 nestes grupos foi de 10,8 e 20,8%, respectivamente, com RR: 1,9 e p = 0,012. Conhecer o exame de Papanicolaou, e presença de lesão não teve associação com infecção HSV-2. A análise multivariada mostrou que a variável que influencia no risco de infecção HSV-2 foi o paciente ter HIV, com risco relativo 1,9 e p = 0,04. Discussão: As úlceras genitais são importante porta de entrada para o vírus HIV e o uso do preservativo é estratégia importante para reduzir a transmissão do HIV e do HSV-2. .

Human papillomavirus risk factors for infection and genotype distribution in aboriginal women from Northern Argentina / Virus papiloma humano (hpv) en mujeres de la etnia Pilagá del nordeste argentino: Factores de riesgo de infección y distribución de tipos virales

The mortality rate for cervical cancer (CC) in Northern Argentina is three times higher than the average for the country (7.8 deaths/100 000 women). We determined the prevalence and genotype distribution of human papillomavirus (HPV) in 227 sexually active women of the native Pilagá community in Formosa, Argentina. We also conducted an HPV-16 variant analysis and studied several community factors that might play a role in viral entry and infection. Endo- and exocervical samples were tested for HPV DNA with MY09/11-PCR or with GP5+/6+-PCR. HPV was detected in 46.7% of the samples and 21 different types were found; the most frequent being HPV-16 (19.4%), -6 and -18 (5.3%), -58 (3.5%) and -31 and -33 (3.1%). In relation to HPV-16 variants, 68.2% were European and 31.8% Asian-American. Among the cofactors analyzed only disposal of human excreta to the open air (P=0.01) was significantly associated with HPV infection. Our prevalence estimates clearly show that Pilagá women are highly exposed to or infected with high risk HPV types and therefore are at a high risk of developing precancerous lesions and eventually CC at the population level.

La tasa de mortalidad por cáncer cervical (CC) en la región norte de la Argentina es tres veces más alta que la media del país (7.8 muertes/100 000 mujeres). En el presente trabajo se determinó la prevalencia de infección por virus papiloma humano (VPH) y la distribución y frecuencia de los genotipos en 227 mujeres sexualmente activas de la etnia aborigen Pilagá (Formosa, Argentina). También se realizó un análisis de las variantes intratípicas de VPH-16 presentes en la comunidad y se analizaron diversos factores socioculturales que podrían tener algún rol destacado en la transmisión de la infección viral. Se estudiaron muestras de células endo-exocervicales mediante PCR basadas en los cebadores MY09/11 y GP5+/6+ con posterior restricción enzimática y/o hibridación dot-blot. La infección por VPH fue detectada en el 46.7% de las mujeres analizadas. Fueron identificados 21 genotipos, de los cuales los más frecuentes fueron HPV-16 (19.4%), -6 y -18 (5.3%), -58 (3.5%) y -31 y -33 (3.1%). Respecto al HPV-16, se encontraron 68.2% de variantes europeas y 31.8% de asiático-americanas. Entre los cofactores analizados, solo la disposición de excretas al aire libre estuvo significativamente asociada con la infección por VPH (P = 0.01). Los datos obtenidos reflejan que la comunidad Pilagá está altamente expuesta a las infecciones por genotipos de alto riesgo de VPH, lo cual puede estar asociado a una alta incidencia de lesiones cervicales preneoplásicas y neoplásicas.

Prevalencia de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en el Cauca, Colombia / The prevalence of abnormal cytology and inflammation and their association with risk factors for uterine cervical neoplasms in Cauca, Colombia

Objetivos Establecer la prevalencia del resultado de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en mujeres del departamento del Cauca, Colombia. Metodología Después de la Arma voluntaria del consentimiento informado, las mujeres fueron entrevistadas a través de un cuestionario para colectar variables de tipo sociodemográfico y clínico, incluyendo historia reproductiva, actividad sexual, historia de citología y hábito de fumar. Posteriormente, se procedió a la toma de la citología para su análisis y clasificación según el sistema Bethesda 2001. Un total de 1735 mujeres fueron reclutadas para este estudio. Resultados Acorde con el resultado de citología, 1061 mujeres presentaron citología normal (61 %), 36 citología anormal (2 %) y 638 cambios celulares reactivos asociados a inflamación (37 %). Los resultados indican que tener relaciones sexuales a temprana edad, la multiparidad, el uso de anticonceptivos hormonales y no realizarse la citología anualmente fueron factores de riesgo asociados a citología anormal. Conclusiones Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de cribado para la prevención de neoplasias del cuello uterino en mujeres de la región y el país.

Objectives Establishing the prevalence of abnormal and inflammation cytology reports and its association with risks factors for uterine cervical neoplasms amongst females from the Cauca department in Colombia. Methodology After signing a consent-form, females were interviewed using a questionnaire to collect socio-demographic and clinical data, including reproductive history, sexual activity, cytology history and smoking habits. Cytology was then taken for analysis and classification according to the 2001 Bethesda System. A total of 1,735 females were recruited for the study. Results According to the cytology report, 1061 women had normal cytology (61 %), 36 abnormal cytology (2 %) and 638 reactive cellular changes associated with inflammation (37 %). The results indicated that having sexual intercourse at an early age, multiparity, using hormonal contraceptives and not having annual cytology screening were associated with abnormal cytology reports. Conclusions These results provided valuable information for public health institutions for developing better screening programmes to prevent risks of uterine cervical neoplasms amongst females from our region and throughout Colombia.