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The Oncologist Jun 2024Human papillomavirus (HPV)-associated malignancies account for ~5% of human cancers worldwide. Thirteen, or more, HPV types are oncogenic, but infection with these... (Review)
Review
Human papillomavirus (HPV)-associated malignancies account for ~5% of human cancers worldwide. Thirteen, or more, HPV types are oncogenic, but infection with these viruses is common and usually cleared within 2 years. Only infections that become persistent are associated with the development of cancer, often occurring several decades later. These cancers mostly arise in 6 different anatomical regions: 5 are anogenital (anus, cervix, penis, vagina, and vulva) and the sixth is the oropharynx. Oncogenic HPVs promote cellular proliferation and genomic instability, but the anatomical niche of the target tissue also plays an important role in the development of cancer. Cells that reside in transitional regions between different types of epithelia, such as in the anus, cervix, and oropharynx, are particularly vulnerable to oncogenesis.
Topics: Humans; Papillomavirus Infections; Female; Male; Papillomaviridae; Neoplasms; Persistent Infection
PubMed: 38630576
DOI: 10.1093/oncolo/oyae071 -
Current Problems in Pediatric and... Jul 2020Vulvovaginitis, referring to inflammation of the vulva and vagina, is a commonly reported concern among adolescents and young women presenting for gynecologic care.... (Review)
Review
Vulvovaginitis, referring to inflammation of the vulva and vagina, is a commonly reported concern among adolescents and young women presenting for gynecologic care. Symptoms of vulvovaginitis may include vaginal discharge, odor, itching, pain, dysuria, skin irritation, burning, and dyspareunia. Vulvovaginitis may result from infectious or non-infectious causes. Bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis represent the three most common infectious causes of vulvovaginitis in adolescents and young adults. Additionally, non-infectious causes such as the presence of a foreign body in the vagina, chemical irritants, douching, and poor hygiene may also lead to symptoms of vulvovaginitis. A thorough history in combination with the appropriate physical examination and laboratory evaluation is necessary to identify the cause of a patient's symptoms. Importantly, adolescent patients should be given the opportunity to speak privately with the provider without a parent or guardian present in the room, particularly when gathering the sexual history. Appropriate anticipatory guidance and counseling should be provided once a diagnosis has been made, and prevention of future episodes of vulvovaginitis should be discussed.
Topics: Anti-Infective Agents; Candidiasis, Vulvovaginal; Female; Humans; Sexual Behavior; Sexually Transmitted Diseases; Vagina; Vulvovaginitis
PubMed: 32778468
DOI: 10.1016/j.cppeds.2020.100836 -
Histopathology Jan 2020Vulval squamous cell carcinoma (VSCC) can arise through two distinct pathways [human papillomavirus (HPV)-associated and HPV-independent], and these VSCC variants are... (Review)
Review
Vulval squamous cell carcinoma (VSCC) can arise through two distinct pathways [human papillomavirus (HPV)-associated and HPV-independent], and these VSCC variants are recognised as different disease entities on the basis of different aetiologies, morphological features, molecular events during oncogenesis, precursor lesions, prognosis, and response to treatment. The precursor of HPV-associated VSCC, variously referred to as high-grade squamous intraepithelial lesion (HSIL) [vulvar intraepithelial neoplasia (VIN) 2/3] or usual-type VIN, is morphologically identical to the more common HSIL (cervical intraepithelial neoplasia 2/3) of the cervix. The precursor lesions of HPV-independent VSCC include differentiated VIN, differentiated exophytic vulvar intraepithelial lesion, and vulvar acanthosis with altered differentiation; these have been under-recognised by pathologists in the past, leading to delays in treatment. This review will discuss the recent advances in diagnostic surgical pathology of VSCC and its precursors, and how these diagnoses can impact on patient management.
Topics: Carcinoma, Squamous Cell; Female; Humans; Papillomaviridae; Papillomavirus Infections; Precancerous Conditions; Vulva; Vulvar Neoplasms
PubMed: 31846523
DOI: 10.1111/his.13989 -
Free Radical Biology & Medicine Aug 2021High-risk human papillomavirus (HR-HPVs) are associated with the development of cervical, anus, vagina, vulva, penis, and oropharynx cancer. HR-HPVs target and modify... (Review)
Review
High-risk human papillomavirus (HR-HPVs) are associated with the development of cervical, anus, vagina, vulva, penis, and oropharynx cancer. HR-HPVs target and modify the function of different cell biomolecules such as glucose, amino acids, lipids, among others. The latter induce cell proliferation, cell death evasion, and genomic instability resulting in cell transformation. Moreover, lipids are essential biomolecules in HR-HPVs infection and cell vesicular trafficking. They are also critical in producing cellular energy, the epithelial-mesenchymal transition (EMT) process, and therapy resistance of HPV-related cancers. HPV proteins induce oxidative stress (OS), which in turn promotes lipid peroxidation and cell damage, resulting in cell death such as apoptosis, autophagy, and ferroptosis. HR-HPV-related cancer cells cope with OS and lipid peroxidation, preventing cell death; however, these cells are sensitized by OS, which could be used as a target for redox therapies to induce their elimination. This review focuses on the role of lipids in HR-HPV infection and HPV-related cancer development, maintenance, resistance to therapy, and the possible treatments associated with lipids. Furthermore, we emphasize the significant role of OS in lipid peroxidation to induce cell death through apoptosis, autophagy, and ferroptosis to eliminate HPV-related cancers.
Topics: Female; Ferroptosis; Humans; Lipid Metabolism; Male; Neoplasms; Oxidative Stress; Papillomavirus Infections
PubMed: 34129929
DOI: 10.1016/j.freeradbiomed.2021.06.009 -
The Cochrane Database of Systematic... Nov 2019Uptake of human papillomavirus (HPV) vaccine remains low in many countries, although the bivalent and quadrivalent HPV vaccines given as a three-dose schedule are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uptake of human papillomavirus (HPV) vaccine remains low in many countries, although the bivalent and quadrivalent HPV vaccines given as a three-dose schedule are effective in the prevention of precancerous lesions of the cervix in women. Simpler immunisation schedules, such as those with fewer doses, might reduce barriers to vaccination, as may programmes that include males.
OBJECTIVES
To evaluate the efficacy, immunogenicity, and harms of different dose schedules and different types of HPV vaccines in females and males.
SEARCH METHODS
We conducted electronic searches on 27 September 2018 in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library), and Ovid Embase. We also searched the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov (both 27 September 2018), vaccine manufacturer websites, and checked reference lists from an index of HPV studies and other relevant systematic reviews.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) with no language restriction. We considered studies if they enrolled HIV-negative males or females aged 9 to 26 years, or HIV-positive males or females of any age.
DATA COLLECTION AND ANALYSIS
We used methods recommended by Cochrane. We use the term 'control' to refer to comparator products containing an adjuvant or active vaccine and 'placebo' to refer to products that contain no adjuvant or active vaccine. Most primary outcomes in this review were clinical outcomes. However, for comparisons comparing dose schedules, the included RCTs were designed to measure antibody responses (i.e. immunogenicity) as the primary outcome, rather than clinical outcomes, since it is unethical to collect cervical samples from girls under 16 years of age. We analysed immunogenicity outcomes (i.e. geometric mean titres) with ratios of means, clinical outcomes (e.g. cancer and intraepithelial neoplasia) with risk ratios or rate ratios and, for serious adverse events and deaths, we calculated odds ratios. We rated the certainty of evidence with GRADE.
MAIN RESULTS
We included 20 RCTs with 31,940 participants. The length of follow-up in the included studies ranged from seven months to five years. Two doses versus three doses of HPV vaccine in 9- to 15-year-old females Antibody responses after two-dose and three-dose HPV vaccine schedules were similar after up to five years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected clinical outcome data. Evidence about serious adverse events in studies comparing dose schedules was of very low-certainty owing to imprecision and indirectness (three doses 35/1159; two doses 36/1158; 4 RCTs). One death was reported in the three-dose group (1/898) and none in the two-dose group (0/899) (low-certainty evidence). Interval between doses of HPV vaccine in 9- to 14-year-old females and males Antibody responses were stronger with a longer interval (6 or 12 months) between the first two doses of HPV vaccine than a shorter interval (2 or 6 months) at up to three years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected data about clinical outcomes. Evidence about serious adverse events in studies comparing intervals was of very low-certainty, owing to imprecision and indirectness. No deaths were reported in any of the studies (0/1898, 3 RCTs, low-certainty evidence). HPV vaccination of 10- to 26-year-old males In one RCT there was moderate-certainty evidence that quadrivalent HPV vaccine, compared with control, reduced the incidence of external genital lesions (control 36 per 3081 person-years; quadrivalent 6 per 3173 person-years; rate ratio 0.16, 95% CI 0.07 to 0.38; 6254 person-years) and anogenital warts (control 28 per 2814 person-years; quadrivalent 3 per 2831 person-years; rate ratio 0.11, 95% CI 0.03 to 0.38; 5645 person-years). The quadrivalent vaccine resulted in more injection-site adverse events, such as pain or redness, than control (537 versus 601 per 1000; risk ratio (RR) 1.12, 95% CI 1.06 to 1.18, 3895 participants, high-certainty evidence). There was very low-certainty evidence from two RCTs about serious adverse events with quadrivalent vaccine (control 12/2588; quadrivalent 8/2574), and about deaths (control 11/2591; quadrivalent 3/2582), owing to imprecision and indirectness. Nonavalent versus quadrivalent vaccine in 9- to 26-year-old females and males Three RCTs were included; one in females aged 9- to 15-years (n = 600), one in females aged 16- to 26-years (n = 14,215), and one in males aged 16- to 26-years (n = 500). The RCT in 16- to 26-year-old females reported clinical outcomes. There was little to no difference in the incidence of the combined outcome of high-grade cervical epithelial neoplasia, adenocarcinoma in situ, or cervical cancer between the HPV vaccines (quadrivalent 325/6882, nonavalent 326/6871; OR 1.00, 95% CI 0.85 to 1.16; 13,753 participants; high-certainty evidence). The other two RCTs did not collect data about clinical outcomes. There were slightly more local adverse events with the nonavalent vaccine (905 per 1000) than the quadrivalent vaccine (846 per 1000) (RR 1.07, 95% CI 1.05 to 1.08; 3 RCTs, 15,863 participants; high-certainty evidence). Comparative evidence about serious adverse events in the three RCTs (nonavalent 243/8234, quadrivalent 192/7629; OR 0.60, 95% CI 0.14 to 2.61) was of low certainty, owing to imprecision and indirectness. HPV vaccination for people living with HIV Seven RCTs reported on HPV vaccines in people with HIV, with two small trials that collected data about clinical outcomes. Antibody responses were higher following vaccination with either bivalent or quadrivalent HPV vaccine than with control, and these responses could be demonstrated to have been maintained for up to 24 months in children living with HIV (low-certainty evidence). The evidence about clinical outcomes and harms for HPV vaccines in people with HIV is very uncertain (low- to very low-certainty evidence), owing to imprecision and indirectness.
AUTHORS' CONCLUSIONS
The immunogenicity of two-dose and three-dose HPV vaccine schedules, measured using antibody responses in young females, is comparable. The quadrivalent vaccine probably reduces external genital lesions and anogenital warts in males compared with control. The nonavalent and quadrivalent vaccines offer similar protection against a combined outcome of cervical, vaginal, and vulval precancer lesions or cancer. In people living with HIV, both the bivalent and quadrivalent HPV vaccines result in high antibody responses. For all comparisons of alternative HPV vaccine schedules, the certainty of the body of evidence about serious adverse events reported during the study periods was low or very low, either because the number of events was low, or the evidence was indirect, or both. Post-marketing surveillance is needed to continue monitoring harms that might be associated with HPV vaccines in the population, and this evidence will be incorporated in future updates of this review. Long-term observational studies are needed to determine the effectiveness of reduced-dose schedules against HPV-related cancer endpoints, and whether adopting these schedules improves vaccine coverage rates.
Topics: Adolescent; Adult; Child; Dose-Response Relationship, Immunologic; Female; Humans; Male; Papillomavirus Infections; Papillomavirus Vaccines; Randomized Controlled Trials as Topic; Uterine Cervical Neoplasms; Young Adult
PubMed: 31755549
DOI: 10.1002/14651858.CD013479 -
Indian Dermatology Online Journal 2023Vulval dermatoses may present with varied manifestations ranging from asymptomatic to chronic disabling conditions. The multifactorial nature of symptoms and physical...
BACKGROUND
Vulval dermatoses may present with varied manifestations ranging from asymptomatic to chronic disabling conditions. The multifactorial nature of symptoms and physical expression of the disease on the vulva complicate the evaluation and management of genital dermatoses, thereby severely impairing the quality of life of patients.
OBJECTIVES
To study the clinical patterns and socio-demographic features of vulval dermatoses and their impact on the quality of life using the dermatology life quality index (DLQI) questionnaire.
MATERIALS AND METHODS
Female patients of all age groups who attended our outpatient department (OPD) from October 2019 to March 2021 with vulval lesions were included in the study after a detailed history and complete examination. Based on sites of involvement, the lesions were classified as genital lesions alone, genital and skin lesions, oro-genital lesions, and oro-genital and skin lesions. DLQI score was assessed using the DLQI questionnaire.
RESULTS
In total, 520 patients were recruited for the study after following the inclusion and exclusion criteria. The most common age group was 31-40 years (33.65%). The majority of the patients were married (91.92%), housewives (82.88%), and illiterate (49.61%) women. The most common presenting symptom was itching (43%). The most common vulval dermatoses were infections, seen in 401 (77.11%) patients, followed by inflammatory diseases in 78 (15%) patients, and immunobullous diseases (1.53%). Patients with genital, skin, and oral involvement showed statistically significant higher DLQI scores ( value < 0.05). Patients with immunobullous disorders had the highest mean DLQI scores.
LIMITATIONS
As this study was a hospital-based study, the observations may not represent and reflect the general population.
CONCLUSION
Patients with genital, skin, and oral lesions had the highest DLQI scores, indicating higher impact on the quality of life. Assessment of the disease's impact on the quality of life is essential because it not only aids in early management but also helps in minimizing the duration of the ailment.
PubMed: 36776168
DOI: 10.4103/idoj.idoj_339_22 -
Ugeskrift For Laeger May 2022HPV vaccination is associated with a reduced risk of cervical cancer and its precursors, with greatest protection when the vaccine is administered before sexual debut.... (Review)
Review
HPV vaccination is associated with a reduced risk of cervical cancer and its precursors, with greatest protection when the vaccine is administered before sexual debut. This review aims to discuss whether immunization with the nonavalent HPV vaccine should be recommended to women who have previously been vaccinated with the bi- or quadrivalent HPV vaccine and to women who have previously undergone treatment for condylomas or dysplasia of the vulva, vagina, or cervix.
Topics: Female; Humans; Papillomavirus Infections; Papillomavirus Vaccines; Sexual Behavior; Uterine Cervical Neoplasms; Vaccination
PubMed: 35656616
DOI: No ID Found -
Seminars in Diagnostic Pathology Jan 2021The vulva can be affected by a variety of sexually transmitted infections as well as other common infections that are not typically related to sexual transmission.... (Review)
Review
The vulva can be affected by a variety of sexually transmitted infections as well as other common infections that are not typically related to sexual transmission. Vulvar infections may adversely affect the quality of life of the patients by causing discomfort and pain. Some of these infections, especially the ulcerative ones, may also increase the risk of transmission of other infectious diseases, including HIV. Due to the recently increasing number of sexually transmitted infections and atypical presentations of these infections in immunocompromised patients, it is important for pathologists to be familiar with histopathologic features of the infectious diseases of the vulva, so that accurate diagnoses can be rendered as promptly as possible. This review discusses the clinicopathologic presentations of the non-HPV related infections of the vulva.
Topics: Female; Humans; Quality of Life; Sexually Transmitted Diseases; Vulva; Vulvar Diseases
PubMed: 33067080
DOI: 10.1053/j.semdp.2020.09.012 -
Aesthetic Plastic Surgery Dec 2021This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue...
BACKGROUND
This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue derived-stromal vascular fraction, so-called 360 Vaginal Beautification technique, in labia majora augmentation and vaginal tightening operation.
METHODS
A total of 97 female patients who underwent labia majora augmentation and vaginal tightening operation with 360 Vaginal Beautification technique were included. Post-discharge early (3rd and 7th postoperative day) and late (1 and 3rd postoperative month) surgical complications were assessed , while the Female Genital Self-Image Scale (FGSIS) was applied before surgery and also during postoperative 6-12 months.
RESULTS
All complications noted on postoperative 3rd day (ecchymosis of labia majus, ecchymosis of clitoral hood, tenderness in the pubic area and pain at the vaginal entrance points) regressed on postoperative 7th day with no infection, edema, lipoma or granuloma formation in any patient. Total mean FGSIS score was 17.7 ± 1.6 in the pre-operative period, and increased significantly to 20.9 ± 1.4 and 22.2 ± 1.8 in the postoperative 6th month (p < 0.001) and 12th month (p = 0.013), respectively.
CONCLUSIONS
The use of autologous fat, called 360 vaginal beautification, in the labia majora augmentation and vaginal tightening appears to be a safe technique due to use of autologous tissue transfer and to be associated with high satisfaction rate and an advantage of being more minimally invasive than surgical labia majora augmentation and vaginal tightening.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
Topics: Aftercare; Female; Humans; Patient Discharge; Retrospective Studies; Stromal Vascular Fraction; Treatment Outcome; Vagina; Vulva
PubMed: 34373975
DOI: 10.1007/s00266-021-02488-w -
Pathogens and Disease Jul 2020Gynecological and obstetrical infectious diseases are an important component of women's health. A system approach to gynecological and obstetrical infection helps unify... (Review)
Review
Gynecological and obstetrical infectious diseases are an important component of women's health. A system approach to gynecological and obstetrical infection helps unify and classify microbial etiology and pathogenesis within a clinical anatomical framework of lower and upper genital tract syndromes. The reproductive system of women includes the vulva, vagina, cervix, uterus, fallopian tubes and ovaries. During pregnancy, additional tissues include the chorioamnion and placenta together with the fetus and amniotic fluid. We review in two parts reproductive system infection syndromes in women using selected research results to illustrate the clinical utility of the system approach in terms of diagnosis, treatment and prevention. We conclude that a reproductive system perspective will lead to improvements in understanding, management and prevention of these diseases.
Topics: Chlamydia Infections; Chlamydia trachomatis; Condylomata Acuminata; Female; Genitalia; Humans; Pregnancy; Pregnancy Complications, Infectious; Reproductive Tract Infections; Sexually Transmitted Diseases; Ulcer; Uterine Cervical Diseases; Uterine Cervical Neoplasms; Vulvar Diseases; Women's Health
PubMed: 32463432
DOI: 10.1093/femspd/ftaa022