Screening HPV infection alone more accurate than Pap test in detection of cervical cancer

Screening for human papillomavirus (HPV) infection alone gives more accurate results than Pap (smear) testing for cervical cancer, say the authors of two papers to published today in the journal Gynecologic Oncology. HPV infection causes almost all cervical cancer, and it is estimated that more than half of sexually active people are infected with HPV at some point in their lives. Now new research has shown that in many cases, an HPV test alone can be used for cervical cancer screening instead of a Pap or cotesting with both an HPV and a Pap test, the researchers say.

In the first paper1, Dr Warner Huh, from the Department of Gynecologic Oncology, University of Alabama, Birmingham, USA, sets out the findings of a panel convened to provide guidance on using HPV as the first-line primary screening test. The panel included representatives from all the major US organizations involved in cervical cancer screening, and addressed questions related to the safety and effectiveness of HPV testing for primary screening and whether it could be considered as an alternative to the screening methods currently in use in the US. The panel was convened because of an application to the Food and Drug Administration (FDA) for an existing HPV test to be used for primary HPV cervical cancer screening. The guidance was based on a literature review and also on review of data from the ATHENA study which was conducted to support the primary screening application to the FDA.

"We found that, in patients aged 25 years and upwards, primary HPV testing performed better than a Pap alone, and we recommend that such tests should be carried out no sooner than every three years. This is an important advance in cervical cancer screening because it offers a better reassurance of low cancer risk compared to Pap screening, which is also carried out at three year intervals," Dr Huh said.

Infection with just two HPV genotypes, 16 and 18, is responsible for about 70% of all invasive cervical cancers worldwide. The panel recommends that patients testing positive for either of these two high risk genotypes should have immediate colposcopy - a procedure using a lighted magnifying device that allows doctors to see abnormal areas in the cervix that would be missed by the naked eye. Women with one of the 12 other HPV genotypes can be followed-up in 12 months with repeat testing with both the HPV test and a Pap.

"We believe that there is still considerable confusion over the three current screening options, and the intervals at which they should be performed. We hope that our deliberations will go some way towards reducing this uncertainty. However, I would still like to see more data from the US, and evidence from other countries using primary HPV screening such as Australia and The Netherlands. But in the absence of data to the contrary, we believe that primary HPV testing has potential to further reduce cervical cancer in the US," Dr Huh said.

The second paper2 reveals end-of-study results of the ATHENA trial which evaluated safety and effectiveness of HPV primary screening as an alternative to Pap in women of 25 years and older. 42,209 women in this age group were enrolled into the trial and had both Pap and HPV testing. Those with abnormal Pap test results and those who were HPV positive were referred for colposcopy.

"We found that HPV primary screening was as effective in women aged 25 years and over when compared to Pap alone for women 25 and 29 and cotesting for those aged 30 and over. However, HPV screening alone requires only one test, and this is important for many women who may not be able to afford the cost of two tests," said Dr Thomas Wright, a Professor Emeritus of Pathology and Cell Biology at Columbia University, New York, USA.

To determine the impact of starting HPV screening at different ages, the researchers compared the prevalence of HPV positivity and Pap abnormalities as well as the three year detection rate of high-grade cervical disease by age group. They found that although HPV positivity was almost twice as high in women aged 25-29 as it was in women aged 30-39, HPV testing identified about twice as many high-grade cervical disease cases in women aged 25-29 than did the Pap.

"When Pap screening is used in this age group, the women with missed high-grade cervical disease are told to return in three years for repeat screening and some are likely to develop invasive cervical cancer", said Dr Wright.

"Our results, from the first prospective US study to evaluate the performance of HPV primary screening, have shown clearly that this new screening approach should be considered as an option for women 25 years and older", Dr Wright said. However, he added that the recent FDA approval for HPV primary screening is limited to a single commercially available HPV test and to only one of the two widely utilised liquid-based Pap tests. "In order to facilitate the widespread adoption of this safe and effective method of screening, it would be advantageous to have additional HPV tests and the other liquid-based Pap tests approved. We hope that our research will help reduce morbidity and mortality from cervical cancer worldwide," he said.

Source: https://medicalxpress.com/news/2015-01-screening-hpv-infection-accurate-pap.html

Sexually Transmitted Diseases in Women

Sexually transmitted diseases (STDs) are among the most common infectious diseases in the United States today. More than 20 STDs have been identified and they affect an estimated 19 million men and women in this country each year. The annual treatment cost of STDs in the United States is estimated to be more than $14 billion.

How do STDs affect women?

Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because for women there are often no visible symptoms, so they do not seek care until serious problems have developed.

Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which is a cause of both infertility and ectopic (tubal) pregnancy. Ectopic pregnancy can be fatal. STDs in women also may be associated with cervical cancer. Human papillomavirus infection (HPV) can cause genital warts and cervical and other genital cancers. STDs can be passed from a mother to her baby before, during or immediately after birth. Some of these new-born infections can be cured easily, but others may cause a baby to be permanently disabled or even die.

What are the most common types of STDs?

Chlamydial Infection

This infection is the most common of all bacterial STDs, with an estimated 2.8 million new cases occurring each year. Chlamydial infection may cause an abnormal vaginal discharge and burning during urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease (PID), one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection; it often goes undiagnosed and untreated. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.

Genital Herpes

Genital herpes affects at least 45 million Americans ages 12 and older. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by the herpes simplex viruses type 1 and type 2. Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender sores that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter. The virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms, but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent recurrences and perhaps transmission. Women who acquire genital herpes can transmit the virus to their babies during delivery. Untreated HSV infection in new-borns can result in mental retardation and death.

Genital Warts 

Genital warts (also called venereal warts or condylomata acuminata) are caused by the human papillomavirus, a virus related to the one that causes common skin warts. Certain high-risk types of HPV can cause cervical cancer and other genital cancers, but these are different from the types that cause genital warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. There is a very low risk that a pregnant woman with genital warts can pass HPV to her baby. In the rare cases where HPV is passed, the baby could develop warts in the throat or voice box. Genital warts infect between 500,000 to 1 million Americans each year. They are usually removed by freezing, burning or laser treatment. If the warts are very large, they can be removed by surgery. If they recur, they may be treated with injections of a type of interferon. Although treatments may get rid of warts, they do not get rid of HPV, which can still be passed on to sex partners.

Gonorrhea

Gonorrhea is the second most commonly reported infectious disease in the United States. The CDC estimates that more than 700,000 persons in this country get new gonorrheal infections each year; only about half of these infections are reported to the CDC. Most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The most common symptoms of gonorrhea are a vaginal discharge or vaginal bleeding between periods. Untreated cases can lead to serious complications, including PID, ectopic pregnancy and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade resistance to penicillin has emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis 

While the rate of primary and secondary (P&S) syphilis – the most infectious stages of the disease – reached an all-time low in 2000, it has increased dramatically in recent years. Between 2004 and 2005, the number of reported P&S syphilis cases in the United States increased from 7,980 to 8,724. The overall increase in syphilis cases was driven primarily by increases among males. However, troubling trends also were seen among females, as the rate of reported cases among females increased for the first time in more than 10 years. Syphilis is easily curable in its early stages. The initial symptom is a chancre, a painless open sore that usually appears around or in the vagina. If untreated, it can lead to serious long-term complications, including problems of the heart and central nervous system, organ damage and even death. Congenital syphilis can cause stillbirth, death soon after birth, and physical deformity and neurological complications in children who survive. The full course of the disease can take years. Penicillin remains the most effective drug in the treatment of syphilis.

Other STDs

Other diseases that may be sexually transmitted include human immunodeficiency virus (HIV), trichomoniasis, bacterial vaginosis, cytomegalovirus infections and pubic lice (crabs). STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the new-born. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 percent to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.

What can you do to prevent STDs?

The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD:

Have a mutually monogamous sexual relationship with an uninfected partner.

Use condoms correctly every time you have sex. The use of latex or polyurethane condoms during vaginal intercourse, when used consistently and correctly, can reduce the risk of transmission of STDs.

Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.

Source: http://www.idph.state.il.us/about/womenshealth/factsheets/std.htm

Chlamydia: Sexually Transmitted Infection

Chlamydia is a common sexually transmitted disease (STD) caused by infection with Chlamydia trachomatis. It can cause cervicitis in women and urethritis and proctitis in both men and women. Chlamydial infections in women can lead to serious consequences including pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Lymphogranuloma venereum (LGV), another type of STD caused by different serovars of the same bacterium, occurs commonly in the developing world, and has more recently emerged as a cause of outbreaks of proctitis among men who have sex with men (MSM) worldwide.

Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. In 2010, 1.4 million cases of chlamydia were reported to the U.S.CDC from 50 states and the District of Columbia, but an estimated 2.86 million infections occur annually. Many cases are not reported because most people with chlamydia do not have symptoms and do not seek testing. Chlamydia is most common among young people. It is estimated that one in 15 sexually active females aged 14-19 years has chlamydia.

People at risk for chlamydia

Any sexually active person can be infected with chlamydia. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should refrain from having sex until they are able to see a health care provider about their symptoms.

Also, anyone with an oral, anal or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Because chlamydia is usually asymptomatic, screening is necessary to identify most infections. Screening programs have been demonstrated to reduce rates of adverse sequelae in women. CDC recommends yearly chlamydia screening of all sexually active women age 25 or younger and older women with risk factors for chlamydial infections (e.g., women who have a new or more than one sex partner). Pregnant women should be screened during their first prenatal care visit. Pregnant women younger than 25 or at increased risk for chlamydia (e.g., women who have a new or more than one sex partner) should be screened again in their third trimester. Any woman who is sexually active should discuss her risk factors with a health care provider who can then determine if more frequent screening is necessary.

Routine screening is not recommended for men. However, the screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics) when resources permit and do not hinder screening efforts in women.

Men who have sex with men (MSM) who have receptive anal sex should be screened for chlamydia each year. MSM who have multiple and/or anonymous sex partners should be screened more frequently (e.g., at three to six-month intervals).

HIV-infected sexually active women who are age 25 or younger or have other risk factors, and all HIV-infected patients who report having receptive anal sex should be screened for chlamydia at their first HIV care visit and then at least annually. A patient’s health care provider might determine more frequent screening is necessary, based on the patient’s risk factors.

Symptoms

Chlamydia is known as a “silent” infection because most infected people have no symptoms. If symptoms do occur, they may not appear until several weeks after exposure. Even when it causes no symptoms, chlamydia can damage a woman’s reproductive organs.

In women, the bacteria first infect the cervix (structure that connects the vagina or birth canal to the uterus or womb) and/or the urethra (urine canal). Some infected women have an abnormal vaginal discharge or a burning sensation when urinating. Untreated infections can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent or can cause symptoms such as abdominal and pelvic pain. Even if PID causes no symptoms initially, it can lead to infertility (not being able to get pregnant) and other complications later on.

Some infected men have discharge from their penis or a burning sensation when urinating. Pain and swelling in one or both testicles (known as “epididymitis”) may occur but is less common.

Chlamydia can infect the rectum in men and women, either through receptive anal sex, or possibly via spread from the cervix and vagina. While these infections often cause no symptoms, they can cause rectal pain, discharge, and/or bleeding (known as “proctitis”).

Complications due to Chlamydia Infection

The initial damage that chlamydia causes often goes unnoticed. However, chlamydial infections can lead to serious health problems.

In women, Untreated infection can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent or can cause symptoms such as abdominal and pelvic pain. Both symptomatic and silent PID can cause permanent damage to a woman’s reproductive tract and lead to long-term pelvic pain, inability to get pregnant and potentially deadly ectopic pregnancy (pregnancy outside the uterus).

Complications are rare in men. Infection sometimes spreads to the tube that carries sperm from the testis, causing pain, fever, but, rarely, preventing a man from being able to father children.

Chlamydia in pregnant woman

In pregnant women, untreated chlamydia has been associated with pre-term delivery, and can spread to the new born, causing an eye infection or pneumonia. Screening and treatment of chlamydia during pregnancy is the best way to prevent these complications. All pregnant women should be screened for chlamydia at their first prenatal visit.

Diagnosis

There are laboratory tests to diagnose chlamydia. Specimens commonly used for testing include a cotton swab of the vagina (collected by the woman herself or her health care provider) or a urine sample.

Chlamydia Treatment

Penicillin is not effective against chlamydia.

Chlamydia can be easily treated and cured with antibiotics. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV-negative.

Persons with chlamydia should abstain from having sex for seven days after single dose antibiotics, or until completion of a seven-day course of antibiotics, to prevent spreading the infection to partners.

Repeat infection with chlamydia is common. Persons whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple chlamydial infections increases a woman's risk of serious reproductive health complications, including pelvic inflammatory disease and ectopic pregnancy. Women and men with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were successfully treated.

Infants infected with chlamydia may develop conjunctivitis (infection of the membrane lining the eyelids) and/or pneumonia. Chlamydial infection in infants can be treated with antibiotics.

Prevention Strategies

Not having sex is the best protection against chlamydia and other STDs. Having sex with only one uninfected partner who only has sex with you is also safe. Latex male condoms, when used consistently and correctly, can reduce the risk of getting or giving chlamydia. The surest way to avoid chlamydia is to abstain from vaginal, anal and oral sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

To submit your abstracts at the conference STD 2018: http://bit.ly/stdabst2018

Source: http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/chlamydia