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    human papillomavirus/Genital Warts

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    تاريخ التسجيل : 22/03/2010
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    human papillomavirus/Genital Warts

    مُساهمة من طرف admin في الجمعة مايو 20, 2011 4:24 pm

    1-Original contribution
    Human papillomavirusnext term type 6 in squamous cell carcinoma of the bladder and cervixstar, open
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    S.P. Wilczynski MD, PhDCorresponding Author Contact Information, 1, 2, 3, M. Oft MD1, 2, 3, N. Cook BS1, 2, 3, S.Y. Liao MD1, 2, 3 and T. Iftner PhD1, 2, 3

    1Department of Anatomic Pathology, City of Hope National Medical Center, Duarte, CA USA

    2Institut für Klinische und Molekulare Virologie, Universität Erlangen-Nürnberg, Erlangen, Germany

    3Department of Pathology, University of California at Irvine, Irvine, CA USA
    Accepted 30 April 1992.
    Available online 2 April 2004.

    Abstract

    previous termHuman papillomavirusnext term (HPV) types 16 and 18 are the most frequent genotypes identified in genital malignancies, while HPV types 6 and 11 are found predominantly in condylomas and low-grade dysplasias. It is thought that HPV types 16 and 18 represent high-risk genotypes, while HPV types 6 and 11 rarely, if ever, participate in the development of malignant tumors. In a series of over 300 invasive tumors of the lower genital tract analyzed for the presence of HPV three have been found to contain HPV type 6 DNA: two invasive squamous cell carcinomas of the cervix and one squamous cell carcinoma of the bladder. previous termHuman papillomavirusnext term type 6 was the only HPV type detected in these tumor DNAs by Southern blot hybridization and by the polymerase chain reaction using both consensus and type-specific primers. In situ hybridization using whole genomic RNA probes localized viral DNA to tumor cells. Although extensive virologic and epidemiologic studies conducted in the last decade indicate that HPV types 16 and 18 are more likely to be associated with high-grade dysplasias and invasive cancer, HPV type 6 may not be as innocuous as previously supposed.

    Keywords: previous termhuman papillomavirusnext term type 6; cervical cancer; bladder cancer
    star, openSupported by a Public Health Service grant (CA53005) to S.P.W. and by Wilhelm Sander-Stiftung no. 89.042.1 to T.I.
    Corresponding Author Contact InformationAddress correspondence and reprint requests to S. P. Wilczynski, MD, PhD, Department of Anatomic Pathology, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010.

    2-Paper
    Age-dependence of human papillomavirusnext term DNA presence in oral squamous cell carcinomas
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    I. B. F. Cruz2, 1, P. J. F. SnijdersCorresponding Author Contact Information, 1, Corresponding Author Contact Information, R. D. M. Steenbergen1, C. J. L. M. Meijer1, G. B. Snowc, J. M. M. Walboomers1 and I. van der Waal2

    1 Unit of Molecular Pathology, Department of Pathology, 1081 HV, Amsterdam, The Netherlands

    2 Department of Oral & Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry Amsterdam (ACTA), 1081 HV, Amsterdam, The Netherlands

    c Department of Otolaryngology, Head and Neck Surgery, Free University Hospital, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
    Received 17 July 1995;
    Revised 6 October 1995;
    accepted 9 August 1996.
    Available online 9 December 1999.

    Abstract

    The aetiology of oral cancer is thought to be multifactorial. Apart from the two known major risk factors (tobacco and alcohol), a viral aetiology has been proposed, with special reference to previous termhuman papillomavirusnext term (HPV).

    35 cases of oral squamous cell carcinoma (OSCC), seen at the Departments of Oral & Maxillofacial Surgery and Oral Pathology and Otolaryngology of the Free University of Amsterdam, were analysed as well as 12 biopsies of clinically and histologically normal gingival mucosa collected from healthy individuals after tooth extractions, using the polymerase chain reaction (PCR) and two different sets of primers that are able to detect a broad spectrum of HPV types.

    An overall HPV positivity of 54.3% in OSCC was found, the majority of positive cases (78.9%) harbouring HPV type 16. In contrast, no positivity for HPV was detected in the clinically normal oral mucosal samples analysed. Furthermore, a significant association between HPV presence and age was found: patients older than 60 years showed a lower prevalence of the virus (29.4%) compared with patients below this age (77.8%) (P < 0.05). The results from the present study suggest an association between HPV and OSCC, particularly in patients under the seventh decade.

    Author Keywords: DNA; previous termhuman papillomavirus; human papillomavirusnext term type 16; polymerase chain reaction; age
    3-Epidemiologic analysis of histologic cervical inflammation: relationship to human papillomavirusnext term infectionsstar, open
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    Melinda Butsch Kovacic MPH, PhDa, Corresponding Author Contact Information, E-mail The Corresponding Author, Hormuzd A. Katki PhDb, Aimee R. Kreimer PhDc and Mark E. Sherman MDb

    aInstitute for Personalized and Predictive Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA

    bDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and previous termHumannext term Services, Rockville, MD 20852, USA

    cDivision of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and previous termHumannext term Services, Rockville, MD 20852, USA
    Received 31 August 2007;
    revised 4 December 2007;
    accepted 6 December 2007.
    Available online 20 May 2008.

    Summary

    Infections with carcinogenic previous termhumannext term papillomaviruses, the causal agents of cervical intraepithelial neoplasia and cancer, as well as infections with noncarcinogenic previous termhumannext term papillomaviruses, are common but typically resolve spontaneously. Effective cell-mediated immune responses are critical for previous termhuman papillomavirusnext term clearance; however, data relating cervical inflammation to the outcome of previous termhuman papillomavirusnext term infection are lacking. To investigate this topic, we performed a masked parallel review of inflammation in the stroma and epithelium of cervical biopsies (n = 564) collected from a retrospectively defined subcohort of women systematically followed up in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study. Women in our analysis had undergone colposcopically directed enrollment biopsies diagnosed as negative or cervical intraepithelial neoplasia 1 and had corresponding previous termhuman papillomavirusnext term polymerase chain reaction test results of negative (n = 250), positive for a single carcinogenic (n = 237), or noncarcinogenic (n = 81) type. Inflammation in cervical stroma varied with cofactors for previous termhuman papillomavirusnext term progression: current smokers showed less inflammation (odds ratio, 0.55; 95% confidence interval, 0.31-0.97), whereas current oral contraceptive users had increased inflammation (odds ratio, 1.7; 95% confidence interval, 0.92-3.0) as did those with a self-reported 2-year history of a sexually transmitted disease (odds ratio, 1.9; 95% confidence interval, 1.0-3.5). Biopsies of women with carcinogenic previous termhumannext term papillomaviruses had greater inflammation within the epithelium (odds ratio, 1.6; 95% confidence interval, 1.1-2.3) compared with previous termhuman papillomavirusnext term–negative women. Associations with previous termhuman papillomavirusnext term type–specific persistence or progression to histologic cervical intraepithelial neoplasia 3 were diminished among women with moderate or marked inflammation in stroma (odds ratio, 0.49; 95% confidence interval, 0.25-0.99) or within epithelium (odds ratio, 0.51; 95% confidence interval, 0.26-0.97). These data suggest that cervical inflammation varies with previous termhuman papillomavirusnext term cofactors, type of previous termhuman papillomavirusnext term infection, and risk of persistence and progression. Additional studies are needed to confirm and extend these findings.

    Keywords: Histology; Cervical intraepithelial neoplasia; previous termHuman papillomavirusnext term; Immune infiltrates; Inflammation; Stroma; Epithelium; Smoking; Oral contraceptives; STDs
    4-
    Detection of human papillomavirusnext term type 16 DNA in cervical swabs and formalin-fixed, paraffin-embedded squamous cell carcinomas of non-genital tissues using a synthetic oligodeoxynucleotide probe
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    P. RakoczyCorresponding Author Contact Information, 1, T. Demeter1, L. Hutchinson1, G.F. Sterrett2, E.C. Pixley3 and J.K. Kulski1

    1Department of Microbiology, University of Western Australia, Nedlands, Australia

    2Department of Histopathology, Sir Charles Gairdner Hospital. Nedlands, Australia

    3St. Anne's Hospital, Mt. Lawley, Australia
    Accepted 22 May 1989.
    Available online 12 November 2002.

    Abstract

    The potential of using a chemically synthesized oligodeoxynucleotide as a diagnostic probe to detect previous termhuman papillomavirusnext term type 16 (HPV-16) in genital infections was evaluated by comparing it with a cloned full-length HPV-16 probe in dotblot DNA hybridizations. An oligonucleotide sequence, 20 bases in length from the E6 region of HPV-16 (E6 oligo) and different from the DNA sequences of HPV types 6, 11 and 18 by at least 2 base pairs, was chosen for chemical synthesis. The oligoprobe, which was 5'-end labelled with [32P]dATP, was found to be specific, but approximately ten times less sensitive than the full-length radiolabelled probe of HPV-16, in dot-blot hybridizations with the DNA of HPV-6, -11, -16 and -18, HPV positive and negative cell-lines. From 36 cervical or vulval scrapes two samples were found positive with both cloned HPV-16 and oligoprobe hybridization. Of 21 samples of formalin-fixed, paraffin-embedded squamous cell carcinomas originating from anus, oesophagus, penis, colon, breast and skin only 4 anal squamous cell carcinomas were positives when hybridized with cloned HPV-16 DNA or with the oligoprobe. This study confirms that HPV-16, which is frequently associated with squamous cell carcinoma of the cervix is also strongly associated with swuamous cell carcinoma of the anus.

    Keywords: Oligonucleotide; previous termHuman papillomavirusnext term; Hybridization
    5-Reprints
    Review
    Screening for human papillomavirusnext term infections of the lower genital tract
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    Annekathryn Goodman MDCorresponding Author Contact Information, E-mail The Corresponding Author

    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Wang Ambulatory Care Center, Suite 231, Boston, MA 02114, USA

    Available online 13 September 2002.

    Abstract

    previous termHuman papillomavirusnext term (HPV) infections are the etiologic agents in the development of lower genital tract neoplasia. Risk factors for the development of cervical cancer include high risk HPV subtype, persistent infection, high viral load, immunosuppression, tobacco use, and absence of cytologic screening. Strategies to increase the yield on screening for cervical neoplasia have included the use of HPV subtyping. This review summarizes the studies of HPV testing as a primary screening test, an adjunct for screening low and high risk populations, and for follow-up in women with persistent squamous intraepithelial lesions. Use of HPV screening is not yet applicable to populations with successful screening programs in place. Molecular markers for progression to cancer in women with persistent high risk HPV infections need to be discovered.

    Author Keywords: Cervical cancer screening; previous termHuman papillomavirusnext term infections; HPV subtyping; HPV testing
    6-Review article
    Human Papillomavirusnext term-Related Disease in Men: Not Just a Women's Issue
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    Joel M. Palefsky M.D., C.M., F.R.C.P(C)Corresponding Author Contact Information, a, E-mail The Corresponding Author

    a Department of Medicine, University of California, San Francisco, California
    Received 22 November 2009;
    accepted 11 January 2010.
    Available online 20 March 2010.


    Referred to by: Erratum
    Journal of Adolescent Health, Volume 46, Issue 6, June 2010, Page 614
    PDF (174 K) |
    Abstract

    The most common cause of mortality related to previous termhuman papillomavirusnext term (HPV) infection is cervical cancer. However, male HPV infection is also an important concern, both for the disease burden in men and for the risk of transmission to women. HPV is associated with a variety of cancers in men, including anal cancer and a subset of penile and oral cancers. The incidence of anal and oral cancers related to HPV is increasing in the general population and is growing even faster among individuals who are immunocompromised because of previous termhumannext term immunodeficiency virus (HIV) infection. Penile HPV infection is very common among heterosexual men and remains high throughout a wide range of ages. Likewise, anal HPV infection and anal intraepithelial neoplasia are very common throughout a wide range of ages in both HIV-negative and HIV-positive men who have sex with men. Other HPV-related diseases of clinical importance in men include condylomata acuminata (genital warts) and recurrent respiratory papillomatosis. The quadrivalent HPV vaccine has been shown to be highly efficacious in the prevention of genital warts in women and precancerous lesions of the cervix, vulva, and vagina. In addition, recent interim data have shown that the quadrivalent HPV vaccine is highly effective in reducing external genital lesions in young men. Although the protective efficacy of HPV vaccination in men has not yet been fully established—pending the outcome of public policy discussions and cost-efficacy studies—there may be a strong rationale for vaccinating boys, similar to girls, at an early age when they have had limited or no prior sexual activity.

    Keywords: previous termHuman papillomavirusnext term; Anal cancer; Penile cancer; Vaccination
    7-Purchase
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    Tang-Yuan Chua, b, Corresponding Author Contact Information, E-mail The Corresponding Author

    aDepartment of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

    bGraduate Institute of Clinical Medicine, Tzu Chi University, Hualien, Taiwan
    Received 11 September 2007;
    revised 23 October 2007;
    accepted 16 November 2007.
    Available online 5 September 2008.

    Abstract

    Cervical cancer is a disease that is caused by persistent previous termhuman papillomavirusnext term (HPV) infection. The fate of this sexually transmitted infection is determined by long-term host-viral and host-environmental interactions. Given that the majority population of Han Chinese have a similarity in genetic makeup, and cultural and social systems, it is not surprising to see a common spectrum of type-or variant-specific HPV prevalence and risk for cervical cancer in Taiwan, Hong Kong and Singapore. These populations also share similar behavioral and environmental exposure risks, as well as genetic susceptibility to cervical cancer. In this post-genomic era, when the code, control and function of the previous termhumannext term genome are being quickly unveiled, new genetic and epigenetic biomarkers for cervical cancer are emerging systemically and in an overwhelming way. This review covers the conventional epidemiological risks of HPV infection and the development of cervical cancer, as well as the emerging new molecular biomarkers, in a focused population of Chinese subjects in Southeast Asia and Southern China.

    Keywords: Cervical cancer; Chinese population; Genetic marker; previous termHuman papillomavirusnext term

    Corresponding Author Contact InformationCorresponding author. Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, Hualien, Taiwan

    8-Papillomavirusnext term virus like particle-based therapeutic vaccine against previous termhuman papillomavirusnext term infection related diseases: Immunological problems and future directions
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    Jiezhong Chenb, Corresponding Author Contact Information, E-mail The Corresponding Author, Guoying Nib and Xiao Song Liua, b, Corresponding Author Contact Information, E-mail The Corresponding Author

    a Graduate School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia

    b Illawarra Health and Medical Research Institute, University of Wollongong, NSW 2522, Australia
    Received 6 January 2011;
    accepted 7 March 2011.
    Available online 12 March 2011.

    Abstract

    Chronic infection with certain types of previous termhumannext term papillomaviruses (HPV), especially HPV-16 and HPV-18, leads to the development of cervical cancer. Prophylactic HPV vaccines based on HPV virus like particles (VLPs) have now been developed. The commercial vaccines, Gardasil and Cervarix are clinically effective in preventing HPV infection but do not have a therapeutic effect against existing chronic HPV infections. However, previous termpapillomavirusnext term (PV) VLPs elicit strong cytotoxic T cell (CTL) responses and PV VLPs without any adjuvant have therapeutic effects in animal PV infection model. Alum in Gardasil, Alum and 3-O-deacylated-4′-monophosphoryl lipid A (ASO4) in Cervarix may stimulate IL10 production and inhibit the Th1, CTL immune response of immunized individuals. PV VLPs also stimulate the production of IL10 by CD4+ T cells, which prevent their CTL generation effect as a therapeutic vaccine. Neutralizing IL10 at the time of PV VLPs immunization increases cytotoxic T cell responses. PV VLPs incorporating PV early protein E2, 6 and 7, together with immune stimulator that promote strong type 1 responses, and at the same time blocking the effect of IL10 may have therapeutic effect against HPV infection related diseases and are worth further basic and clinical investigation.

    Keywords: previous termHuman papillomavirusnext term; Virus like particles; Cervical intraepithelial neoplasia; Therapeutic vaccine; Alum; IL10

    Abbreviations: PV, previous termpapillomavirusnext term; VLPs, virus like particles; CIN, cervical intraepithelial neoplasia; MPL, 3-O-deacylated-4′-monophosphoryl lipid A
    9-

    Distribution of human papillomavirusnext term 58 and 52 E6/E7 variants in cervical neoplasia in Chinese women
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    Tian Dinga, Xinyu Wanga, Feng Yea, Xiaodong Chenga, Ding Mab, Weiguo Lua and Xing Xiea, low asterisk, E-mail The Corresponding Author

    a Women's Reproductive Health Laboratory of Zhejiang Province and Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, People's Republic of China

    b Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, People's Republic of China
    Received 2 July 2010.
    Available online 25 September 2010.

    Abstract
    Objectives

    The specific intratype HPV genome variations may be associated with the development of cervical cancer in specific geographic regions and a given population. previous termHuman papillomavirusnext term (HPV) 58 and 52 have been found to be relatively prevalent among Asian women including Chinese women. This study aimed to assess the risk of HPV 58 and 52 variants for cervical cancer and its precursors in Chinese women.
    Methods

    A total of 2021cervical samples were collected. After DNA extraction and genotyping, a total of 298 (177 HPV58-single positive and 121 HPV52-single positive) DNA samples were analyzed for E6 and E7 sequence variations by direct sequencing.
    Results

    A total of 29 new reported variations of HPV 58 and 52 were found. For HPV58, the presence of C632T (T20I) and G760A (G63S) variants in E7 showed a positive trend of the association with the severity of neoplasia (Ptrend < 0.05, χ2 test for trend).
    Conclusions

    These findings suggest that C632T (T20I) and G760A (G63S) variants in HPV58 E7 are probably risk factors associated with the development of cervical cancer in Chinese women. The presence of HPV58/52 E6 and E7 variants may be different in Chinese women.

    Keywords: previous termHuman papillomavirusnext term (HPV); Cervical intraepithelial neoplasia (CIN); HPV variants; HPV58; HPV52
    10-Meeting paper
    Articles in full
    Cervical cancer and human papillomavirusnext term in indigenous Guyanese women
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    Rebecca S. Kightlinger DOa, Corresponding Author Contact Information, E-mail The Corresponding Author, William P. Irvin MDb, Kellie J. Archer PhDc, Nancy W. Huang MDd, Raeleen A. Wilson PA-C, MSe, Jacqueline R. Doran BScf, Neil B. Quigley PhDg and JoAnn V. Pinkerton MDa

    a Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA

    b Department of Gynecologic Oncology, Riverside Regional Medical Center, Newport News, VA

    c Department of Biostatistics, Virginia Commonwealth University, Richmond, VA

    d Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA

    e Hope, A Women's Cancer Center, Asheville, NC

    f The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

    g Molecular Pathology Laboratory Network, Maryville, TN
    Received 4 August 2009;
    revised 4 February 2010;
    accepted 5 March 2010.
    Available online 28 April 2010.

    Objective

    The purpose of this study was to determine the prevalence of cervical disease, previous termhuman papillomavirusnext term infection, and previous termhuman papillomavirusnext term (HPV) genotypes in indigenous villages of Guyana.
    Study Design

    This is a retrospective analysis of a clinical cervical cancer screening and treatment program: 2250 women underwent cytologic screening; 1423 women were concomitantly screened for HPV. HPV genotyping was performed in 45 women with high-grade dysplasia and in 9 women with cervical carcinoma.
    Results

    We found invasive cervical carcinoma in 0.80% of the women, cervical intraepithelial neoplasia II and III in 5.07% of the women, and a high-risk HPV infection rate in 19.3% of the women, all of which peaked between the ages of 20-30 years. Sixteen genotypes were detected in women with high-grade dysplasia or cancer: HPV 31, 25.0%; HPV 16, 22.7%; HPV 18, 13.6%. The rate of HPV 16 and 18 in cervical cancer was 55.50%.
    Conclusion

    Indigenous Guyanese women have a high rate of cervical cancer and high-grade dysplasia, with an apparent predominance of HPV 16 and18 in invasive cancer and overrepresentation of HPV 31 in high-grade dysplasia.

    Key words: DNA; genotype; Guyana; previous termhuman papillomavirusnext term; neoplasia
    11-Mini-Review
    Human Papillomavirusnext term in Infants: Transmission, Prevalence, and Persistence
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    Delese E. LaCour MDCorresponding Author Contact Information, a, E-mail The Corresponding Author and Connie Trimble MDa

    a Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

    Available online 20 May 2011.

    previous termHuman Papillomavirusnext term (HPV) is very common in reproductive age women. It has been demonstrated that this infection can be transmitted from mother to infant. Evidence of HPV infection can be seen in infant and toddlers. A review of the literate was undertaken to examine the manner in which HPV can be transmitted, the rate at which transmission occurs, and if HPV can persist. The manifestations of HPV were also reviewed. It is not clear what effect the quadravalent HPV vaccine, given to mothers will have on HPV infections in infants.

    Key Words: previous termHuman Papillomavirusnext term; Infants; Persistence; Transmis
    12-

    Vaccination and the evolutionary ecology of human papillomavirusnext term
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    Eric M. Poolmana, Corresponding Author Contact Information, E-mail The Corresponding Author, Elamin H. Elbashab and Alison P. Galvania

    a Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06520-8034, United States

    b Health Economic Statistics, UG1C-60, Merck Research Laboratories, P.O. Box 1000, North Wales, PA 19454-1099, United States

    Available online 3 July 2008.

    Abstract

    New and upcoming vaccines provide protection against types 16 and 18 of previous termhuman papillomavirusnext term (HPV), which are responsible for an estimated 70% of all cervical cancers. One vaccine also protects against HPV types 6 and 11, which cause more than 90% of genital warts. We use a mathematical model of HPV transmission and immunity to explore the effect of vaccination on the evolution of HPV types. If vaccination provides cross-immunity at least equal to that of natural infection, it may contract the niche space available to other HPV types a million-fold. If natural infection provides greater cross-immunity than vaccination, vaccination may expand available niche space up to 470-fold. The balance of epidemiologic data suggests vaccination will reduce the available niche space.

    Keywords: previous termHuman papillomavirusnext term; Vaccine; Evolution
    Article Outline
    13-Review
    Benefits of vaccinating young adult women with a prophylactic quadrivalent human papillomavirusnext term (types 6, 11, 16 and 18) vaccine
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    J. Monsonegoa, Corresponding Author Contact Information, E-mail The Corresponding Author, J. Cortesb, 1, E-mail The Corresponding Author, C. Greppec, 2, E-mail The Corresponding Author, M. Hampld, 3, E-mail The Corresponding Author, E. Jourae, 4, E-mail The Corresponding Author and A. Singerf, 5, E-mail The Corresponding Author

    a Institute of the Cervix, Federation Mutualiste Parisienne, 174 Rue de Courcelles, 75017 Paris, France

    b Spanish Society of Obstetrics and Gynaecology, Alfonso el Magnánimo 29, 07004 Palma de Mallorca, Spain

    c Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden

    d Department of Obstetrics and Gynaecology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    e Department of Gynaecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria

    f Department of Gynaecology, The Whittington Hospital, London, UK
    Received 26 July 2010;
    revised 7 September 2010;
    accepted 7 October 2010.
    Available online 22 October 2010.

    Abstract

    Cervical cancer is a leading cause of cancer-related deaths worldwide. The causal role of previous termhuman papillomavirusnext term (HPV) infection in the pathogenesis of cervical cancer has prompted the development of vaccines against HPV. The highest risk of HPV infection is in women aged 16–25 years. Almost all young adult women can benefit from HPV vaccination. There is strong epidemiological and clinical support for vaccination programmes that target sexually active women in this age group to prevent HPV infection, and thus avert the development of HPV-related disease. Furthermore, the implementation of HPV vaccination programmes may benefit the development or awareness of cervical cancer prevention strategies and ultimately reduce the burden of cervical cancer and improve cervical cancer control.

    Keywords: previous termHuman papillomavirusnext term; Vaccination; Young adult women
    14-Original articles
    Human papillomavirusnext term testing for triage of women referred because of abnormal smears: a decision analysis considering outcomes and costs
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    Willem Jan Meerdinga, Corresponding Author Contact Information, E-mail The Corresponding Author, Marjolein van Ballegooijena, Matthé P. M. Burgerb, M. Elske van den Akker-van Marlea, Wim G. V. Quintc and J. Dik F. Habbemaa

    a Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    b Department of Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands

    c Department of Molecular Biology, Diagnostic Centre SSDZ, Delft, The Netherlands
    Received 31 July 2001;
    revised 23 February 2002;
    accepted 29 April 2002. ;
    Available online 26 November 2002.

    Abstract

    The objective of this article was to evaluate the utility of high-risk previous termhuman papillomavirusnext term (HR-HPV) testing for triage of women referred for colposcopy because of abnormal smears. We considered women with persistent mild or moderate dyskaryosis and women with severe dyskaryosis who were referred for colposcopy. For both patient groups we evaluated three alternative management policies: (1) conventional management based on histological assessment; (2) HR-HPV-triage with direct treatment without prior histologic assessment for HR-HPV-positive women and conventional management for HR-HPV-negative women; and (3) direct treatment without histologic assessment for all referred women. For each policy the average number of medical procedures, doctor visits, and the costs per referred woman were calculated. Based on a literature review, the results were tested and translated to other patient groups. Per woman with persistent mild or moderate dyskaryosis and compared with conventional policy, HR-HPV-triage will avoid 0.51 colposcopically directed biopsies, but adds 0.05 local treatments of the cervix (i.e., loop excision of the transformation zone) and 0.09 outpatient visits, and will cost $134 extra. HPV triage is less efficient in women with borderline or mildly dyskaryotic cytology. In women with severe dyskaryosis, direct treatment is more efficient as conventional management or HPV triage. The decision to introduce HPV testing or direct treatment in women with persistent mild or moderate dyskaryosis strongly depends on the relative burden attributed to a colposcopically directed biopsy and an outpatient visit compared to loop excision of the transformation zone treatment of the cervix. For women with severe dyskaryosis, direct treatment should be seriously considered.

    Author Keywords: Vaginal smears; previous termHuman papillomavirusnext term; Triage; Cervical intraepithelial neoplasia; Comparative study; Decision analysis; Predictive value of tests

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