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Human Papillomavirus (HPV) is the most prevalent sexually transmitted infection, posing a significant public health concern with HPV-associated oropharyngeal cancer emerging as the most common HPV-associated cancer (HPV-aOC). Risky sexual behaviours, notably, oral sex emerge as a critical risk factor for HPV-aOC. Despite its profound impact, there exists a poor awareness of the connection between HPV and oropharyngeal cancer, coupled with suboptimal vaccine uptake. By elucidating the nexus between sexual behaviour and HPV-aOC, this paper aims to foster a paradigm shift towards modified sexual activity, ultimately leading to a reduced risk of HPV-aOC. This study also advocates for multi-faceted approaches such as the use of protective barriers, reducing the number of oral sex partners, increasing awareness through public health education, and augmenting vaccine uptake to limit the prevalent risks of HPV-aOC. Through these concerted efforts, it is envisaged that the incidence and prevalence of HPV-aOC can be mitigated. [ABSTRACT FROM AUTHOR]

Background: This paper aims to instigate discussion and publication of methodologies applied to enhance quality management through comprehensive scientific reports. It provides a detailed description of the design, implementation, and results of the quality control program employed in the SMESH study. Methods: Cross-sectional, multicenter, national study designed to assess the prevalence of human papillomavirus in sex workers and in men who have sex with men (MSM). Respondent-driven sampling recruitment was used. An online system was developed for the study and checkpoints were defined for data entry. The system checked the quality of biological samples and performed a retest with part of the sample. Results: A total of 1.598 participants (442 sex workers and 1.156 MSM) were included. Fifty-four health professionals were trained for face-to-face data collection. The retest showed Kappa values ranging between 0.3030 and 0.7663. Conclusion: The retest data were mostly classified as indicating a strong association. The data generated by the checkpoints showed the successful implementation of the quality control program. [ABSTRACT FROM AUTHOR]

Objective: To verify the association of high-risk human papillomavirus (hrHPV) viral load reflected by cycle threshold (Ct) values from HPV testing on Cobas4800 assay with the histologic grades of cervical lesions via analysis on the combined data from two cervical cancer screening trials and to explore the referability of Ct values in management of the abnormalities from cervical cancer primary screening. Methods: We analyzed the data from Chinese Multi-Center Screening Trial (CHMUST) and BUJI Cervical Cancer Screening Study Project (BUJI Study). All data to be analyzed in this paper were related to provider-collected samples. One-way ANOVA was performed to compare the Ct values among different histological groups, and Kendall's tau-b correlation was applied to examine the association between Ct values and cervical lesion grades. The stepwise incidence of CIN2+ and CIN3+ in every 100 HPV positive individuals were calculated according to the descending of the genotype specific Ct values. The highest Ct values related to CIN3+ incidence rate 4% (or 25%) were used as the cutoffs to distinguish low-Ct value cases from the high-Ct value ones. Results: A total of 1376 women in CHUMUST and BUJI Study who were aged 30–59 and positive of hrHPV for provider-collected samples on Cobas4800 with complete data in terms of the relevant Ct values (CtV) and the histological diagnosis were included for analysis. Our data showed significant difference among different histological grades of cervical lesions in the CtV of hrHPV, HPV16-plus (positive of HPV16 only or HPV16 plus 18 and/or pooled 12-HPV), and pooled 12-HPV (P < 0.05). No significant difference was found among different grades of lesions in term of correlated CtV of HPV18-plus (positive of HPV18 only or HPV18 plus pooled 12-HPV) (P > 0.05). The CIN2+ or CIN3+ incidence per 100 positives significantly increased corresponding to the descending of the CtV of hrHPV, HPV16-plus and pooled 12-HPV. Compared with high-CtV groups (CtV > 33.2 for hrHPV, CtV > 29.6 for pooled 12-HPV), the relevant risks (RRs) of CIN2+ for hrHPV and pooled 12-HPV positive groups with low-CtV (CtV ≤ 33.2 and ≤ 29.6, respectively) were 3.2 (95%CI 2.18–4.80) and 2.3 (95%CI 1.50–3.45). Similarly, the RRs of CIN3+ for hrHPV and pooled 12-HPV positive groups with low-CtV were 6.5 (95%CI 2.83–14.80) and 2.7 (95%CI 1.15–6.39), respectively. The RRs of CIN2+ for medium- (30.3 < CtV ≤ 37.4) and low- (≤ 30.3) CtV HPV16-plus positives were 5.1 (95%CI 0.68–38.38) and 20.6 (95%CI 2.96–143.92) related to high-CtV (> 37.4) groups, and the CIN3+ incidence in low-CtV value group was nine-fold higher of that in medium-CtV ones [RRs, 9.0 (95%CI 2.89–28.10)]. In comparing with the algorithms of "HPV16-plus/18-plus + cytology ≥ ASCUS for pooled 12-HPV", triage algorithm "HPV16-plus/18-plus + Ct value ≤ 33.2 for pooled 12-HPV" could achieve a comparable sensitivity of 93.2%. Conclusion: HPV viral loads reflected by Ct values for hrHPV, HPV16-plus and pooled 12-HPV from Cobas4800 HPV testing were directly associated with the severity of cervical lesions. A lower HPV genotype-specific Ct value prompted a significantly high CIN3+ risk of 4% or higher in women positive of hrHPV, HPV16-plus or pooled 12-HPV, indicating that HPV viral load reflected by Ct values on Cobas4800 may be a promising risk indicator in management of abnormalities from primary cervical cancer screening. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma is the most common malignant tumor of the uterine cervix with a well-documented link to infection with human papillomaviruses (HPV). According to a recent classification, there are several morphological variants of cervical squamous carcinoma, without reference to sarcomatoid squamous cell carcinoma, which is well described in other organs. Case presentation: In this paper, we describe an extremely rare case of a 77-year-old woman with primary malignant cervical tumor displaying biphasic histomorphology with an epithelioid and sarcomatoid part; the latter was immunohistochemistry positive for cytokeratin and vimentin. The association with a high-grade squamous intraepithelial lesion and molecular proof of HPV33 infection in the tumor tissue supported our diagnosis of carcinoma with partial sarcomatoid differentiation. Conclusion: We report a rare case of a primary cervical epithelial tumor with a partial sarcomatoid phenotype, an unequivocal HPV infection, and an associated precancerous lesion in the cervical mucosa. This is the first description of an HPV33 infection underlying a biphasic epithelioid-sarcomatous tumor of the uterine cervix. The terminology overlap between sarcomatoid carcinoma and carcinosarcoma is also discussed. [ABSTRACT FROM AUTHOR]

Background: Human Papillomavirus (HPV) genotyping is an important approach to fight cervical cancer due to the relevant information regarding risk stratification for diagnosis and the better understanding of the relationship of HPV with carcinogenesis. This paper proposed two new feature extraction techniques, i.e. ChaosCentroid and ChaosFrequency, for predicting HPV genotypes associated with the cancer. The additional diversified 12 HPV genotypes, i.e. types 6, 11, 16, 18, 31, 33, 35, 45, 52, 53, 58, and 66, were studied in this paper. In our proposed techniques, a partitioned Chaos Game Representation (CGR) is deployed to represent HPV genomes. ChaosCentroid captures the structure of sequences in terms of centroid of each sub-region with Euclidean distances among the centroids and the center of CGR as the relations of all sub-regions. ChaosFrequency extracts the statistical distribution of mono-, di-, or higher order nucleotides along HPV genomes and forms a matrix of frequency of dots in each sub-region. For performance evaluation, four different types of classifiers, i.e. Multi-layer Perceptron, Radial Basis Function, K-Nearest Neighbor, and Fuzzy K-Nearest Neighbor Techniques were deployed, and our best results from each classifier were compared with the NCBI genotyping tool. Results: The experimental results obtained by four different classifiers are in the same trend. ChaosCentroid gave considerably higher performance than ChaosFrequency when the input length is one but it was moderately lower than ChaosFrequency when the input length is two. Both proposed techniques yielded almost or exactly the best performance when the input length is more than three. But there is no significance between our proposed techniques and the comparative alignment method. Conclusions: Our proposed alignment-free and scale-independent method can successfully transform HPV genomes with 7,000 - 10,000 base pairs into features of 1 - 11 dimensions. This signifies that our ChaosCentroid and ChaosFrequency can be served as the effective feature extraction techniques for predicting the HPV genotypes. [ABSTRACT FROM AUTHOR]

The incidence of human papillomavirus (HPV) associated oropharyngeal cancer has increased to epidemic-like proportions in the United States and other industrialized nations. While significant progress has been made in the understanding of this disease with respect to its underlying biology and clinical behavior, numerous questions persist regarding treatment. It is now firmly established that patients with HPV-positive oropharyngeal cancer have a significantly improved prognosis as a result of their exquisite radiosensitivity compared to their HPV-negative counterparts and thus can be targeted with de-escalated approaches using reduced doses of radiation and/or chemotherapy. The fundamental goal of de-escalation is to maintain the high cure and survival rates associated with traditional approaches while reducing the incidence of both short- and long-term toxicity. Although the exact reason for the improved radiosensitivity of HPV-positive oropharyngeal carcinoma is unclear, prospective studies have now been published demonstrating that de-escalated radiation can successfully maintain the high rates of cure and preserve quality of life for appropriately selected patients with this disease. However, the selection criteria and specific means for de-escalation remain uncertain, and paradigms continue to evolve. Given that HPV-positive oropharyngeal cancer is increasingly recognized as a public health problem, the search for answers to many of these provocative questions has important societal implications and is the subject of this review. [ABSTRACT FROM AUTHOR]

Background: Our aim was to investigate oral health in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients in relation to long-term survival. We assessed whether the level of alveolar bone loss due to periodontitis at diagnosis, measured from orthopantomogram (OPG), and reported dental health-related quality of life (HRQoL) scores obtained at diagnosis contain prognostic information for HNSCC patients. Methods: A total of 79 patients from a consecutive cohort of 106 diagnosed with HNSCC between November 2002 and June 2005 were included. All patients reported dental HRQoL, OPG-determined alveolar bone loss were measured in 79 patients at diagnosis. Reduced alveolar bone loss (≥ 4 mm) from cement-enamel junction on at least two molars or premolars registered both horizontally and vertically served as indicator of periodontal disease. Results: With alveolar bone loss, we determined increased mortality by univariate analysis (RR = 2.28, CI: 1.22–4.28, p = 0.01) and a strong trend by multivariate analyses adjusted for standard clinical information (RR = 1.95, CI: 0.98–3.87, p = 0.056). Reported lowered dental HRQoL scores predicted long-term survival in both univariate (RR = 3.58, CI: 1.99–6.45, p < 0.001) and multivariate adjusted for standard clinical information (RR = 2.17, CI: 1.17–4.01, p = 0.014). When analyzed with Cox regression, including alveolar bone loss and dental HRQoL, both factors, adjusted by clinical variables, were significant predictors of long-term survival: dental HRQoL (p = 0.007) and present alveolar bone loss (p = 0.034). Non-HNSCC disease-specific long-term survival predicted was also predicted when alveolar bone loss and dental HRQoL were analyzed simultaneously and adjusted for standard clinical information. Conclusions: The degree of alveolar bone loss, as determined by OPG, and dental HRQoL both obtained at the time of HNSCC diagnosis, predicted long-term survival. When analyzed simultaneously, both factors remained significant in both univariate and multivariate analyses, adjusted by pertinent clinical variables, highlighting their unique prognostic value. [ABSTRACT FROM AUTHOR]

Background: Globally, sexually transmitted infections (STIs) collectively cause 2.3 million deaths and 1.2 million cases of cancer annually. However, the epidemiology of STIs in the Middle East and North Africa (MENA) is not well assessed because of various social and cultural factors. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and covering 23 MENA countries, 19 STIs, and data from 20,435,971 participants. PubMed, Embase, regional and international databases, and country-level reports were searched up to May 2024. Results: The analysis revealed significant regional variations in the prevalence of STIs within the MENA region. In North Africa, the most common STIs were bacterial vaginosis (31%), human papillomavirus (HPV, 23%), and Candida spp. (15%). In the Gulf Cooperation Council region and Yemen, Ureaplasma (25%), nongonococcal urethritis (NGU, 16%), and Mycoplasma spp. (12%) were the predominant infections. In the Levant region, the top STIs were HPV (20%), hepatitis B virus (HBV, 9%), and Candida spp. (9%). In Iran, Ureaplasma spp. (18%), HPV (17%), and cytomegalovirus (8%) were the most prevalent infections, whereas Ureaplasma spp. (20%), Candida spp. (18%), and HPV (16%) were most frequently detected in Türkiye. Gender-based disparities were observed, with a higher prevalence of Ureaplasma spp., Neisseria gonorrhoeae, and herpes in men and higher rates of Mycoplasma spp., HPV, HBV, and Candida spp. in women. Overall, high rates of nongonococcal urethritis (16.3%), Ureaplasma spp. (13.7%), HPV (12.7%), and Candida spp. (9.4%) were recorded in the MENA region. Conclusions: Most MENA countries lack national STI screening programs, and the reported data are primarily from symptomatic individuals. Establishing robust surveillance systems, addressing stigma and barriers to healthcare access, and expanding STIs screening and vaccination programs are crucial for accurately capturing the true burden of STIs in MENA countries. [ABSTRACT FROM AUTHOR]

Background: Individuals with a higher level of awareness and knowledge of HPV are more likely to dispel misconceptions about HPV and reduce their likelihood of engaging in risky sexual behavior. Behavioural change can be achieved through interventions such as participatory action research (PAR), which has been applied in various contexts. Few studies have reported on the use of PAR in Nigeria. This study aims to utilise PAR as an intervention to increase HPV awareness, improve knowledge of HPV infection, and promote behavioural change for HPV prevention among young adolescents in Benue State, Nigeria. Methods: The study design uses a school-based, pre-post intervention approach with a cross-sectional component. Study participants are young adolescents aged 10–19 years in selected co-educational secondary schools in three local government areas (LGAs) spread across the three senatorial zones in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, and the sample size was computed using the before and after implementation with some prior information from a previous study. Data on sociodemographic characteristics, HPV awareness and knowledge of infection and prevention, prevention practices, and willingness for HPV vaccination were obtained with a self-administered semi-structured questionnaire adapted from the Vaccination and HPV Knowledge (THinK) survey. The HPV Knowledge survey (New Zealand) was utilized to collect information from students at baseline and post-implementation after PAR intervention. The Wilcoxon Signed Test (WST) was used to investigate the significance of the median differences before and after the intervention. A p-value less than 0.05 or 0.001 was considered significant. Results: A total of 548 adolescents were sampled before the intervention. After the intervention, the sample size decreased to 503, reflecting an 8% attrition rate. PAR effectively increased HPV awareness among the participants from 80.9% before the intervention to 99.8% afterward. The PAR led to a significant change in knowledge of HPV infection and primary prevention and an increase in perception of HPV primary prevention. decrease in misconceptions and risky sexual behaviours, increase in HIV screening tests, and increase in the willingness of participants to uptake the HPV vaccine. Among the measures of risky sexual behaviours was a decreased perception that having more than one sexual partner is not a risk factor for HPV after the PAR intervention. The number of participants in sexual relationships decreased from 84 (16.7%) at baseline to 37 (7.4%) post-implementation. The PAR also led to a decrease in the number of participants who reported having STDs. The Wilcoxon Signed test was further disaggregated based on sex (male and female), school funding type (public and private), and school class level (junior and senior). Conclusions: PAR led to a significant increase in awareness and knowledge of HPV, knowledge of different aspects of HPV infection, and willingness to uptake the HPV vaccine. Additionally, the study has provided evidence that PAR interventions can be a viable tool in delaying sexual initiation and reducing sexual behavioural tendencies, especially in high-risk groups. [ABSTRACT FROM AUTHOR]

Background: Since December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities' demographic characteristics, economic development, and policy support. Methods: The model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings. Results: The cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust. Conclusions: Compared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy. [ABSTRACT FROM AUTHOR]

Background: Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge. Methods: Key terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women's Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement). Results: Research reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV. Conclusions: Both male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed. [ABSTRACT FROM AUTHOR]