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In 2019, French National Health Authority recommended the human papillomavirus vaccination (HPV) for boys, in addition to girls, with effective reimbursement since January 2021. The objective of this study was to assess the practice of general practitioners in Ardèche, Loire and Haute-Loire regions with regards to HPV vaccination, particularly for young boys, one year after the reimbursement. [ABSTRACT FROM AUTHOR]

Résumé: L'épigénétique joue un rôle important dans la réplication virale et dans la pathogenèse des infections virales. Les virus et les facteurs épigénétiques interagissent notamment pour favoriser le cycle de réplication viral en stimulant l'entrée dans le cycle lytique, mais également en favorisant la latence virale. Par ailleurs, l'épigénétique contrôle la réponse immunitaire mise en œuvre par l'hôte pour contrecarrer l'infection virale. Ainsi, les modifications épigénétiques constituent des cibles thérapeutiques potentielles pour maîtriser les infections virales. Plusieurs études ont déjà montré l'efficacité des inhibiteurs des histones désacétylases, déméthylases, acétyltransférases et méthyltransférases et aussi des inhibiteurs des ADN méthyltransférases dans la suppression des infections virales ou dans la réactivation de la latence. Dans cette revue, nous examinerons la régulation épigénétique de l'infection des virus à ADN tels que HSV, EBV, HCMV, KSHV, HBV, HPV et HAdV et des virus à ARN tels que HCV, HIV, IAV et CoV. Nous montrerons également que des approches thérapeutiques ciblant l'épigénétique peuvent être utilisées dans le contrôle des infections virales. Epigenetics play an important role in viral replication and in viral associated pathogenesis. In fact, viruses interact with epigenetic factors to promote the viral replication by stimulating the entry into the lytic cycle, but also by promoting viral latency. Furthermore, epigenetics control the immune response implemented by the host to counteract viral infections. Thus, epigenetic modifications are identified as potential therapeutic targets to control viral infections. Several studies have already shown the efficiency of inhibitors of histone deacetylases, demethylases, acetyltransferases and methyltransferases, as well as inhibitors of DNA methyltransferases in viral infections repression or in latency reactivation. In this review, we will examine the epigenetic regulation of viral infections by several DNA viruses, e.g. HSV, EBV, HCMV, KSHV, HBV, HPV and HAdV, and RNA viruses, e.g. HCV, HIV, IAV and CoV. Also, we will discuss the potential use of therapeutic approaches targeting epigenetics for the control of viral infections. [ABSTRACT FROM AUTHOR]

Résumé: La pratique du dépistage du cancer du col utérin (CCU) repose actuellement, selon les recommandations, sur la réalisation d'une cytologie (frottis cervico-utérin – FCU) tous les trois ans chez les femmes asymptomatiques âgées de 25 à 65 ans mais toutes les études confirment l'insuffisance de ce dépistage et son hétérogénéité selon les populations. De nouveaux outils sont proposés pour le dépistage, notamment la recherche HPV. Quelles sont leurs performances comparativement à la technique classique du FCU avec analyse cytologique ? The practice of cervical cancer screening (CCU) is currently based, according to the recommendations, on performing a cytology (cervical smear – FCU) every three years in asymptomatic women aged 25 to 65 years but all studies confirm the inadequacy of this screening and its heterogeneity according to the populations. New tools are offered for screening, including HPV research. What are their performances compared to the classic FCU technique with cytological analysis? [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Le papillomavirus humain (HPV) est la principale cause du cancer du col de l'utérus, première cause de décès par cancer chez la femme en Afrique. L'objectif de cette étude était de déterminer la prévalence de l'infection HPV à haut risque (HR-HPV) et la distribution des génotypes rencontrés dans la population des femmes sexuellement actives de la ville de Ouagadougou. Méthodologie: Dans quatre centres de santé de deuxième échelon, 234 femmes recrutées avaient volontairement accepté un écouvillonnage du canal endocervical. L'identification des génotypes HPV-HR a été réalisée par PCR en temps réel. Résultats: La prévalence de l'infection au HR-HPV était de 52,56 %. Quatorze génotypes correspondant à 216 infections, ont été caractérisés : HPV 59 (42/216), HPV 66 (30/216), HPV 56 (20/216), HPV 45 (20/216), HPV 58 (18/216), HPV 39 (18/216), HPV 51 (16/216), HPV 68 (14/216), HPV 52 (12/216), HPV 18 (12/216), HPV 35 (6/216), HPV 31 (5/216), HPV 16 (3/216), HPV 33 (0/216). L'infection à HPV était statistiquement associée à l'âge (p = 0,033), ainsi que certaines pratiques sexuelles telles que la fellation (p = 0,001). Conclusion: La prévalence de l'infection HPV-HR chez les femmes sans lésion de notre étude est plus élevée que celle obtenue précédemment dans les études faites à Ouagadougou chez les femmes de la population générale et celles retrouvées dans le reste du monde. Aussi, les génotypes les plus fréquemment rencontrés ne sont pas HPV16 et 18. Background: Human papillomavirus (HPV) is the leading cause of cervical cancer, which in turn is the leading cause of cancer death in women in Africa. The objective of this study was to determine the prevalence of high-risk HPV infection (HR-HPV) and the distribution of genotypes encountered in the sexually active female population of Ouagadougou. Method: In four level-two health centers, we recruited 234 women who agreed to undergo an endocervical swab. HR-HPV genotypes were identified by real-time PCR. The Chi-square test was used for comparisons, with significance defined by a P-value < 0.05. Results: The prevalence of HR-HPV infection was 52.56%. Fourteen genotypes corresponding to 216 infections were characterized: HPV 59 (42/216), HPV 66 (30/216), HPV 56 (20/216), HPV 45 (20/216), HPV 58 (18/216), HPV 39 (18/216), HPV 51 (16/216), HPV 68 (14/216), HPV 52 (12/216), HPV 18 (12/216), HPV 35 (6/216), HPV 31 (5/216), HPV 16 (3/216), HPV 33 (0/216). HPV infection was statistically associated with age (P = 0.033) and with some specific sexual practices, such as oral sex (P = 0.001). Conclusion: The prevalence of HR-HPV infection among women without lesions in our study is higher than that reported previously in studies conducted in Ouagadougou among women in the general population and those found in the rest of the world. Moreover, HPV16 and 18 were not the genotypes most frequently encountered. [ABSTRACT FROM AUTHOR]

Buschke-Lowenstein (BLT) tumor or giant condyloma acuminatum (GCA) is a rare viral disease belonging to the group of verrucous carcinomas; the virus responsible is human papilloma virus (HPV) type 6 and 11 which is transmitted in humans by sexual contact. It is characterized by its extension within the surface layer and at depth, by its degenerative potential and by its recurrent nature after treatment. Therapy is based on surgery. We report the case of a 53-year old patient with a history of recurrent urethritis and a multiplicity of partners without homosexual encounters, presenting with a lesion at the level of the penis. The symptoms started three years before and were caused by a nonpainful budding tumor growing gradually at the level of the root of the penis resulting in tingling and bleeding. Clinical examination showed a dyschromic, infiltrating, cauliflower-like, papillomatous tumor measuring 13cm along its longer axis on the dorsal surface of the penis, with patchy ulcers and extending to the suprapubic region. The remainder of the clinical examination was normal and the assessment of sexually transmitted infection (STI) was negative. Treatment was based on complete surgical resection of the tumor. Soft tissue was covered by the surrounding skin. The anatomopathological study showed a giant genital wart without signs of malignancy. The postoperative course was uneventful. The patient didn't develop tumor recurrence during a 5-year follow-up period. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the extent of human papilloma virus vaccine awareness among parents of girls in vaccine age group, their acceptability of the vaccine and factors associated with refusal. We conducted a survey among parents of girls aged 8-15 years, followed-up for several diseases in the Department of Pediatrics at the University Hospital Mohamed VI in Marrakech, Morocco, on parents' profile, their awareness of cancer of the cervix, HPV and HPV vaccine, the acceptance of HPV vaccine for their daughters and the arguments related to refusal. Ninety six questionnaires were included in the analysis. Cancer of the cervix was considered frequent for 58% of parents. Only 5% of parents knew about HPV vaccine. Media were the source of information in all cases. Nobody had no idea about the cost of the vaccine and its tolerance. No girl was vaccinated against HPV. Sixty-three per cent of parents want their daughters to be vaccinated, this rate increased by 82% after awareness. Thirteen per cent of the parents were hesitant while 24% refused to vaccinate their daughters mainly due to side effects (51%). Parents refusing vaccine were predominantly males with medium socioeconomic status and cultural level and were unaware of the virus and the vaccine in 91% of cases. This study highlights the reasons for parents' reluctance towards HPV vaccine in order to optimize strategies for effective communication with parents. [ABSTRACT FROM AUTHOR]

The human papilloma virus is responsible for many kinds of proliferative lesions of the oral mucosa. The aim of this article is to assess two pathologies among the most frequently observed, condyloma acuminate and focal oral hyperplasia. From the study of three young girls seen in a mission in Chad, and a literature survey, we consider the epidemiological chain, by describing the lesions, and specifying their pathogenesis and their mode of transmission, leading to positive and differential diagnoses and the therapeutic aspects. This case report shows a departure from the conventional theory of transmission by sexual contact, and the consequences of this for children. [ABSTRACT FROM AUTHOR]

Résumé: Les infections sont une cause importante de cancer dans le monde, représentant environ 16 % des cas. Dix agents infectieux ont été classés carcinogènes avérés du groupe I. Quatre de ces agents (Helicobacter pylori, virus des hépatites B et C et certains papillomavirus humains) sont responsables de 95 % des cas de cancers attribuables aux infections. Les mécanismes oncogénétiques sont multiples, soit directs via notamment certaines protéines des microorganismes, soit indirects le plus souvent par le biais d’une inflammation chronique. Ceci a permis d’envisager une prévention de certains cancers avec par exemple une stratégie vaccinale prophylactique. Des avancées ont également été réalisées dans le domaine curatif. Des progrès restent toutefois à accomplir pour découvrir de nouvelles étiologies infectieuses et affiner la compréhension des mécanismes de carcinogenèse, garant d’un meilleur ciblage des thérapeutiques anticancéreuses. [ABSTRACT FROM AUTHOR]

Résumé: Plus 120 de types de papillomavirus humains (HPV) infectent l’homme. Ces virus qui sont strictement épithéliotropes ont soit un tropisme cutané, soit un tropisme muqueux. Les HPV à tropisme muqueux, retrouvés essentiellement au niveau des muqueuses ano-génitales sont responsables de l’infection sexuellement transmissible la plus fréquente, touchant la majorité des individus sexuellement actifs. Une quinzaine de ces HPV présentent un pouvoir oncogène marqué (high-riskHPV: HR-HPV) et on peut considérer que ces virus sont responsables de près de 5 % des cancers humains. C’est le virus HPV16 qui est de loin le plus fréquemment impliqué. Le cancer le plus fréquemment associé à HPV est le cancer du col de l’utérus, pratiquement tous les cancers du col étant induits par HPV. D’autres cancers touchant la sphère génitale (vagin, vulve, pénis) peuvent être associés dans une moindre proportion aux HR-HPV. Ces virus sont également impliqués dans les cancers de l’anus et dans certains cancers des voies aérodigestives supérieures, le cancer de l’amygdale en particulier. Les HPV cutanés peuvent être détectés chez pratiquement tous les individus et le rôle de ces virus dans les cancers cutanés est moins évident. Toutefois, certains types tels que HPV5 et HPV8 sont associés à des carcinomes cutanés chez les sujets atteints d’épidermodysplasie verruciforme, et ils paraissent également jouer un rôle dans le développement de cancer cutané non-mélanome plus particulièrement chez des sujets immunodéprimés. La prévention des cancers humains associés à HPV concerne essentiellement le cancer du col et fait appel d’une part au dépistage et d’autre part à la vaccination. [Copyright &y& Elsevier]

Résumé: Objectifs: Évaluer en milieu scolaire les connaissances et comportements des adolescents sur la sexualité, estimer la couverture vaccinale des filles contre le papillomavirus humain (HPV) et rechercher des facteurs associés aux niveaux de connaissance des thèmes abordés. Méthode: Étude transversale de type ű connaissances-attitudes-pratiques Ƈ effectuée par autoquestionnaire anonyme à la rentrée scolaire 2010 chez les adolescents admis au lycée militaire de Saint-Cyr. Résultats: Au total, 669 élèves ont été interrogés, d’âge moyen 17ans (extrêmes : 13–21ans) et de sex-ratio 2,3. Près de 40 % avaient eu au moins un rapport sexuel, avec au premier rapport un âge comparable dans les 2 sexes (p =0,83) et une contraception dans 92 % des cas. Parmi les filles de 14ans ou plus (n =200), 47 % (n =94) étaient vaccinées contre l’HPV. La connaissance des infections sexuellement transmissibles (IST) était médiocre pour 24,8 % des garçons et 15 % des filles (p =0,05). De même, le niveau de connaissance sur l’HPV et le cancer du col était significativement meilleur chez les filles (p =10−4). En analyse multivariée, une connaissance insuffisante était associée significativement au sexe masculin, à l’âge inférieur ou égal à 18ans, à l’absence de dialogue avec les parents sur ces sujets, à un faible niveau socioéconomique des parents, et à l’absence d’éducation sanitaire. Discussion: L’identification de facteurs de méconnaissance sur la sexualité a permis de mieux cibler les actions de prévention et d’information à mener dans ce lycée. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Le but de cette étude est de déterminer la prévalence des virus du papillome humain (HPV) et la distribution des génotypes HPV en fonction de l’âge, de la cytologie et de l’histologie chez les femmes ayant eu un examen gynécologique de routine et l’impact sur les stratégies de prévention. Patientes et méthodes: Les prélèvements cytologiques ont été testés pour la présence de l’ADN, l’ARN et les génotypes d’HPV. Les femmes ayant une cytologie ASC-US+ et/ou un test HPV positif ont été évaluées en colposcopie. Chez les femmes ayant une colposcopie normale, deux biopsies ont été effectuées systématiquement sur la zone de transformation à six et 12heures. Résultats: Au total, 515 (10,3 %) des 5002 femmes avaient moins de 25ans et 4487 (89,7 %) 25ans ou plus. La prévalence de l’HPV était de 10,1 % à 16,1 % suivant le test HPV utilisé. La prévalence de l’HPV était plus élevée que celle de la cytologie. La prévalence des HPV 16/18 était de 5,2 % et 2,7 %, respectivement, chez les femmes de moins de 25ans et 25ans ou plus. Plus de deux partenaires sexuels les 12 derniers mois est le facteur de risque le plus élevé pour l’exposition aux HPV (odds ratio [OR] supérieur à 3,60). Comparé aux autres types d’HPV, l’HPV 16 est l’indicateur de risque le plus élevé des CIN3+ (OR=11,64 ; p <0,001). Une large proportion (60,6 %) de CIN2+ étaient associées à des HPV de types 31, 33, 45 ou 58. Discussion et conclusion: Ces résultats indiquent que la plupart des jeunes femmes pourrait bénéficier de la vaccination prophylactique contre les HPV, mais confirme l’importance du dépistage et souligne la nécessité de développer des vaccins incluant le plus possible de types d’HPV. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Human Papillomaviruses (HPV) infection is high in heterosexual couples. We have evaluated clinically the frequency and the histological type of genital lesions in men whose partners have an HPV cervical and/or external genital lesion. Patients and methods: We conducted a cross-sectional study; we examined 246 men whose partner was referred for HPV lesions treatment of either the external genital tract or the cervix. All clinical HPV lesions detected in the men then underwent histological examination. Results: In 72% of cases, the couples were 18 to 35 years old. We detected HPV clinical lesions, confirmed histologically in 43% (106/246) of men. Warts and high-grade intraepithelial neoplasia were diagnosed in 83 (78%) and 23 (22%) of cases, respectively. The prevalence of clinical HPV lesions in men ranged from 34% in case of HG CIN to 80% when the female partner suffered from genital warts. Discussion and conclusions: The high frequency of clinical HPV lesions in men whose the partner has warts should lead to a peniscopy of the partner in these cases. Similarly, the peniscopy detects an HPV lesion in a third of men of which the partner gets a HG CIN. It is necessary to realize prospective studies to reevaluate the impact of diagnosing and treating male lesions with regard to the evolution of HG CIN in their partner. [Copyright &y& Elsevier]

Abstract: Objectives: The availability of information on HPV and Pap tests has increased dramatically with the introduction of national HPV vaccination programs. But data on the effectiveness of this information is limited. However, our desire is to reduce patient anxiety and promote better delivery of information. Patients and methods: Therefore a questionnaire-based cohort study was conducted to investigate women''s experience with the announcement of an abnormal Pap smear result, then the ensuing events, as well as their practitioner''s management. This article focuses on the French experience, underpinned by comparative data with Spain and Portugal. Results: It shows that, face with stress reactions and patient''s anxiety, the level of information from the medical profession is still seen as inadequate, while the Internet as an information source has its limitations and dangers. The close entourage is most relied on, which supports the need for better public information. Discussion and conclusion: Uniformity and standardization of information strategies is not yet on European time. [Copyright &y& Elsevier]

Abstract: The infection of the head and neck epithelium by high-risk human papillomaviruses (HPV) is a risk factor for cancer onset and development. The incidence of HPV-related head and neck squamous cell carcinoma is currently increasing. These lesions display distinct clinical features. HPV positive patients are often younger and have a smaller history of tobacco smoking and alcohol drinking, but have a history of virus-transmitting sex practices. HPV-related tumours are mainly found in the oropharynx, are more associated to a local lymph node invasion and display a poorly differentiated morphology. Despite these more aggressive features, HPV-positive head and neck squamous cell carcinomas correlate with an improved local control, disease-free and global survival. It is thought that HPV-driven specific biologic abnormalities underlie higher tumour sensitivity to chemotherapeutic drugs and ionizing radiations. The expression of the HPV E6 and E7 oncoproteins induce cell transformation by interfering with cell signalling pathways involved in apoptosis, cell cycle, angiogenesis and induce the overexpression of the CDKN2A gene. Therefore, alternative treatments based on therapies targeting these pathways in combination with radiation dose de-escalation could be proposed to HPV-positive patients, if they are properly and reliably identified. [Copyright &y& Elsevier]

Summary: Malignant transformation of juvenile-onset recurrent respiratory papillomatosis (RRP) is a rare event and the cases reported have been mainly observed in adults. We report the case of a 15-year-old girl with a history of severe RRP who died of a HPV 11-associated bronchopulmonary squamous cell carcinoma with pericardial invasion. HPV 11 was identified in nasopharyngeal and tracheal papillomas, as well as in the pericardial fluid. HPV 11 isolate was further analyzed by amplification and sequencing of the E1, E2, E4, E6, and E7 genes. Only one amino acid substitution in E4 due to natural polymorphism was observed. Exons 5–9 of the patient''s tumor protein 53 (TP53) gene were sequenced and no mutations were identified. This observation confirms that malignant conversion of juvenile-onset RRP associated with HPV 11 to squamous cell carcinoma may arise in children. HPV 11-induced carcinogenesis needs to be further investigated. [Copyright &y& Elsevier]

Abstract: Pap smear screening of women under 25years old remains controversial. No randomized study exists on this topic. The perception of individual benefit often prevails, although there is no proof of effectiveness and no demonstrated risk–benefit ratio. A review of published studies – taking into account epidemiological data, effectiveness of screening of young women, adverse medical outcomes and costs – suggests that there are more arguments against screening before 25 than in favour of it. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Human papillomaviruses (HPV) are the main risk factor for cervical cancer. By introducing its DNA into the genome of infected human cells, the virus expresses two oncoproteins (E6 and E7) that induce inactivation of tumour suppressors and telomerase. HPV infection is extremely common. But most of women will clear the infection over an 8–10-month period without developing any cervical lesion. In fact, it is the persistence of infection that truly exposes to the risk of cervical cancer. HPV testing, used for primary screening, has better sensitivity but lower specificity than cervical cytology. A secondary use of cytology would compensate the loss of HPV testing specificity. Thus, cervical cytology would be performed only in HPV positive women and colposcopy finally performed only in women with abnormal cytology. The characteristics of such screening would allow to increase interscreening intervals and therefore to reduce additional costs. The quantification of HPV viral load could be a way to differentiate significant infections from others. Despite proven significant association between high HPV viral load and the risk of CIN 2-3 and cervical cancer, crude variations within disease grades currently limit the clinical utility of viral load measurement. More than a just measure of HPV viral load, its evolution over time is what would really be of clinical relevance. [Copyright &y& Elsevier]

Abstract: Objectives: The objective of this study is to validate the use of test INNO-LIPA HPV Genotyping Extra (Innogenetics) on liquid cytology media EasyFix Labonord by comparing the extraction kit QIAamp DNA Blood Mini Kit® (Qiagen) and an automated method, Nuclisens easyMAG® (Biomérieux). Methods: Thirty-two samples were typed by the technique Hybrid Capture 2 (HC2) Digene (Qiagen). DNA was extracted through manual or automated extraction and quality controlled PCR “HLA”. Typing was performed with the INNO-LIPA test. A nested PCR followed by sequencing was used to compare different results. Results: Similar results were found for the two types of extraction, with an increase of sensitivity after automated extraction. Among the nine patients with a negative result with the HC2 test, seven had a negative result in INNO-LIPA and two a positive result (one untypable and one HPV66). On the 23 patients with a positive result with the HC2 test, 17 are consistent results. The six discordant results include one negative, one HPV54, two untypable HPV and two HPV53. The overall concordance between the HC2 and INNO-LIPA tests is 81 % with a κ test of 0.79. Conclusion: Coupled with an automated extraction, the test INNO-LIPA confirmed its high sensitivity for detecting and typing HPV in the EasyFix media Labonord, especially in the presence of multiple genotypes. This typing systematic approach is becoming increasingly relevant in the context of HPV vaccination. [Copyright &y& Elsevier]

Summary: Children''s feet may develop practically all possible varieties of viral verrucas. Their clinical description and histology may vary according to location or to the variety of virus concerned, although myrmecia are nearly always found on the sole. Errors of diagnosis are frequent. The types of virus which cause these all belong to the human Papillomavirus (HPV) category; they are not oncogenic. Their shrinking and eventual disappearance is a clinical fact whose cause has as yet no known explanation: it occurs quickly, discreetly and completely without leaving a scar. This is followed by a long-term immunity, meaning that no relapse will occur within a significant period. On the other hand, they may give rise to an unexpected outbreak of basic verrucas, on the sole and elsewhere, as soon as the previous ones have been removed, or during a period of immunosuppression. The forms of treatment prescribed must take into account all this data. In order to remove them, liquid nitrogen is regularly used when the verrucas are not too thick, or an electric lancet or even a laser. [Copyright &y& Elsevier]

High-risk oncogenic human papillomavirus (HR-HPV) are strongly associated with squamous cell carcinoma and adenocarcinoma of the uterine cervix. Relatively detailed data on prevalence of HR-HPV infections by age in France are available in several cytologically normal women populations but none on incidence. These latter data may be obtained according to the relationship between prevalence and incidence due to the spontaneous viral clearance over time. The study has shown that HR-HPV infections incidence changes slightly according to the selected hypotheses for the viral clearance and that a peak is reached at about 12% for the women aged 22. A relatively high incidence is observed at older age classes with about 4% at 60 years old. These results are close to that observed in other countries even if the incidence peak appears slightly lower and happens later. Nevertheless, the model did not include possible viral reactivation or reinfection that could modify the incidence curve angle. The incidence of the HR-HPV infections is essential to define vaccination strategies and to determine the women ages at which the vaccine could be optimally administered. [Copyright &y& Elsevier]

Abstract: Background: HPV HR detection test are needed when ASCUS is diagnosed on Pap test. The risk of progression to cervical cancer is dependant on the HPV genotype and three types (HPV 16, 18 and 45) are found in 77.4% of the cervical cancer. Here we have tested a new probe 16/18/45 (Digene) that is able to detect specifically these three types. Material and methods: Thirty-seven women with a Hybrid Capture® 2 High Risk test (Digene) positive were selected to test the new probe 16/18/45. Samples were typed using sequencing reaction after GP5+/GP6+ PCR. Types were given after comparison with the GenBank. Discordant results were controlled with Inno-Lipa HPV genotyping v2 test (Innogenetics). Results: Among the 37 women with HR HPV result, 48.6% were positive with the probe 16/18/45 (18 patients). After genotyping, 12 results were concordant and six discordant (three HPV 31, two HPV 58 et one HPV 59). For the other 19 patients with negative result, 18 are concordant and one discordant (HPV 18). Global concordance for typing between this probe and sequencing was 81% with a κ test of 0.62 that means a good concordance. Positive predictive value is 66.6% and negative predictive value is 94.7%. Conclusion: This study shows a good efficiency of the 16/18/45 probe to detect the genotypes that have the higher risk of progression to cervical cancer. This probe could also allow to follow the epidemiology of HR HPV infection after a large use of HPV vaccines. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Precursor lesions of invasive cancer of uterine cervix begin at the squamocolumnar junction. On this zone in permanent transformation, human papillomavirus (HPV) gives condylomatous lesions, pure or associated with neoplasic transformation of the epithelium. For 50 years, various histological classifications have been proposed. First, four groups have been designed: light, moderate, severe dysplasia and in situ carcinoma. Secondly, Richart proposed the cervix intraepithelial neoplasia classification (CIN) with three grades (1 to 3) according to their severity. Progression from CIN 1 to CIN 3 and invasive carcinoma is admitted and is consistent with the concept of lesional continuum. However, because of the elevated rate of spontaneous regression of CIN 1, it is probably a lesion of very low potential aggressivity and its role as a precursor is uncertain. Now two groups of different evolutivity are currently considered: low grade and high grade lesions. The last ones, as opposed to the first, are monoclonal, have major epithelial abnormalities with sometimes abnormal mitoses and are frequently aneuploid. Aggressivity depends on the persistence of HR HPV more than on progressive morphologic transformation. By integrating in-host genoma, it induces modifications on cellular cycle proteins. Revelation by immunohistochemistry brings help to diagnosis of high grade lesions when traditional morphology is ambiguous. [Copyright &y& Elsevier]

Objective: The aim of this study was to determine the frequency, persistence and risk of recurrence of human papillomavirus (HPV) lesions of the uterine cervix in human immunodeficiency virus (HIV)-infected women. Patients and methods: To determine the frequency of such lesions, we compared 148 HIV-positive patients with 4862 HIV-negative patients who had a cervical smear test in Toulouse university hospital. To determine the persistence and recurrence rate of the lesions, we prospectively followed 63 of the HIV-positive patients. Their follow-up was compared with that of 227 of the HIV-negative patients. Results: Abnormal smears were much more frequent in HIV-positive patients (42 versus 5%, P <0.001). Persistence or aggravation of the lesions was also greater in HIV-positive patients (82 versus 43%, P <0.001). Lastly, the recurrence rate of dysplastic lesions after treatment was significantly higher in HIV-positive patients (64 versus 11%, P <0.001). Discussion and conclusion: As the frequency, persistence and risk of recurrence of cervical HPV lesions are very high in HIV-positive women, close gynecological surveillance of these patients is indispensable. Surveillance must not be restricted to the uterine cervix because of the frequency of multifocal lesions: vagina, vulva, perineum and anus. It must also be adapted to the severity of immunodeficiency and the patient's history. [Copyright &y& Elsevier]

Abstract: Background: Detection of high-risk human papillomavirus has proved its usefulness in complement of abnormal cervical scrape result. The Hybrid Capture® 2 (HC2, Digene) test has proven its efficiency. We have compared this test with HPV Consensus kit® (HPVC, Argène) and Amplicor HPV test® (AHPV, RocheDiagnostics) on a panel of 88 samples with low HC2 ratios or discordant results between HC2 and cervical scrape. Material and methods: Cervical samples were tested in parallel by the three methods using a nested amplification of L1 region as reference. Results: Eighty-six samples were suitable for analysis. Results of HC2 and AHPV tests were closely related. The use of a “generic” probe in the HPVC test was responsible for undetermined results, which were not clinically relevant. Conclusion: Despite the low viral load of the samples chosen, the hybridization (HC2) and PCR (AHPV or HPVC) methods gave comparable results, with false positive and false negative results for all tests, but a 75% concordance and a high sensibility to detect HPV infection. However, a complementary study on a larger population with ASCUS diagnosis and biopsy under colposcopy would be necessary to valid these assays for a clinical indication. [Copyright &y& Elsevier]

The International Society for the Study of Vulvar Disease (ISSVD) recommends not to use a grading any more and to include in the term vulvar intraepithelial neoplasia (VIN), usual type, the previously called VIN 2 where the nuclear atypia and mitotic figures are confined to the basal half of the epithelium and VIN 3 where nuclear abnormalities and abnormal mitotic figures are present throughout most or all of the thickness of the epithelium. VIN, usual type, is related to a human papillomavirus (HPV) high-risk type infection in most of the cases. The histologic changes previously encompassed within the term VIN 1 will be described as flat condyloma or HPV effect. The less common type of VIN lesion is termed VIN, differentiated type, previously called “high grade” differentiated type or VIN simplex type. This type of VIN is a highly differentiated lesion. The atypia is confined to the basal and parabasal layers of the epithelium, where the cells have abundant cytoplasm and form abortive pearls and the nuclei are relatively uniform in size and contain coarse chromatin and prominent nucleoli. The epithelium does not contain koilocytosis because it is not associated with HPV. It is seen primarily in older women, with a previous history of lichen sclerosus. The diagnosis is often made late in association with keratinising squamous cell carcinomas. [Copyright &y& Elsevier]

The vulvar intraepithelial neoplasia has been identified as one of the 12 neoplasias whose incidence increases in the developed countries. The vulvar intraepithelial neoplasia (VIN) and invasive vulvar cancer incidence increases by 2,4% per annum; and this principally in young women. The VIN account for 57% of the vulvar neoplasias and are actually more frequent than invasive carcinomas. In the United States, between 1973 and 2000, the incidence of the VIN increased by 411% against 20% for invasive cancers. Similar figures were reported from Norwegian registers. The VIN have a different age distribution than invasive cancers: the incidence of the VIN increases until the age of 40–49 years then decreases while the incidence of invasive cancers increases after 50 years without real peak of incidence. The increase in the incidence of VIN could be followed by an increase in the incidence of invasive cancers but the unknowns on the natural history of the VIN and the impact of the treatments make any extrapolation hazardous. The association between the VIN and the human papillomavirus (HPV) has been well established. It should be noted that, contrary to the cervical neoplasia that are related for nearly 100% to the HPV, only 30–40% of invasive cancers of the vulva are related to HPV, while the other carcinomas are related to the evolution of a vulvar lichen sclerous. The HPV induce various types of anogenital lesion according to their genotype. These lesions can be benign for the HPV6 and 11 and preneoplastic or neoplastic for the HPV16 and 18. The presence of HPV16 and 18 is found in 70 to 80% of the VIN suggesting that HPV vaccines could decrease the incidence VIN and HPV related invasive vulvar cancer. [Copyright &y& Elsevier]

Abstract: Immunomodulators have been used for some time in various medical specialities, but have only recently been used in gynaecology. The first drug in this therapeutic class, Immiquimod (Aldara®), has been shown to be effective in treating lesions induced by Human Papillomavirus (HPV) such as genital warts or cervical and vulvar dysplasia, by stimulating the immune system of an infected individual. Thanks to its ease of use and its few side effects, Imiquimod would appear to be, in the future, the treatment of choice for these types of viral infections, alone or in association with therapeutic vaccines or physical abative therapies as a prevention of relapses. This review aims at summarizing and clarifying the mechanism of action of the different immunomodulators, their indications and their effectiveness in gynecologic practice. [Copyright &y& Elsevier]

Abstract: Objectives: The objectives of this study were to estimate the incidence of genital warts and treatment costs in women consulting gynaecologists in France in 2005. Patients and methods: A prospective observational study was performed through a representative sample of gynaecologists. Investigators enrolled all patients seen with genital warts during a 2-month period. A questionnaire detailing socio-demographic characteristics, case description, patient''s clinical profile, past/ current management, and treatment of genital warts was completed by the investigators. Results: 212 gynaecologists participated in the study. Questionnaires were completed for 263 patients including 198 (75.3%) new cases, 53 (20.2%) recurrent cases and 12 (4.5%) resistant cases. The overall incidence was estimated at 228.9/100,000 (female 15–65year old population) corresponding to 47,755 cases annually managed by gynaecologists in France. The average treatment cost was 482.70€ for society and 342.40 € for third-party payers. The annual direct cost of genital warts management was estimated at 23,051,339€, of which 16,351,312€ was funded by the French health care system. Discussion and conclusion: The costs of treating genital warts are considerable. The introduction of a quadrivalent (type 6,11,16,18) Human Papillomavirus vaccine including types responsible for 90% of genital warts could potentially substantially reduce these costs. [Copyright &y& Elsevier]

Abstract: Objective: Oncogenic human papillomaviruses (HPV) cause cervical cancer (CC). Screening prevents CC by detecting and removing cervical intraepithelial neoplasia (CIN) lesions that are detected through abnormal Pap smears. This study assessed the costs of CC screening, management of abnormal Pap smears, and treatment of CIN in France. Patients and methods: Pap smears received by laboratory Pasteur-Cerba during a 7-month period were examined. Patients with abnormal Pap smears were identified and followed for 6months after diagnosis. The management of abnormal Pap smears was documented. These data and other published studies were used to estimate the total number of pap smears, distribution of abnormal smears requiring further examinations, and number of CIN diagnosed. Economic analyses were performed to estimate total CC screening costs from the health care payer (HCP) and societal perspective. Results: An estimated 6,111,787 Pap smears were performed in 2004, including 222,350 abnormal (3.9%) and 63,616 follow-up smears. In total, 58,920 cervical biopsies and 52,525 HPV tests were performed after an abnormal Pap smear. The cost associated with CC screening, including management of abnormal findings, was estimated at 174.2million € from the HCP perspective. Total treatment cost for all CIN was estimated at 22.3million € (HCP perspective). Discussion and conclusion: Overall cost for screening, diagnosis and management of Pap smears was estimated at 335.7million € of which 196.5million € where funded by the HCP. An HPV vaccine that prevents pre-cancerous or cancerous lesions of the cervix will decrease the socio-economic burden associated with the screening of these lesions. [Copyright &y& Elsevier]

Abstract: Human Papillomavirus (HPV) infection is established as the necessary cause of cervical precancers and cancers. To date, more than 120 genotypes are known, but only high risk oncogen genotypes could induce a cancer. HPV 16 and 18 are implied in nearly 70% of cervical cancer around the world. Although some persistent HPV infections progress to cervical cancer, host immunity is generally able to clear most HPV infections providing an opportunity for cervical cancer prevention through vaccination. Candidate prophylactic vaccines based on papillomavirus L1 virus-like particles (VLPs) are currently on human clinical trials: one targeting cervical cancer with a bivalent VLP L1 vaccine containing the two genotypes most frequently involved in cervical cancer (type 16 and 18) and the other, protecting against warts as well as cervical cancer, with a quadrivalent HPV VLP L1 vaccine containing genotypes 6, 11, 16 and 18. The first clinical trials revealed the satisfactory tolerance and excellent immunogenicity of these vaccines inducing high serum antibody titers with minimal side effects. After more than three years, both clinical trials on women 15 to 25 years old have shown that vaccines are able to type specifically protect against nearly 90% of infection and all cervical intra-epithelial neoplasia. The vaccinal strategy defined to date targets preadolescents and adolescent young females (11–13 years) before the first sexual course but some questions are still not resolved concerning the prescriber, the actors of the vaccination and the duration of the protection. Nevertheless cervical cancer screening should be carried on for many years, even if a large vaccinal strategy is decided. Such a vaccine would save lives and reduce the need for costly medical procedures and the psychological stress induced by this cancer. [Copyright &y& Elsevier]

Abstract: Buschke-Löwenstein tumour is classified as a verrucous carcinoma. It presents like an exophytic tumour of the genital or peri-anal area, with ulceration and sometimes fistulae and sinuses. It is preferentially seen in men and immunocompromised patients. Histological appearance is not far from condyloma acuminata, but with a tendency to compress and displace deeper tissues, without basement membrane disruption. HPV types 6 or 11 are regularly found in association with this tumour. Other STI have to be searched. Physical examination and precise imagery are useful to chose the right treatment regimen. Radical excision is recommended to avoid malignant transformation, but has to be large because of the high number of recurrences. Other treatment modalities such as chemotherapy or imiquimod could be of interest to avoid mutilating surgical interventions. A regular follow-up is necessary because of frequent recurrences and possible malignant transformation. [Copyright &y& Elsevier]

Abstract: Objective: Analyse the performance of human papillomavirus testing with hybrid capture II® on liquid-based CYTO-screen® system for women diagnosed with atypical squamous cells of undetermined significance according to the age. Patients and methods: Were included all women diagnosed with atypical squamous cells of undetermined significance for whom human papillomavirus testing was performed and cytological and histological procedures were available over a follow-up period of 6 to 18 months. Results: Human papillomavirus testing was performed in 3,047 patients, and results were compared to cytological and histological follow-up diagnosis in 1,880 cases (61.7%). The sensitivity for diagnosing cervical intraepithelial neoplasia was 93.3% in women less than 30 of age and 89.7% in women more than 30 of age. Specificity was 44.9% in women less than 30 of age and 64.4% in women more than 30 of age. Likelihood ratios confirmed these results as they show a low discriminatory power in case of positive result specifically in women less than 30 of age but an excellent performance in case of negative result. Discussion and conclusion: The use of human papillomavirus testing after a diagnosis of atypical squamous cells of undetermined significance with the residual material of Cyto-screen®sant le mil system is a possible triage procedure to identify patients needing a colposcopy. Its specificity is better for women over 30. [Copyright &y& Elsevier]

Abstract: Cervical cancer remains a critical public health problem that is second only to breast cancer in overall disease burden for women throughout the world. In spite of the success of cervical cancer screening, Pap cytology screening is yet to be effectively implemented or has failed to reduce cervical cancer rates to an appreciable extent. Screening appears to benefit only a small fraction of women although a much larger percentage endures the inconvenience of the Pap test in order to avoid cervical cancer. The establishment of Human Papillomavirus (HPV) infection as the necessary cause of cervical precancers and cancers provides a tremendous opportunity for cervical cancer prevention through vaccination. HPV 16 and 18 which cause 70% of cervical cancers worldwide. Thus a prophylactic vaccine to prevent HPV related precancerous lesions and cancers would save lives, reduce the need for costly medical procedures and provide both women and communities throughout the world with substantial benefits. Based on the induction of neutralizing antibodies by non infectious Virus Like Particles (VLP) of L1 capside protein, prophylactic HPV vaccines have consistently induced high titter of neutralizing antibodies with minimal side effects and induce more than 90% protection from persistent HPV 16-18 infection and HPV 16 and 18 associated high-grade Cervical Intraepithelial Neoplasia (CIN) in proof of concept efficacy trials. HPV 16-18 vaccination will prevent HPV16-18 incident infection, and subsequently decrease in 90% the frequency of abnormal Pap attributable to these types and in about 50% overall abnormal Pap. HPV vaccination will reduce the number of women who require colposcopy, biopsy and cervical treatment for precancerous cervical lesions. The level of protection from death due to cervical cancer could exceed 95%. Three large phases prophylactic HPV VLP trials are now in progress and will form the basis for licensing of candidate vaccines in 2006. HPV vaccination targeting young female adolescents, aged 11 to 16 years, with a catch-up of those aged 17–25 years, would be a strategy to be addressed. Cervical cancer screening strategies, that will be cost-effective for the proper surveillance of women protected by HPV vaccination, are under analysis. [Copyright &y& Elsevier]

Abstract: Objective. – To study main clinical characteristics of patients with vulvar intraepithelial neoplasia 3 (VIN3). To investigate the long-term outcome and risk factors associated with recurrence or progression to invasive carcinoma. Patients and methods. – Retrospective study of 56 patients with VIN3 from January 1st 1995 to December 31st 2003. Results. – Lesions were unifocal for 30 patients (53.6%) whereas they were multifocal for 26 patients (46.4%). When the lesion was multifocal, women were younger than in the unifocal group (41.2±16.7 vs. 52.5±13.5 years, P <0.03). Clinical symptoms, disease characteristics and medical history were not different between the two groups. Clinical HPV infections were more frequent in the multifocal group (65.4 vs. 23.3%, P <0.01). The mean follow-up was 39 months. Nine patients (16.1%) had recurrence of VIN3. Progression to invasive carcinoma occurred in 4 patients (7.1%). Multifocal lesions, occult micro-invasive disease and positive margins were related to recurrence or progression to invasive carcinoma. However, age at diagnosis, HPV infection, lichen sclerosis, immunosuppression and initial treatment did not correlate with evolution. Discussion and conclusion. – Recurrence and progression to invasive carcinoma can occur during VIN3 evolution. Our results confirm previous reports and suggest that all patients need a long-term follow-up regardless of patients'' age or clinical characteristics. [Copyright &y& Elsevier]

Abstract: Background. – Many laboratories use the DNA Hybrid Capture® 2 HPV-high risk assay (Digene) to detect and type oncogenic HPV. The aim of this work was to compare this assay with a new HPV genotyping assay: HPV Consensus kit® (Argène). Actually, this assay is not commercialy available. Materials and methods. – Ninety-four cervical samples were tested with both the routine assay Hybrid Capture® 2 and the HPV Consensus kit®. Discordants results were analysed by amplification with a nested PCR and sequencing of amplified products. Results. – Only 81 results could be analysed concerning the oncogenic risk. The overall concordance was 92,6%. But we find 13 "generic" results with the HPV Consensus kit®, the generic probe including high risk and low risk genotypes. Conclusion. – HPV Consensus kit® results showed a better detection sensitivity for this assay than Hybrid Capture® 2 assay. Nevertheless, "generic" results give no information about the oncogenic risk of the HPV detected in a sample. [Copyright &y& Elsevier]

Abstract: Human papillomaviruses (HPV) are the most prevalent sexually-transmitted agents worldwide. HPV are small circular double-stranded DNA epitheliotropic viruses that exhibit either cutaneous or mucosal specificity. Most HPV infections are self-limiting and are spontaneously cleared within months or years. However, infections may persist and result in a variety of benign, pre-malignant and malignant tumors. Cytological and histopathological abnormalities associated with HPV infections of the male and female lower anogenital tract include condylomata, low-grade and high-grade squamous intraepithelial lesions which are incipient cancers, and squamous cell carcinomas. The modal time between HPV infection occurring in the late teens or early 20 s and precancer peaking around 30 years of age is 7-10 years. Women detected with invasive cancers tend to be an average 10 years older than women with high-grade disease. The natural history of cervical cancer reveals that infection with high-risk types may lead to low-grade or high-grade intraepithelial lesions. High-grade lesions may progress to cervical carcinoma if not treated. The purpose of screening, in addition to detecting cervical cancers at an early stage, is to detect and remove high-grade lesions and thus prevent the potential progression to cervical carcinoma. Early detection of cervical neoplasia is possible with regular Pap smears performed from 21 to 70 years of age. In case of abnormal Pap smear, a biopsy performed under colposcopy will allow the diagnosis of cervical lesion. Cancer of the cervix is the second leading cause of cancer related deaths among women across the world (3,400 new cases in France in 2000). [Copyright &y& Elsevier]

Les papillomavirus humains sont des virus à tropisme épithélial, responsables pour ceux d’entre eux qui sont oncogènes du cancer du col de l’utérus. Cette revue de la littérature aborde les vaccins en développement, qu’ils soient prophylactiques ou thérapeutiques. Mots clés : papillomavirus humains, vaccins Human papillomaviruses (HPV) have an epithelial tropism and numerous oncogenic HPV are responsible for uterine cervical cancer. Here we analyse the published studies concerning both prophylactic and therapeutic vaccines against HPV. Keywords: human papillomaviruses, vaccination [ABSTRACT FROM AUTHOR]

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Abstract: Buschke–Lowenstein tumor or giant condyloma acuminata is characterized by a proliferation locally aggressive with extensive tissue destruction. We report three cases of Buschke–Lowenstein tumor with anorectal localization. The histology is characterized by papillomatosis and endo or exophytic acanthosis secondary to papillomavirus. The variety of treatment regimens applied do not allow formulation of definitive therapeutic guidelines. [Copyright &y& Elsevier]

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