Oncogenic types of human papilloma viruses (HPVs) have been established to be the causative agents for cervical cancers and high-grade squamous intraepithelial lesions (HSILs). The clinical application of molecular tests for HPV detection for screening purposes has been of considerable interest. DNA amplification methods allow the use of self-collected samples (including urine) from material collected away from the original disease site. For screening of cervical pathology, detection of HPV-DNA in urine would be useful only if it represents cervical HPV infection and/or HPV-related cervical pathology. We conducted a review of the literature in order to ascertain: (1) if urine is an adequate sample for HPV-detection; (2) whether sensitive techniques are available for HPV-detection in urine and (3) if detection of HPV in urine truly represents cervical infection/pathology. The review process consisted of assembling facts and analysing the published literature on the following facts: anatomical considerations of the lower genital and the lower urinary tract, biological behaviour of HPV and its shedding behaviour, technical issues regarding sample collection, processing and HPV-DNA assay systems, concordance rates of HPV-DNA detection and their type specificity in the paired samples (urine and cervical scrapes) obtained in different clinico-epidemiological settings and comparative detection rates of HSILs in the paired samples.

VIA can be used as a mass screening tool for cervical cancer in resource-poor settings.

Alternative strategies such as visual inspection of cervix with acetic acid, are real time, economical and easily implemented methods for cervical cancer screening. However, variable sensitivity and specificity have been observed in various community based studies. The possible reasons could include variation in man power training, light source used for visualization, and preparation of diluted (4-5%) acetic acid and its storage. A standardized protocol for training, teaching material (easy to understand in the local language) for trainees, supervision and reinforcement by intermittent and supplementary training to check the quality of their observation, a standard protocol for preparation dilute acetic acid and its storage and a standard good light source (equivalent to day light) are needed to minimize the variation in sensitivity and specificity of VIA in community settings.

ObjectiveTo assess the performance of a low cost magnifying device (Magnivisualizer) compared to a standard optical colposcope for detection of precancerous and cancerous lesions of the uterine cervix.MethodsA total of 659 consecutive symptomatic women attending a gynecologic outpatient clinic underwent unaided visual inspection followed by cytology, visual inspection of the cervix using 5% acetic acid (VIA), and VIA under magnification (VIAM) with the Magnivisualizer. All women, independently of test results, were referred for colposcopic examination. Colposcopic-directed biopsies were obtained from all positive lesions and compared to positive VIAM cases.ResultsThe detection rate for VIA positive lesions was 12% (134/659), while it was 29% for VIAM positive lesions (191/659). The sensitivities of detection of cervical intraepithelial neoplasia (CIN) 2 and higher lesions were 61.7% for VIA, 88.3% for VIAM, and 86.7% for colposcopy, with a specificity of 58.5% for VIA, 55.8% for VIAM, and 90.4% for colposcopy. The performance of colposcopy and VIAM was moderate (κ, 0.48; 95% confidence interval [CI], 0.41 to 0.54) for detection of CIN 1 and higher lesions and excellent (κ, 0.87; 95% CI, 0.82 to 0.94) for detection of CIN 2 and higher lesions.ConclusionIn low resource settings, where colposcopic facilities are not available at the community level, a simple low-cost, handheld Magnivisualizer can be considered a valid option for detection of cervical precancerous and cancerous lesions. However, it cannot replace traditional colposcopy because it has a low specificity that results in many unnecessary biopsies.

A.: Significance of inflammatory cervical smears. APMIS 103: 273-278, 1995. Two hundred and fifty-seven women attending a Maternal and Child Health Centre (MCH) were examined for different colposcopic and histological patterns associated with cervical inflammation as detected by cytology and for their association with different gynaecological infections. The cytodiagnosis revealed inflammation in 207 women (80.5%)) and non-inflammation in 49 (19.5'X)); one smear was inadequate for evaluation. Fifty-six per cent of the women with inflammation and 20% with noninflammation had an atypical transformation zone (ATZ), the risk of ATZ being 4.9-fold higher in those with inflammation. Biopsies from 128 women with abnormal colposcopy revealed morphological changes suggestive of human papillomavirus (HPV) in 89 (69.5%) and dysplasia of varying grades in 8 (6.3%). Seventy per cent of histologically diagnosed HPV lesions stained immunohistochemically, whereas 84% reacted with a biotinylated Pdn-HPV probe by DNA in situ hybridization (DISH). In addition to HPV, chlamydia (OR 15.6, 95% CI 2.2, 311.6), T. vuginulis (OR 18.4), bacterial vaginosis (OR 24.7, 95'X) CI 3.5, 492) and herpes simplex virus (OR 4.9, 95%" CI 1.4, 20.9) were significantly associated with inflammatory smears. Of 11 dysplasias detected by colposcopy and confirmed by biopsy, 8 (72.7'Xr) had inflammatory cytology in the initial Pap smears. Thus a large proportion of women with inflammatory smears had multiple gynaecological infections and may be at increased risk of developing preneoplastic or neoplastic changes. Furthermore, they risk transmitting the infections to their partners.