Highlights CIN management is currently surveillance or surgical therapy. This review describes current research on medical therapies. Imiquimod is the most studied with evidence of safety and efficacy. 5-Fluorouracil has also shown promise with two clinical trials showing efficacy as adjuvant and primary treatment. Antivirals therapies have produced mixed results with cidofovir showing the most potential. The data remains weak regarding hormonal, herbal and alternative therapies rending it difficult to draw conclusions.

Pregnant women are accepting of outpatient penicillin allergy testing, and most who report an allergy test negative.

ObjectivesTo determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5‐fluorouracil (5‐FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3.MethodsThis pilot prospective study was conducted in women aged 18–45 years with p16+ CIN 2/3. Participants underwent an 8‐week alternating regimen of self‐applied 5% 5‐FU on weeks 1, 3, 5, and 7 and physician‐applied imiquimod on weeks 2, 4, 6, and 8. Adverse events (AEs) were collected by symptom diary and clinical exam. Feasibility was measured by tolerability and safety (AEs) of the study intervention. Tolerability was assessed as the number of participants able to apply 50% or more of the treatment doses. The safety outcome was calculated as the number of participants who experienced “specified AEs” defined as possibly, probably, or definitely related grade 2 or worse AE or grade 1 genital AEs (blisters, ulcerations, or pustules) lasting more than 5 days. The efficacy of the intervention was determined by histology and high‐risk human papillomavirus (hrHPV) testing was done after treatment.ResultsThe median age of the 13 participants was 27 ± 2.9 years. Eleven (84.61%) participants applied 50% or more of the treatment. All participants reported grade 1 AEs; 6 (46.15%) reported grade 2 AEs; and 0 reported grade 3/4 AEs. Three (23.08%) participants had specified AEs. Histologic regression to normal or CIN 1 among those completing 50% or more of the treatment doses was observed in 10 (90.91%) participants, and 7 (63.63%) tested negative for hr‐HPV at the end of the study.ConclusionsTopical treatment for CIN 2/3 with 5‐FU/imiquimod is feasible, with preliminary evidence of efficacy. Topical therapies need further investigation as adjuncts or alternatives to surgical therapy for CIN 2/3.

Objectives To estimate the prevalence of and identify modifiable risk factors for alternative antibiotics for group B Streptococcus (GBS) prophylaxis in penicillin-allergic women. Methods Retrospective cohort study of pregnant women within a health care network from January 1, 2014, to December 31, 2017. Included women were GBS colonized, delivered at ≥ 37 weeks' gestation, and reported penicillin/cephalosporin allergy. The primary outcome was the use of alternate antibiotics GBS prophylaxis, defined per Centers for Disease Control and Prevention guidelines as antibiotics other than penicillin, ampicillin, or cefazolin. Results We identified 190 GBS-colonized pregnant women self-reporting a penicillin/cephalosporin allergy; 5% reported anaphylaxis, 44% high-risk symptoms (isolated hives, shortness of breath, swelling, or vomiting), and 51% low-risk symptoms (isolated rash, itching, or nausea). Two-thirds (63%) had alternative antibiotic prophylaxis. In adjusted analyses, nonwhite race (adjusted odds ratio [aOR]: 2.42; 95% confidence interval [CI]: 1.19–4.94) and high-risk allergic reaction (aOR: 2.42; 95% CI: 1.30–4.49) were associated with higher odds of alternative antibiotics prophylaxis compared with low-risk allergic reaction. Low-risk allergic reaction group was less likely to receive alternative antibiotic prophylaxis (aOR: 0.36; 95 CI%: 0.19–0.66). Conclusion Alternative antibiotic use for GBS prophylaxis is frequent with penicillin/cephalosporin allergies. Efforts to confirm allergy and perform penicillin hypersensitivity testing may increase compliance with guidelines for antibiotic administration.

No abstract