Neovaginal and Anal High-Risk Human Papillomavirus DNA Among Thai Transgender Women in Gender Health Clinics

Abstract

Background: Although human papillomavirus (HPV)-related lesions in the neovagina of transgender women have been well documented, information on high-risk HPV (hrHPV) in the neovagina has been very limited. The objective of this study was to determine hrHPV DNA detection rate in the neovagina of transgender women.Methods: Neovaginal and anal swab were collected in liquid-based cytology fluid from transgender women visiting Gender Health Clinic and Tangerine Community Health Clinic in Bangkok, Thailand. Samples were processed for hrHPV DNA (reported as subtypes 16 and 18 or the pooled result of subtypes 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) by automated real-time polymerase chain reaction and for neovaginal cytology according to the Bethesda system. Demographic data and sexual history were obtained, and physical examination was conducted. HIV status was obtained from existing medical records.Results: Samples were collected from 57 transgender women (mean age, 30.4 years [interquartile range, 8 years]). From 35 of 57 valid neovaginal samples, 8 (20%) tested positive for hrHPV DNA. From 30 of 57 valid anal samples, 6 (19.4%) tested positive for hrHPV DNA. HIV status was known for 52 transgender women, 1 of which were HIV infected; neovaginal hrHPV was invalid in that patient.Conclusions: One of 5 transgender women visiting sexual health clinics in Bangkok was found to have hrHPV DNA in neovaginal and anal compartments. Studies are needed to look at incidence and persistence of hrHPV infection to inform anogenital precancerous and cancerous screening programs for transgender women.

Neovaginal Human Papillomavirus Prevalence in Transfeminine Individuals

“…6 The median postoperative time to HPV diagnosis was provided only in the Thailand and Netherlands studies, in which it was, respectively, 6.5 years and 2.4 years. 4,5 A longer postoperative time (more than 18 years) was observed in studies reporting HPV-related malignancies, whereas an average postoperative time (less than 13 years) was observed for studies that reported HPV positivity alone or HPV-related nonmalignant abnormalities (Tables 1 and 2). Reporting of sexual activity varied vastly among studies.…”

Human papillomavirus positivity at three anatomical sites among transgender women in Central Brazil

“…In the present study, gender-affirming surgery (vaginoplasty) was a risk factor for genital HPV DNA, and the neovaginal HPV positivity was 54.5%. To our knowledge, only 2 other studies had detected HPV in the neovagina among TGW, and both reported a prevalence of 20% for high-risk HPV 23,24 . The consequences of HPV infection in the neovagina remain unclear; however, there have been reports of HPV-associated neovaginal lesions and squamous cell carcinoma 25 .…”

“…To our knowledge, only 2 other studies had detected HPV in the neovagina among TGW, and both reported a prevalence of 20% for high-risk HPV. 23,24 The consequences of HPV infection in the neovagina remain unclear; however, there have been reports of HPV-associated neovaginal lesions and squamous cell carcinoma. 25 Available research suggests high rates of HPV infection and disease among TGW; nevertheless, there still exist no recommendations and guidelines regarding HPV screening in this population.…”

Câncer em neovagina de mulheres trans: uma revisão sistemática

“…Todos os artigos sete (100%) selecionados possuíam autoria, periódicos e bases de dados internacionais, o que pode representar a carência de estudos nacionais sobre a saúde sexual de mulheres transexuais, ainda que se tenha a política pública de saúde como o processo transexualizador que inclui a vaginoplastia como ação de intervenção para a transição física, procedimento esse que gera uma neovagina. Quatro artigos (71,5%) (Bollo et al, 2018;Fernandes et al, 2014;Fierz et al, 2019;Wang et al, 2020) tinham no título explicitado o estudo de carcinoma neovaginal, sendo um (14,3%) (Wang et al, 2020) com caso confirmado de metástase a partir do carcinoma espinocelular e três artigos (28,6%) (Bollo et al, 2018;Uaamnuichai et al, 2021;Wang et al, 2020) com Papilomavírus Humano como fator de risco para o desenvolvimento de lesões na neovagina. Apenas um (14,3%) artigo (Trum et al, 2015) mencionou o olhar ginecológico para mulheres submetidas a vaginoplastia.…”

“…Sintoma pélvico Das 74 cirurgias de confirmação de gênero foram utilizados retalho de tecido peniano e da bolsa escrotal em 71 (95,9%) (Bollo et al, 2018;Fernandes et al, 2014;Fierz et al, 2019;Grosse et al, 2017;Trum et al, 2015;Uaamnuichai et al, 2021;Wang et al, 2020), tecido epitelial não genital em 1(1,4%) (Grosse et al, 2017) e sigmóide em 2 (2,7%) mulheres trans (Grosse et al, 2017). O período de latência entre a idade na reconstrução e a idade do diagnóstico de câncer foi entre 20 a 44 anos após a realização da vaginoplastia, mediana de 33 anos, podendo considerar uma idade de corte (idade determinante) para o aparecimento de neoplasias neovaginais, devendo ocorrer então a diminuição do intervalo do monitoramento a partir desse tempo.…”