Category: 8. Health

  • Vaginal microbiome fights back against stubborn BV infections

    Vaginal microbiome fights back against stubborn BV infections

    New research reveals how the vaginal microbiome can sabotage antibiotic treatment, explaining why bacterial vaginosis keeps coming back, and what it will take to finally stop it.

    Study: Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. Image credit: Kateryna Kon/Shutterstock.com

    Scientists have reviewed the available literature to document the effect of vaginal microbiome-drug interactions on the efficacy of antibiotics against recurrent bacterial vaginosis (BV). This review has been published in Npj Biofilms and Microbiomes.

    Bacterial vaginosis: Prevalence, symptoms, and diagnosis

    BV is a common infection occurring in women of reproductive age causing discomfort and pain in the vagina. Although the majority of BV patients experience no symptoms, some women may have a prominent vaginal discharge with a fishy odor, along with burning and itching sensation.

    BV is characterized by vaginal bacterial dysbiosis, particularly a loss of Lactobacillus, which may pose severe health threats. For instance, it increases the risk of sexually transmitted infection (STI), pelvic inflammatory disease, preterm birth, and preeclampsia in pregnant women.

    Global prevalence of BV varies significantly. A recent survey estimated that approximately 30% of US women of reproductive age have BV, and this number increases to more than 50% in sub-Saharan African women.

    Since no single causative agent of BV is known, it is diagnosed using the Nugent Score. It is also diagnosed clinically through nucleic acid amplification tests (NAATs) or by identifying the presence of at least three Amsel criteria, including a pH greater than 4.5, characteristic homogeneous milk-like vaginal discharge, a fishy odor, and 20% clue cells.

    However, the authors emphasize that routine screening for asymptomatic BV is not generally recommended, as treatment may not significantly reduce adverse pregnancy outcomes.

    High recurrence rate of bacterial vaginosis

    Although antibiotic therapy, such as metronidazole, tinidazole, or clindamycin, is recommended to treat BV, a high recurrence rate within one to six months of treatment has been recorded in approximately 20% to 70% of women.

    Key contributing factors, rather than a single cause, to high BV recurrence rates are the persistence of protective bacterial biofilm, and antibiotic resistance within the bacterial biofilm and vaginal canal. Other factors that contribute to this recurrence include non-adherence to multidose therapy, continual exchange of pathogenic bacterial vaginosis-associated bacteria (BVAB) between sexual partners pre or post treatment, and inability to restore optimal levels of Lactobacillus in the vaginal microbiome.

    How vaginal pharmacomicrobiomics affect the efficacy of antibiotic therapy?

    Pharmacomicrobiomics involves the interaction between drugs and microbes, which is crucial for enhancing the scope of precision medicine. It focuses on understanding how microbiome variations affect drug disposition, toxicity, and efficacy. The microbiome present in various anatomic sites, such as the mouth, gut, skin, lungs, and vagina, may either improve or hinder the efficacy of drugs.

    Overexpression of a DNA repair protein (RecA) in Bacteroides fragilis, a common gut and vaginal commensal bacterium, elevates resistance to metronidazole. Previous studies have indicated that oral metronidazole only temporarily reinstates healthy vaginal microbiota in patients with recurrent BV. A higher prevalence of Prevotella before treatment and Gardnerella post-treatment has been associated with enhanced risk of BV recurrence.

    Many scientists have hypothesized that vaginal microbial dysbiosis is associated with modifications in drug disposition, activity, and toxicity, which contributes to antibiotic resistance and adverse reproductive outcome due to genital infection. For instance, the metabolism of the anti-HIV drug, tenofovir (TFV), by Gardnerella vaginalis has been linked to reduced HIV prevention efficacy. TFV reduced HIV incidence by only 18% in African women with G. vaginalis-dominated (BV-like) microbiota and 61% in women with Lactobacillus-dominant microbiota.

    Host-specific and drug-specific factors determine the systematic distribution of drugs in different body parts. Multiple studies have shown that a dysbiotic female genital tract causes BV to increase the local pH by trapping ions that reduce the effectiveness of tenofovir disoproxil fumarate (TDF). It also promotes alterations in other factors essential for the drug compound to migrate across the female genital tract compartment to treat BV.

    Previous studies have also shown that T-cell uptake of TFV is influenced by alterations in vaginal microbiota and pH, contributing to the drug’s inconsistent efficacy in BV-positive individuals. An abundance of specific microbes, such as Lactobacillus, may alter the movement of drugs across the genital tract by modifying local drug transporters in a pH-dependent or independent manner. Bacteroides and Prevotella are two common BVAB highly resistant to metronidazole by altering pyruvate fermentation.

    The importance of vaginal pH on drug efficacy has also been shown in labor induction for term or preterm birth. It has been speculated that vaginal microbiota could indirectly influence the effectiveness of drugs by altering host drug metabolism and producing bacterial metabolites that compete with the drug receptor.

    Reproductive hormones directly regulate the composition and abundance of the vaginal microbiome during the menstrual cycle and pregnancy, which may influence how drugs are absorbed and metabolized, particularly when using vaginal inserts or pessaries.

    Transporters recognize and export various antibiotics, including β-lactams, macrolides, and aminoglycosides, to their target sites. Multiple studies have shown that G. vaginalis, a renowned BVAB, upregulates efflux pumps and ABC transporters, which significantly contribute to bacterial colonization and infection of host tissues and multidrug resistance by actively eliminating various antibiotics and metabolites from bacterial cells.

    The authors hypothesize that transport proteins expressed on vaginal epithelial cells and bacteria may be exchanged via extracellular vesicles. This speculative but plausible mechanism could further contribute to resistance and drug clearance. In addition to resistance, transporter proteins may influence how efficiently antibiotics reach and accumulate in vaginal tissues, potentially explaining some cases of treatment failure due to insufficient local drug exposure.

    Conclusions

    The current study hypothesized that the efficacy of recommended antibiotics for treating BV is reduced by vaginal microbiota-associated factors including pH and metabolism, leading to antibiotic resistance. Therefore, to improve therapeutic outcomes and decrease the incidence of persistent and recurrent BV, it is essential to consider the vaginal microbiome-drug interactions and efficacy of antibiotics against recurrent BV.

    The authors emphasize exploring novel strategies to enhance treatment, including probiotics, prebiotics, postbiotics, and bacteriophage therapies. They also suggest investigating the potential of transporter/enzyme inhibitors and new drug delivery systems to improve local drug exposure in the vaginal tract.

    They conclude that future research should leverage experimental models such as vaginal organ-on-chip systems and personalized metagenomic profiling to better understand these interactions and guide individualized treatment approaches.

    Download your PDF copy now!

    Journal reference:

    • Amabebe, E. et al. (2025) Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis. Npj Biofilms and Microbiomes. 11(1), 1-12. https://doi.org/10.1038/s41522-025-00748-0. https://www.nature.com/articles/s41522-025-00748-0

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  • Early Management of Suspected Cervical Spine Injury: A Real-World Insight From a London Major Trauma Centre

    Early Management of Suspected Cervical Spine Injury: A Real-World Insight From a London Major Trauma Centre


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  • Certain Plant-Based Foods May Cut Crohn’s Disease Risk

    Certain Plant-Based Foods May Cut Crohn’s Disease Risk

    TOPLINE:

    A high combined intake of fruits, vegetables, legumes, and potatoes was associated with a reduced risk for Crohn’s disease — driven largely by specific foods such as apples or pears, bananas, mushrooms, and onions or garlic. Alternatively, a high intake of potatoes was associated with an increased risk for ulcerative colitis.

    METHODOLOGY:

    • The International Organization for the Study of Inflammatory Bowel Disease recommends eating more fruits and vegetables for their fiber benefits, but current guidelines do not distinguish between subcategories despite their differing compositions and potential effects on inflammatory bowel disease (IBD) risk.
    • Researchers analyzed data of 341,519 participants without IBD (mean age, 52.1 years; 70% women) from a popular European cohort to evaluate how consumption of individual fruits, vegetables, legumes, and potatoes influenced the risk for Crohn’s disease and ulcerative colitis.
    • At baseline, validated food frequency questionnaires were used to assess dietary intake of fruits, vegetables, legumes, and potatoes (including other tubers).
    • Participants in the lowest vs highest quartiles had median daily intakes of 291.6 vs 840.9 g/d of combined fruits, vegetables, legumes, and potatoes; 17.0 vs 100.3 g/d of apples/pears; 6.6 vs 14.0 g/d of bananas; 2.1 vs 6.2 g/d of mushrooms; 4.1 vs 11.9 g/d of onions or garlic; and 64.7 vs 82.1 g/d of potatoes.

    TAKEAWAY:

    • The median follow-up period was 13.4 years, during which 149 participants developed Crohn’s disease and 379 developed ulcerative colitis.
    • A higher combined intake of fruits, vegetables, legumes, and potatoes was associated with a lower risk of developing Crohn’s disease (highest vs lowest quartile; adjusted hazard ratio [aHR], 0.44; 95% CI, 0.26-0.76) but not ulcerative colitis (aHR, 1.07; 95% CI, 0.76-1.50).
    • A subsequent post hoc analysis showed that the pooled intake of apples or pears, bananas, mushrooms, and onions or garlic was linked to a comparable risk reduction for Crohn’s disease as total fruit, vegetable, legume, and potato intake (highest vs lowest quartile; pooled aHR, 0.58; 95% CI, 0.33-1.02).
    • However, a higher intake of potatoes was associated with a higher risk of developing ulcerative colitis (highest vs lowest quartile; aHR, 1.51; 95% CI, 1.05-2.17).

    IN PRACTICE:

    “In conclusion, we found that high combined intake of fruits, vegetables, legumes, and potatoes is associated with a lower risk of developing CD but not UC. This was particularly apparent for apple/pear, banana, mushrooms, and onion/garlic intakes. A higher risk of UC was observed for a higher intake of potatoes,” the authors of the study wrote.

    SOURCE:

    This study was led by Antoine Meyer, MD, PhD, Université Paris-Saclay, Villejuif, France. It was published online in the American Journal of Gastroenterology.

    LIMITATIONS:

    This study relied on food frequency questionnaires measured only at baseline, which may not have fully captured dietary changes over time. The mostly older, female population may not have represented the broader European or younger populations. As with all observational studies, residual confounding from unmeasured factors could not be ruled out.

    DISCLOSURES:

    The cohort was supported by the International Agency for Research on Cancer, the Department of Epidemiology and Biostatistics, School of Public Health, and other sources. Some authors declared receiving speaker fees, grants, consulting fees, and travel support from various pharmaceutical companies.

    This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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  • PM vows to eradicate polio from Pakistan – RADIO PAKISTAN

    1. PM vows to eradicate polio from Pakistan  RADIO PAKISTAN
    2. New polio case from KP takes tally to 14  Dawn
    3. Pakistan records one more poliovirus case; countrywide tally reaches 14  The Hindu
    4. Pakistan: Over 60,000 polio vaccine refusals reported during April campaign, says report  ANI News
    5. Pakistan reports 14th polio case in 2025  Samaa TV

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  • Cardiometabolic heart failure with preserved ejection fraction: from molecular signatures to personalized treatment | Cardiovascular Diabetology

    Cardiometabolic heart failure with preserved ejection fraction: from molecular signatures to personalized treatment | Cardiovascular Diabetology

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  • Cervical Cancer Risk Overlooked After Age 65

    Cervical Cancer Risk Overlooked After Age 65

    TOPLINE:

    Analysis of over 2.1 million women in China revealed that those aged 65 years or older vs those younger than 65 years had significantly higher rates of high-risk human papillomavirus (hr-HPV) infection (13.67% vs 8.08%) and cervical cancer (0.092% vs 0.01%) although most guidelines recommend discontinuing screening for women aged 65 years or older with a normal screening history.

    METHODOLOGY:

    • Researchers conducted a retrospective analysis of cervical cancer screening data from Shenzhen, China (2017-2023), to assess hr-HPV distribution and cervical intraepithelial neoplasia grade 2 or worse (CIN2+) prevalence in women aged 65 years or older vs those younger than 65 years.
    • Data collection encompassed 628 healthcare facilities, including 496 community health centers, 94 hospitals, 11 maternal and child health hospitals, and 27 other medical facilities.
    • Clinical records included demographic information, cytology results, HPV testing covering 14 hr-HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), and colposcopy/biopsy outcomes.
    • Analysis included 2,152,766 complete records from an initial collection of 2,580,829, yielding an 83.4% data validity rate.

    TAKEAWAY:

    • Analysis of 2,152,766 records revealed that women aged 65 years or older (n = 17,420; 0.81%) vs those younger than 65 years showed higher hr-HPV prevalence (13.67% vs 8.08%), CIN2+ detection rate (0.333% vs 0.155%), and cancer rate (0.092% vs 0.01%; P for all < .001).
    • Single, double, and triple hr-HPV infections were found in 10.56%, 2.32%, and 0.57% of women aged 65 years or older, with CIN2+ detection rates of 2.01%, 2.73%, and 4.04%, respectively, all exceeding rates in those younger than 65 years (P < .001).
    • A significant dose-response relationship emerged between hr-HPV infections and CIN2+ risk in women aged 65 years or older (P for trend < .001), with odds ratios being 55.86 (95% CI, 21.81-143.07), 65.95 (95% CI, 22.63-192.18), and 85.45 (95% CI, 24.15-302.35) for single, double, and triple infections, respectively.

    IN PRACTICE:

    “Currently, there is a significant global gap in cervical cancer prevention for older women, and urgent action is needed. First, screening and early diagnosis for women aged ≥ 65 should be strengthened, including affordable screening services and age-appropriate technologies to detect and treat precancerous lesions. Additionally, community engagement, health education, and media campaigns can raise awareness of cervical cancer risks and prevention among older women, encouraging active participation in screening programs,” authors of the study wrote.

    SOURCE:

    The study was led by Zichen Ye, He Wang, and Yingyu Zhong, who served as joint first authors. It was published online in Gynecology and Obstetrics Clinical Medicine.

    LIMITATIONS:

    The study faced several limitations despite using high-quality, large-sample, real-world cervical cancer screening data collected over 7 years in Shenzhen. Because women aged 65 years or older were not included in the national target screening population, participants may have had symptoms or concerns, introducing potential selection bias. The low number of hr-HPV infections in this age group led to some results trending toward extremes, affecting result stability. Additionally, data from a single region in China limited generalizability to other populations. The researchers could not obtain specific information about the types of cytologic detection products and HPV genotyping products used, which may have affected result precision and comparability.

    DISCLOSURES:

    The study was supported by the Sanming Project of Medicine in Shenzhen (SZSM202211032). The authors reported having no relevant conflicts of interest.

    This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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  • Bird flu: EFSA analyses situation in US and tracks possible routes of spread

    Bird flu: EFSA analyses situation in US and tracks possible routes of spread

    EFSA’s scientists highlight that key European stop-overs with high-density bird congregations, such as Iceland, Britain, Ireland, western Scandinavia, and large wetlands like the Wadden Sea on the Dutch, Danish and German coasts would be useful places for early detection of the virus during the seasonal migration of wild birds.  

    The report also addresses the potential for the virus to be introduced into Europe through trade, concluding that the importation of products with raw milk from affected areas in the USA cannot be completely excluded and therefore could be a possible pathway. The importation of dairy cows and bovine meat could also be a potential route for virus introduction. However, the virus has rarely been found in meat, animal imports are very limited, and very strict trade regulations are in place for meat and live animals entering the EU. 

    EFSA’s report also provides an overview of the situation in the USA, where 981 dairy herds across 16 states were affected between March 2024 and May 2025. The report, which was reviewed by the US authorities, highlights that cattle movement, low biosecurity, and shared farm equipment contributed to the spread of the virus.  

    By the end of the year, EFSA will assess the potential impact of this HPAI genotype entering Europe, recommending measures to prevent its spread.   

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  • Canada Must Boost Its Own Disease Monitoring, Say Medics

    Canada Must Boost Its Own Disease Monitoring, Say Medics


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    Canadians are being put at risk by recent US health department cuts, according to an urgent editorial in the Canadian Medical Association Journal (CMAJ).

    Writing in the latest edition of the journal, the editors argue that the Trump administration’s recent dismantling of public health and research infrastructure “pose[s] immediate and long-term risks to the health of neighboring countries”.

    Canadian governments should strengthen the country’s own health surveillance systems to prevent spread of communicable diseases, the editors say.

    Health cuts crossing borders

    Since coming into office in January, the Trump administration has pulled substantial funding from key US health institutions.

    The budget for the US National Institutes of Health (NIH) has been cut by 40%.

    Thousands of employees have been fired from the country’s Centers for Disease Control and Prevention (CDC) and its Food and Drug Administration (FDA) – although several hundred have since had their roles reinstated.

    Some of the administration’s actions have been challenged and deemed “likely unlawful” by federal judges. Nonetheless, the effects of the cuts persist, and major health initiatives aimed at combating HIV/AIDS, tuberculosis and malaria remain weakened.

    Writing in the CMAJ, the authors of the new editorial argue that the US cuts could harm the health of Canadians as well as Americans, as the mass firings and funding squeeze have “drastically reduced” the US’s capacity to collect and share health data with other countries.

    “Cuts have included actions to paralyze evidence-based science, such as firing of personnel with the skills to develop tests for rapidly evolving diseases,” wrote the authors, Dr. Shannon Charlebois, the CMAJ’s medical editor, and Dr. Jasmine Pawa, a public health and preventive medicine specialist physician at the University of Toronto.

    “This could affect, for example, the Canadian preclinical trials to treat filoviruses (e.g., Ebola virus) that depend on the import of antibodies generated by American scientists working in labs funded by the NIH,” they continued. “These actions pose immediate and long-term risks to the health of neighboring countries and to global health.”

    In response, Charlebois and Pawa say that the Canadian government should strengthen the country’s health surveillance systems.

    They suggest boosting data exchange between electronic medical and health records and utilizing “equity” data such as demographic, social, economic and geographic descriptors of the Canadian population. Further effort, they say, is also needed to clarify Canadian rates of vaccine coverage and antimicrobial resistance.

    Combating health misinformation

    The CMAJ editorial also criticizes individuals in the Trump administration “who seed misinformation and publicly discredit national health institutions adds to the effects of existing misinformation.”

    Robert F. Kennedy Jr., the US’s Secretary of Health and Human Services, has come under particular criticism since his appointment for his history of promoting unfounded health conspiracies, notably around vaccines.

    Charlebois and Pawa argue that Canadians are vulnerable to a “cross-border bleed” of such health misinformation as well as exposure to “biased US media.”

    The authors cite a recent Canadian Medical Association’s 2025 Health and Media Tracking survey, which found that 43% of people in Canada were highly susceptible to believing misinformation, while another 35% were moderately susceptible.

    To counter the spill-over of any health misinformation from south of the border, Charlebois and Pawa recommend Canadian health institutions curate more knowledge that can be provided for “content for plain-language knowledge translators in public media.”


    Reference: Charlebois S, Pawa J. Tackling communicable disease surveillance and misinformation in Canada. CMAJ. 2025. doi: 10.1503/cmaj.250916

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  • Mouse Models Offer Hope for Ultra-Rare Disorder Treatment

    Mouse Models Offer Hope for Ultra-Rare Disorder Treatment

    Scientists at The Jackson Laboratory (JAX) have developed mouse models that survive premature death and enable pre-clinical testing of alternating hemiplegia of childhood, or AHC, a devastating and sometimes fatal neurological disorder that affects about one in a million children with no treatment yet.

    The research, newly published in Neurobiology of Disease, reveals how different mutations can lead to distinct outcomes in AHC. It also sets the stage for developing and applying next-generation therapies including gene editing that will help further study how other genetic diseases progress and how best to treat them.

    “We need to stop thinking about AHC as a rare disease and start thinking about it and other rare diseases as genetic disorders at large,” said Cathleen (Cat) Lutz, a JAX neuroscientist who led the work. “We’re not just studying specific disorders and their underlying disease mechanisms in isolation — we’re advancing therapeutic technologies that could eventually treat many genetic disorders associated with common neurological conditions.”

    A devastating disease

    AHC is a rare neurological disorder that typically begins during infancy, causing sudden episodes of paralysis that can last minutes or even days and may be accompanied by dystonia (muscle stiffness), eye movement issues, and developmental delays. Seizures are a significant and life-threatening component of the disease. There is currently no cure. While current treatments aid with symptom management, they have limited effectiveness.

    While AHC is often mistaken for epilepsy or stroke, it has distinct features and is linked to specific genetic mutations. Most cases are caused by two mutations in a gene called ATP1A3, which helps regulate electrical activity in the brain. Known as D801N and E815K, these mutations are top candidates for gene-editing and molecular therapy strategies the JAX team is exploring to prevent AHC early on.

    This new research revealed how the two separate mutations (though in the same gene) can cause distinct neurological outcomes. Mice with E815K mutations had more severe brain activity abnormalities, including epileptiform spikes, spreading depolarizations, and elevated neuroinflammation — mirroring the more severe seizure susceptibility seen in patients with this mutation. On the other hand, D801N mice experienced more frequent sudden deaths and stronger motor impairments, including dystonia-like episodes and impaired motor learning.

    The team also tracked levels of neurofilament light chain (NFL) in the blood, a neuron-specific protein that serves as a general blood biomarker of brain and neuronal health in humans and animal models. They found that specific AHC mutations lead to an increase of this biomarker that helps in developing biomarkers to monitor disease progression or treatment efficacy in patients.

    Because AHC may require mutation-specific treatment strategies, JAX scientists are currently working with other teams to correct AHC gene mutations in further studies using mice and human cells. The team is also exploring whether the mutations could be reversed after specific neurodevelopmental periods to determine the stage at which a gene-editing treatment is most effective.

    “AHC is a genetic disease and that opens the door to genome editing as a potential treatment, but before we can develop a therapy, we need to understand exactly how the disease works,” Lutz said. “These two new mouse models are a powerful step forward—they give us a way to study these two mutations in action, and more importantly, explore how to fix it in the future.”

    Research on behalf of patients

    The models were bred on a hybrid B6C3H genetic background that significantly reduced early death and fragility seen in earlier attempts to model the disease in mice. This allowed the team to validate their work using a wide range of brain activity, behavioral, and molecular tests to mirror the unpredictable and often frightening spells experienced by children with AHC. These include spontaneous and stress-induced neurological episodes that resemble seizures or muscle spasms triggered by temperature changes, excitement, and other environmental stressors.

    Until now, efforts to study the disease in mice were hampered by the animals’ fragility and high mortality, as mice often died spontaneously when scientists handled them. This made it difficult, if not impossible to test therapies on them, said Markus Terrey, a JAX neuroscientist who led the work. The new models allow scientists to mimic specific genetic mutations seen in children with AHC—offering the clearest picture yet of how the disorder progresses, and how it might be stopped.

    The research comes from JAX’s Rare Disease Translational Center, which focuses on bridging the gap between genetic research and clinical treatment by working closely with other scientific organizations, families, and patient foundations to drive therapies for rare diseases.

    “We are working with mice, and we are also doing the necessary research to advance therapeutics for patients and families by understanding, first and foremost, the science,” explained Lutz, who is the vice president of the Rare Disease Translational Center at JAX. “To do that, the patient families and the foundations are really at the center, at the heart of everything we do. We don’t just pick up journals and papers to decide what research we do. We’re really acting on behalf of the families and the patients, and we have a very close relationship with them.”

    Reference: Terrey M, Krivoshein G, Adamson SI, et al. Alternating hemiplegia of childhood associated mutations in Atp1a3 reveal diverse neurological alterations in mice. Neurobiol Dis. 2025;212:106954. doi: 10.1016/j.nbd.2025.106954

    This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. Our press release publishing policy can be accessed here.

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  • Anogenital high-risk HPV prevalence and screening considerations in female transplant recipients: a cross-sectional study | BMC Women’s Health

    Anogenital high-risk HPV prevalence and screening considerations in female transplant recipients: a cross-sectional study | BMC Women’s Health

    Between November 2019 and July 2021, 201 women were enrolled in the study. These included 98 kidney transplant recipients, 93 liver transplant recipients, and ten patients who received simultaneous kidney and liver transplantation. 65.2% of patients knew they were at increased risk for genitoanal cancers, and 77.6% knew cervical screening could reduce cancer risk. In addition, most patients (92.5%) reported regularly taking advantage of the cervical screening offer.

    HrHPV prevalence

    The baseline characteristics of the participants are shown in Table 1, which compares hrHPV positive and negative patients. Overall, 32 out of 201 (15.9%) patients tested positive for hrHPV at the cervical site. The anal hrHPV prevalence was 20.3% (40/197). No significant difference in cervical hrHPV prevalence was found between kidney and liver transplanted patients (see Table 2). The median age was 52 years (median 18–78), with cervical hrHPV-positive patients being, on average, eight years younger (p = 0.029). HrHPV prevalence declined with increasing age as shown in Fig. 1. However, the differences in cervical hrHPV prevalence across age groups were not statistically significant (p = 0.068), whereas anal hrHPV prevalence did show a significant difference across age groups (p = 0.038). When comparing individuals aged ≤ 45 years to those > 45 years, anal hrHPV prevalence was significantly higher in the younger age group (p = 0.020). In contrast, cervical hrHPV prevalence showed a non-significant trend towards higher rates in the younger group (p = 0.078).The median body mass index (BMI) was 23.4 in the cervical hrHPV-negative group and 21.4 in the cervical hrHPV-positive group (p = 0.030).

    Table 1 Baseline characteristics of the study population comparing cervical hr-HPV-positive and negative patients
    Table 2 Comparison of immunosuppressive treatment of liver transplant recipients, kidney transplant recipients and transplant recipients who received a simultaneous liver and kidney transplantation
    Fig. 1

    hrHPV = high-risk human papillomavirus

    Immunosuppressive treatment

    Overall, 97.5% of the patients were currently taking immunosuppressants, with most (75%) being on a calcineurin inhibitor (CNI) based immunosuppressive regimen consisting of more than two drugs. A comparison of immunosuppression and HPV risk factors is shown in Table 1. Neither the number of immunosuppressants nor the type of immunosuppression was significantly associated with hrHPV infection. Other transplant-specific variables, such as duration of immunosuppressive treatment, pretransplant immunosuppressant use, or graft rejections, did not correlate with hrHPV infection. A comparison of kidney and liver transplant recipients showed differences in immunosuppressive therapy (see Table 2). Compared to liver transplants, more kidney recipients took at least two immunosuppressants and had higher induction therapy rates (85.5% vs. 37%). However, cervical hrHPV prevalence showed no significant difference. Additionally, risk factors like sexual partners and age at first intercourse didn’t differ between kidney and liver recipients.

    Risk factors associated with increased HPV prevalence in the general population, i.e. sexual behaviour and younger age, are confirmed in transplanted patients in a multivariable logistic regression model, with adjusting for transplantation, nicotine use and age of first intercourse (see Table 3). HrHPV-positive women were, on average, one year younger at the time of first sexual intercourse (p = 0.025) and had more than twice as many sexual partners as HPV- negative patients (p < 0.001). Likewise, the number of sexual partners since the first transplant was significantly higher among hrHPV-positive patients (p < 0.001).

    Table 3 Multiple logistic regression of influencing factors on cervical HrHPV positvity

    HPV vaccination

    In total, 12.4% (25/201) of patients had prior HPV vaccination. Among them, 80% (20/25) were under 30, while only 2.9% (5/173) of those over 30 were vaccinated (p < 0.0001). Most patients were vaccinated before their first sexual intercourse (17/25), and six were vaccinated before transplantation. The number of vaccinated patients was higher among HPV-positive patients compared with HPV-negative patients (see Table 1). Three HPV-positive women were vaccinated after their first sexual intercourse and six after their transplantation.

    Follow-up

    The participation rate in the follow-up offered 6 to 18 months after the initial HPV test for cervical hr-HPV positive patients was 91%, with 29 out of 32 patients returning. The positive hr-HPV result was confirmed in 25 cases. In 52% (13/25), more than one HPV type was determined by genotyping. A total of 14 different HPV-Types with oncogenic potential were detected in the cervical site (HPV 16, 18, 31, 33, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73). High-grade squamous intraepithelial lesion (HSIL) was detected in four patients during follow-up in the dysplasia unit (1x CIN2, 2x CIN3, 1x VaIN3). Three out of four patients with precancerous lesions had normal pap smears (NILM).

    In anal swab specimens more than one HPV genotype was detected in 52.5% of patients, and 11 different high-risk oncogenic genotypes were identified (HPV 16, 18, 31, 39, 45, 51, 52, 56, 58, 59, 68). The most common HPV-types are shown in Fig. 2.

    Fig. 2
    figure 2

    * This refers to the number of tested patients; multiple HPV types can occur in a single patient. HPV = Human papillomavirus

    Anal and cervical co-infection

    For further investigation of co-infection in cervical hrHPV-positive patients, genotyping was performed at follow-up, whereas anal HPV testing involved genotyping at baseline and follow-up, and one positive test was considered sufficient for hrHPV positivity. All detected HPV types were included in the evaluation of co-infection, regardless of the time of examination. In patients with cervical hrHPV positivity, anal co-infection was detected in 68,8% (22/32), whereas in cervical HPV-negative patients, only 10.9% (18/165) had an anal hrHPV infection. In 18 of 23 patients, cervical and anal genotyping was available to compare HPV genotypes. Fifteen of these 18 patients were positive for more than one HPV type. There was a strong association at the HPV-specific level: 78% (14/18) of patients exhibited at least one concordant hrHPV type, while 22% (4/18) displayed different hrHPV genotypes. The highest concordance rate was found for HPV 16, with all 6 out of 6 patients (100%) showing a coinfection in the anal swab specimens.

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