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      Infección por virus del papiloma humano: asociación entre infección genital y bucal

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          Abstract

          Objetivo: Identificar las características de la infección por VPH en la cavidad bucal asociada a la infección por VPH genital. Ambiente: Servicio de Ginecología Maternidad "Concepción Palacios". Caracas. Métodos: Se estudiaron 60 pacientes con diagnóstico histológico de VPH genital a quienes se les realizó oroscopia, citología bucal y determinación viral por reacción en cadena de polimerasa (PCR) en boca y cérvix. Resultados: Se aisló el genotipo viral en la cavidad bucal en 48,33 % de las pacientes (29 / 60). Hubo concordancia entre la infección genital y bucal en 44,20 % de los casos. Los genotipos aislados más frecuentes fueron el 6 (71,43 %) y el 11 (22,86 %), solos o en combinación; solo hubo un caso con genotipo 16 (2,86 %). La concordancia entre el genotipo genital y bucal fue de 10,45 % (P=0,1547), sin embargo, cuando el genotipo aislado fue 6 la concordancia fue de 75,86 %. La citología de la cavidad bucal tuvo una sensibilidad de 3,5 % y una especificidad de 93,6 %. La oroscopia tuvo una sensiblidad de 27,6 % y una especificidad de 74,2 %. Conclusiones: Es frecuente la asociación entre infección por VPH genital y bucal. Tanto la citología exfoliativa de la boca como la oroscopia, son métodos diagnósticos poco sensibles y específicos.

          Translated abstract

          Objective: To describe the characteristics of HPV infection in the oral cavity associated with genital HPV infection. Setting: Service of Ginecology of the Maternidad "Concepcion Palacios". Caracas. Methods: 60 patients with histological diagnosis of genital HPV were studied with oroscopy, oral cytology and viral determination with polymerase chain reaction (PCR) in the mouth and in the cervix. Results: viral genotype was isolated in the oral cavity in 48.33 % of patients (29/60). There was concordance between genital and oral infection in 44.20 % of cases. Frequently isolated genotypes were 6 (71.43 %) and 11 (22.86 %), alone or in combination, there was only one case with genotype 16 (2.86.%). The concordance between genital and oral genotype was 10.45 % (p = 0.1547), but when isolated genotype was 6, the agreement was 75.86 %. The cytology of the oral cavity had a sensitivity of 3.5 % and a specificity of 93.6 %. The oroscopy sensitivity was 27.6 % and the specificity was 74.2 %. Conclusions: It is often an association between genital and oral HPV infection. Both exfoliative cytology of the mouth and the oroscopy have low sensitivity and specificity as diagnostic methods.

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          Most cited references66

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          Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance.

          (2003)
          This study was undertaken to compare alternative strategies for the initial management of a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS). A total of 3488 women with a community-based ASCUS interpretation were randomly assigned to immediate colposcopy, triage that was based on enrollment HPV DNA testing and liquid-based cytology at a colposcopy referral threshold of high-grade squamous intraepithelial lesion (HSIL), or conservative management based on repeat cytology at a referral threshold of HSIL. All arms included 2 years of semiannual follow-up and colposcopy at exit. Loop electrosurgical excision procedure was offered to women with histologic diagnoses of cervical intraepithelial neoplasia (CIN) grade 2 or 3 at any visit or persistent CIN grade 1 at exit. The study end point was 2-year cumulative diagnosis of CIN grade 3. The 2-year cumulative diagnosis of CIN grade 3 was 8% to 9% in all study arms. The immediate colposcopy strategy yielded 53.6% sensitivity for cumulative cases of CIN grade 3 diagnosed over 2 years. The human papillomavirus (HPV) triage strategy referred 55.6% of women and detected 72.3% of cumulative cases of CIN grade 3. A conservative management strategy of repeat cytology at the HSIL threshold referred 12.3% of women while detecting 54.6% of cumulative CIN grade 3. To compare triage tests, we re-estimated the performance of HPV and cytology in successfully referring women with underlying CIN grade 3 (ie, ignoring the insensitivity we discovered in colposcopically directed biopsies). A single enrollment HPV test identified 92.4% of the women diagnosed with CIN grade 3. Serial cytology, even at an ASCUS threshold, would have required two visits to achieve similar sensitivity (95.4%) and would have referred 67.1% to colposcopy. HPV triage is at least as sensitive as immediate colposcopy for detecting CIN grade 3 and refers about half as many women to colposcopy. Follow-up that used repeat cytology is sensitive at an ASCUS referral threshold but requires two follow-up visits and ultimately more colposcopic examinations than HPV triage.
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            Anuario de Mortalidad 2006

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              Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review.

              Liquid-based cytology is reported to increase the sensitivity of cervical cytology and the proportion of slides that are satisfactory for assessment, in comparison with conventional cytology. Although some countries have changed to liquid-based cytology for cervical screening, controversy remains. We reviewed the published work to assess the performance of liquid-based cytology relative to conventional cytology in primary studies assessed to be of low, medium, or high methodological quality. 56 primary studies were reviewed and assessed with strict methodological criteria. Liquid-based cytology and conventional cytology were compared in terms of the percentage of slides classified as unsatisfactory, the percentage of slides classified in each cytology category, and the accuracy of detection of high-grade disease. Data were examined for studies overall and in strata to examine the effect of study quality on results. The median difference in the percentage of unsatisfactory slides between liquid-based cytology and conventional cytology was 0.17%. Only one small study was a randomised controlled trial. The classification of high-grade squamous epithelial lesion varied according to study quality (p=0.04), with conventional cytology classifying more slides in this category than did liquid-based cytology in high-quality studies (n=3) only. In medium-quality (n=30) and high-quality studies, liquid-based cytology classified more slides as atypical squamous cells of unknown significance than did conventional cytology when compared with low-quality studies (n=17; p=0.05). Only four studies provided sufficient verified data to allow estimation of sensitivity and specificity and comparison of test accuracy. We saw no evidence that liquid-based cytology reduced the proportion of unsatisfactory slides, or detected more high-grade lesions in high-quality studies, than conventional cytology. This review does not lend support to claims of better performance by liquid-based cytology. Large randomised controlled trials are needed.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                og
                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                0048-7732
                September 2011
                : 71
                : 3
                : 164-173
                Article
                S0048-77322011000300004
                e1208bac-6569-4dff-8caa-2a2431c9b762

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                Human papillomavirus,Polymerase chain reaction,Oroscopy,Oral cavity,Virus papiloma humano,Reacción en cadena de polimerasa,Oroscopia,Cavidad bucal,Citología oral,Oral cytology

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