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The median age of the HR-HPV–positive patients was approximately 11 years younger than the HPV-negative group, and pregnant patients were also more apt to be HPV positive.
In cases diagnosed as ASCUS, there are certain cytologic features and patient types that are more likely to be associated with HR-HPV positivity.
In 2001, the ALTS trial demonstrated the effectiveness of high-risk human papillomavirus (HR- HPV) testing in the triage of patients with a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS). Certain behavioral, clinical and socioeconomic risk factors have been identified in association with HR-HPV infection and the development of cervical neoplasia.
The ALTS trial showed that the cytologic features associated with LSIL had a high correlation with HR-HPV positivity (83%). The correlation between HPV and the development of cervical neoplasia has been well established. Several studies have investigated additional methods of resolving ASCUS, but none have been met with widespread acceptance.
Certain nonclassical cytomorphologic characteristics are associated with positive HR-HPV–DNA status. Shew ML, Fortenberry JD, Tu W, Juliar BE, Batteiger BE, Qadadri B, Brown DR: Association of condom use, sexual behaviors, and sexually transmitted infections with the duration of genital human papillomaviral infection among adolescent women. Smith EM, Johnson SR, Jiang D, Zaleski S, Lynch CF, Brundage S, Anderson RD, Turek LP: The association between pregnancy and human papilloma virus prevalence.
Lu DW, Pirog EC, Zhu X, Wang HL, Pinto KR: Prevalence and typing of HPV DNA in atypical squamous cells in pregnant women. Schneider A, Meinhardt G, De-Villiers EM, Gissmann L: Sensitivity of the cytologic diagnosis of cervical condyloma in comparison with HPV-DNA hybridization studies.
Bollmann M, Bánkfalvi A, Trosic A, Speich N, Schmitt C, Bollmann R: Can we detect cervical human papillomavirus (HPV) infection by cytomorphology alone? Zhao FH, Forman MR, Belinson J, Shen YH, Graubard BI, Patel AC, Rong SD, Pretorius RG, Qiao YL: Risk factors for HPV infection and cervical cancer among unscreened women in a high-risk rural area of China. Viikki M, Pukkala E, Nieminen P, Hakama M: Gynaecological infections as risk determinants of subsequent cervical neoplasia. Saccomanno G, Saunders RP, Ellis H, Archer VE, Wood BG, Beckler PA: Concentrations of carcinoma or atypical cells in sputum. Presented as a poster at the 53rd Annual Meeting of the American Society of Cytopathology, San Diego, California, November 6, 2005. Financial Disclosure: The authors have no connection to any companies or products mentioned in this article. Smallpox vaccine evolved from variolation, a technique that was developed in China and the Ottoman Empire.
Focal and generalized folliculitis following smallpox vaccination among vaccinianaive recipients.
Neither the service provider nor the domain owner maintain any relationship with the advertisers. Fisher’s Exact test (2-tailed) was used to calculate the exact probability of obtaining results by chance. Atypical cells in greater numbers and in groups as opposed to single cells correlated more often with HR-HPV–positive individuals. Although certain criteria have been established for making this diagnosis, this determination remains very subjective and hence problematic. Additionally, this study assessed the utility of retrospective HPV-DNA testing on Pap test specimens as a method of evaluating individual and laboratory ASCUS reporting rates and performance improvement.
Cytology slides were retrospectively reviewed by 5 cytotechnologists (CTs) as part of a site-specific quality improvement indicator in the laboratory, and an information grid was completed on each case. Seventy-three cases (49%) were HR-HPV positive, 75 (51%) were negative; 2 were equivocal and excluded from the study. The average age of patients with a positive HR-HPV result was 28 years and of those with a negative result was 39 years.
The significant cytoplasmic changes in the HR-HPV–positive cases were koilocytelike changes and parakeratosis, as shown in Figures 5 and 6, respectively. Some evidence exists that atypical cells deserve even closer scrutiny in pregnancy as the risk of HPV infection may actually be increased.
ASCUS cases were positive for HR-HPV approximately 50% of the time.1 Various studies, including ours, suggest that it may be possible to further define the cytologic characteristics found in ASCUS that are most strongly associated with HR-HPV. A study by Schneider et al9 showed that the most significant correlation was with mild koilocytosis, mild hyperkeratosis, hyperchromatic nuclei, binucleation or multinucleation, and cleared cytoplasm.
Many studies have suggested that other infections, especially those involving the female reproductive tract, are also involved in the development of cervical neoplasia. A study utilizing this method found an association with increased DNA content and HR-DNA–positive ASCUS having similar biologic features as HSIL. These findings demonstrate acceptable individual and laboratory reporting rates and show that HR-HPV DNA testing can serve as a reliable tool for retrospective assessment of laboratory and individual reporting practices.
In particular, koilocytelike changes, parakeratosis and increased numbers of cells with these and other mildly atypical findings are most significant.
Diagnostic value of non-classic cytological signs of HPV effect in minimally abnormal Pap tests.
Steinman was Fellow in Cytopathology, and currently is Staff Pathologist, Department of Laboratory Medicine, UPMC Mercy Hospital, Pittsburgh, Pennsylvania. Mody is Medical Director of Cytopathology, The Methodist Hospital, and Professor, Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, Houston, Texas. Variolation involved the deliberate exposure of nonimmune persons to material taken from known smallpox victims. VIG therapy is contraindicated in patients with vaccinia keratitis.9VIG without thimerosal is now available and meets the same standards as intravenous immune globulin. Lost work time in excess of 24 hours and any need for hospitalization also should be reported. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
In case of trademark issues please contact the domain owner directly (contact information can be found in whois).
Koilocytelike changes and parakeratosis were more frequently associated with HR-HPV, but the presence of Trichomonas was usually a negative predictor.
Monitoring individual and laboratory ASCUS rates with HR-HPV positivity can be an important quality improvement indicator. First, the many variations in cellular abnormalities associated with ASCUS allows great differences in opinion between pathologists. In the negative cases, the significant changes were cell enlargement (both nuclear and cytoplasmic) and small halos (Figure 4). However, at the time of interpretation, the background information is limited to the patient age, menstrual status, significant past gynecologic history and hormonal status.


Smith et al5 compared 69 pregnant and 54 nonpregnant age-frequency–matched women for the presence of HR-HPV DNA. In our study, the most significant cytologic characteristics associated with HR-HPV–positive ASCUS were the presence of parakeratosis and koilocytelike changes (Figures 5 and 6).
This study also stressed that the total number of features was an important factor in distinguishing HPV-positive cases from HPV-negative cases. Samoff et al12 reported a relationship with HPV persistence and Chlamydia trachomatis infection, but not with Neisseria gonorrhoeae or Trichomonas vaginalis.
Additional disposable items would be required such as glass slides, test tubes, disposable pipettes, fixative vials and necessary reagents. The benefit of this particular method is in sorting HR-positive cases that may progress to invasive carcinoma from those that may resolve. Based on the deviation from the laboratory mean, certain thresholds could be set up and the rates monitored. Our study suggests that screening for these characteristics in the initial cytologic examination coupled with patient profiling can help select those cases needing a further workup. Lady Montague, the wife of the British ambassador to the Ottoman Empire, observed variolation firsthand and advocated use of the technique in England.
Patients with these diseases or a history of these diseases should not be vaccinated.Acute, chronic, or exfoliative skin conditions, including burns, impetigo, chickenpox, contact dermatitis, shingles, herpes, severe acne, Darier's disease (keratosis follicularis), and psoriasis.
The global eradication of smallpox: final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Since herpes infections tend to be recurrent, the antibody response will be maintained, but there is no specific number that would indicate whether it is a more recent or distant infection. Second, the current criteria do not distinguish cellular abnormalities that are more suggestive of HPV infection from those that are not. Seven different PTs signed out these cases, and the HR-HPV positivity rates of 6 were within 10% of the laboratory average HR-HPV rate, with 1 who was 20% higher. The focus of our study was to identify the cytologic characteristics and pertinent background information available at the time of interpretation, which would maximize the screening power of the Pap test in the most cost-effective and time-efficient manner. Additionally, many atypical cells, whether singly or in groups, and increased numbers of atypical groups of cells were also associated with increased incidence of HR-HPV (Table I). Another study, by Zhao et al,13 found no relationship between trichomoniasis and cervical neoplasia but did find a possible correlation with tuberculosis infection. While this technique is reportedly successful at sorting 60% of cases diagnosed as ASCUS into either LSIL or HSIL, it does involve additional cost, time and manpower. This technique may be useful after the diagnosis of HR DNA–positive ASCUS has been rendered, but with the additional cost incurred for this procedure, it is less desirable as a universal screening option. Individuals with significant departure from the laboratory mean or laboratories with significant departure from national reporting rates could trigger closer examination of their interpretive and reporting rates. Obtaining more patient information, such as smoking history, may be additional data to be used for future studies.
Smallpox vaccination carries some serious risks: approximately one in 1 million primary vaccinees and one in 4 million revaccinees will die from adverse vaccine reactions. In 1798, the British physician Edward Jenner used a milkmaid's lymph containing cowpox virus to vaccinate a child.1Over the next 150 years, smallpox vaccine became the most successful vaccine in history. Until these conditions clear, patients should not be vaccinated.Diseases or conditions that cause immunodeficiency or immunosuppression, including human immunodeficiency virus infection or acquired immunodeficiency syndrome, solid organ or stem-cell transplant, generalized malignancy, leukemia, lymphoma, agammaglobulinemia, and autoimmune diseases. Further information, including requests for VIG or cidofovir, can be obtained from the CDC Clinician Information Line (877-554-4625).
As of July 25, 2003, the CDC reported three cases of generalized vaccinia, 18 cases of autoinoculation, 21 cases of myopericarditis, three cases of ocular vaccinia, and one case of postvaccinial encephalitis. CDC clinician demonstrates the use of a bifurcated needle during the 2002 vaccinator workshop.
If the equivocal result becomes positive, you can say that there has been a recent HSV1 infection. I asked for the actual scorings and they said they didn’t have those (just Negative and Equivocal) but that they would like me to do another blood test in a couple weeks which I plan to do.
And finally, although reflex HR-HPV DNA testing is the preferred management option in the diagnosis of ASCUS, it does add an extra cost for the patient.
The grid consisted of patient information: age, pregnancy status as available on the requisition, cell morphology, cell patterns, original cytologic diagnosis by pathologist (PT) and CT, and quality control review diagnosis.
The average age of the pregnant patients was 31 years, with an age range of 16–35 years. Therefore, we used patient age and pregnancy status in our patient profiles because this information could be obtained from the specimen requisition form as it is a required field. Although increased numbers of atypical cells correlated with an increased incidence of HR-HPV infection, the converse did not prove to be true.
In contrast to these findings, a longitudinal cohort study performed by Viikki et al14 involving several different infectious agents showed that both T vaginalis and Herpes simplex were possible additional predictors of cervical neoplasia.
No information is given concerning cost-effectiveness as compared to reflex HR-HPV DNA testing.
Our study also affirms that HR-HPV DNA testing results can be used for retrospective analysis of laboratory and individual reporting practices and could be incorporated into the laboratory quality improvement program.
The most serious side effects of smallpox vaccine include progressive vaccinia, postvaccinial central nervous system disease, and eczema vaccinatum. Patients with these diseases or conditions should not be vaccinated.Treatments that cause immunodeficiency or immunosuppression, including radiation therapy, antimetabolites, alkylating agents, corticosteroids, chemotherapy agents, and organ transplant medications.
The drug is licensed for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. Only one patient received VIG.26The military experience through June 25, 2003 is notable for 36 cases of generalized vaccinia, one case of erythema multiforme, 48 cases of autoinoculation, 37 cases of myopericarditis, and one case of postvaccinial encephalitis. If the criteria used in the initial diagnosis of ASCUS could be better defined and made more specific, the Pap test might be a more powerful tool. For the 5 CTs who screened these cases, the original laboratory statistics for 4 were within 10% of the laboratory average, with the exception of 1 CT, who was 20% lower on the positive HR-HPV rate.
These findings suggest that hormonal or other effects of pregnancy may be associated with an increased risk of HPV infection. A study by Cecchini et al10 evaluated these same nonclassical findings and also found a significant association with HPV infections. Surprisingly, our study not only showed a lack of correlation but also a lower incidence of trichomoniasis in the HPV-positive group as compared with the HPV-negative group. Patients should not be vaccinated until they, or their household contacts, have been off immunosuppressive treatment for three months.Inflammatory eye diseases, including eye surgery and subsequent use of steroid eye drops. Cidofovir has in vivo and in vitro activity against vaccinia virus.8 Cidofovir never has been used to treat vaccinia virus infections in humans.
I just wanted to mention that the equivocal results taken in February and March both were positive HSV III IGM.


Nuclear enlargement was defined as a nucleus 2–3 times the size of an intermediate cell nucleus. The review done by CTs as part of this project would have upgraded 32% of the cases to low grade squamous intraepithelial lesions (LSIL) or ASC-H (ASC, cannot rule out HSIL) and downgraded 24% to NILM (negative for intraepithelial lesion or malignancy). In our study, the 25 pregnant patients (16%) were found to have a higher percentage of positive HR-HPV results than the other women in the study (75% and 25%, respectively, Table I).
This suggests that while increased numbers of atypical cells or groups of cells may increase suspicion for HR-HPV infection, fewer numbers of cells are not a reliable negative indicator.
In summary, the body of evidence for the correlation of specific infectious agents, particularly T vaginalis, and the development of cervical neoplasia is inconclusive at this point. Food and Drug Administration–approved method of processing cervical cytology specimens. These patients should not be vaccinated until the ocular condition is well controlled and they have not been using steroid eye drops for at least two weeks.Pregnancy, or plans to become pregnant in the next four weeks. This agent is reserved for the treatment of patients who do not respond to VIG or are near death.8 Cidofovir usually is given in a single intravenous dose of 5 mg per kg over 60 minutes. Koilocytelike changes were defined as changes in cells that had some cytoplasmic and nuclear features suggestive of koilocytes but were qualitatively short of a diagnosis of koilocyte.
Finally, 7 cases sent for HR-HPV testing were from the negative quality control rescreens as mandated under CLIA ’88. Hyperchromasia and nuclear enlargement were nonspecific findings in our study, while cells that demonstrated both nuclear and cytoplasmic enlargement were most often associated with HPV-negative cases.
You should have had an actual result listed on the test which would then be measured against this scale. They may represent an actual increase in infection, but the possibility that this is an age-related finding cannot be dismissed. Fishers’s Exact test (2-tailed) was used to calculate the exact probability of obtaining results by chance. Our study differed from these other studies in that we did not separate cytomorphologic characteristics according to HR vs.
The condition involves unchecked viral replication, with progressive necrosis leading to severe viremia, shock, and death. According to this, wouldn’t that mean that, were the test equivocal because I DO have it and the antibodies aren’t strong enough, it came from the most recent ex, who I last saw about 2 and a half months ago?
However, even in this study, the pregnant population had a 4.8% higher HPV-positive rate, but whether this increase is significant is not known.
10, then you would be in the equivocal range which is sort of a no mans land that doesn’t really tell you if you are truely positive or not and you would go back and get tested again. It seems as though, were I to have the virus, it would have shown up as positive if it were from anyone in my past. We also evaluated total number of cells with changes rather than total number of features present. 4) A positive IgG to herpes does not tell you when you acquired the infection, just that at some point you did.
According to this doctor, there’s a 50 chance that an equivocal HSV2 result is actually a negative. Subsequent reporting rates and HR-HPV positivity rates continue to be monitored as part of the laboratory’s quality improvement program. In contrast to the Bollmann study, we did not find that fewer cells or minimally abnormal Pap tests were reliable in ruling out a case for further triage.
When the results come back equivocal (four months out from last contact) , what is the ideal amount of time to wait before retesting? Infections with HSV types 1 and 2 can differ significantly in their clinical manifestations and severity. Your doctor may also use words like equivocal or inconclusive to describe this result (see below). In addition, the results of HSV type-specific IgG testing is sometimes used during pregnancy to identify risks of congenital HSV disease and allow for focused counseling prior to delivery. So now i am left with a real dilema, I actually do love this girl, she is the most amazing lady i have ever met, and i was planning on spending the rest of my life with her, however now with this bomb shell, I dont know what to do?
1 or 2 indicates previous exposure, and does not necessarily indicate that HSV is the causative agent of an acute illness. If you get a positive result from a viral culture then you can be very confident (95) that you have genital herpes. The ACIP advises against nonemergency use of smallpox vaccine in patients younger than 18 years or those older than 65 years.Breastfeeding.
Remember that direct testing means testing for the presence of the herpes virus whereas indirect testing checks for the presence of blood antibodies. It might mean your friend is screwed but that doesn’t make it wrong, sometimes people just get dealt a bad hand. In fact, the vast majority of occurrences of neonatal herpes result from a baby being kissed by someone who has just contracted coldsores.
Personally, I don’t think her test results will mean much, or allow me to resolve this, even if they do come back positive. I am concern about my HSV-1 IgM result, is it mean that i got oral herpes or is it only a false positive?
Patients typically present four to 30 days after vaccination with chest pain, electrocardiographic changes, elevated cardiac enzyme levels and, occasionally, abnormal echocardiograms. If alcohol is used to cleanse the vaccination site, the site must be allowed to dry completely before the vaccine is administered.6The bifurcated needle is held perpendicular to the skin and pressed rapidly into the skin three times for primary vaccination and 15 times for revaccination.
These are very technical questions and you can google all about the process as there is no time to explain it here. More commonly, a variety of nonspecific skin rashes, including erythema multiforme, may occur after smallpox vaccination.
Vaccinees are infectious from about the third day after vaccine receipt until the scab falls off, which may take three to four weeks.14Vaccinees should be educated not to touch the actual vaccine site or allow others to touch it. After intentional or accidental contact with the site, vaccinees should wash their hands with soap and water or an alcohol-based (more than 60 percent) hand rinse.11The vaccination site should remain covered, and the dressing should be changed every one to three days.
10 IV or greater Positive-IgG antibody to HSV type 1 glycoprotein G detected, which may indicate a current or past HSV infection. Contaminated dressings should be handled like infectious waste.11,14Vaccinees' clothing, towels, and bed linen should be kept separate from those of unvaccinated contacts. While vaccinees have no restrictions on food preparation or travel, they should avoid public swimming or bathing.11When health care workers are involved in patient care, they should cover their vaccination site with a semipermeable dressing and wear long-sleeved clothing to further reduce the risk of transmission.
Medical leave is not required unless a health care worker develops debilitating symptoms or is unable to adhere to the precautions described above.



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