The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review

Impact of Loop Electrosurgical Excision (LEEP/LLETZ) on the Quality of Sexual Life in Women of Reproductive Age-A Prospective Longitudinal Study

Background: Cervical cancer is one of the most common cancers in women worldwide, with the leading risk factor being high-risk human papillomavirus (HR-HPV); persistent HR-HPV infection leads to cervical dysplasia. With early screening and, if indicated, therapeutic strategies such as a loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ), morbidity and mortality in this population are decreasing. However, it is suspected that these procedures may have an impact on sexual dysfunction. Methods: In this single-center prospective longitudinal study, we recruited patients with a high-grade squamous intraepithelial lesion (HSIL) and HR-HPV-positive result and evaluated the impact of LEEP/LLETZ on their sexual life and psychological well-being. All participants received two questionnaires-the Female Sexual Function Index (FSFI) and the Brief Index of Sexual Function-Women (BISF-W)-after diagnosis, before treatment, and three months after the procedure. Results: A total of 40 women aged 28 to 55 years were enrolled. This study showed no significant changes in both the FSFI (F(1,39) = 0.774; p = 0.38) and BISF-W total scores (F(1,39). This study revealed that 32/40 (80%) of participants based on the FSFI either exhibited no change or improved sexual function. Only 3/40 (7.5%) mentioned sexual dysfunction after procedures. This study also found that the mean score for sexual function based on the FSFI was 2.80; p = 0.102. Conclusions: These findings suggest that patients who qualified for LEEP/LLETZ can be reassured that the anxiety they experience prior to treatment is not necessarily justified. This provides evidence of the safety of loop excision procedures in terms of sexual functioning after the procedure. Nevertheless, further studies are needed to analyze the potential risk factors that may contribute to adverse sexual outcomes and to achieve a better understanding of this complex problem.

Translation and psychometrics of the HPV impact profile in Iranian women

INTRODUCTION

The human papillomavirus (HPV) significantly impacts women's physical and psychological health, and there is a notable absence of specialized tools to assess its psychosocial effects comprehensively. The HPV Impact Profile (HIP) was developed to address this need. This study focuses on the translation and validation of the HIP for use among Iranian women.

METHODS

This methodological study was conducted among women diagnosed with HPV from May 2022 to July 2023. A total of 300 women participated by completing an online self-administered questionnaire. The HIP was translated into Persian following standardized procedures. The psychometric properties of the Persian version were evaluated through multiple validation methods: face validity (qualitative and quantitative), content validity (qualitative and quantitative), construct validity (exploratory factor analysis and confirmatory factor analysis), convergent and divergent validity, and reliability (Cronbach's alpha and McDonald's omega).

RESULTS

The original HIP consisted of 29 items. Following the translation process, the Persian version underwent rigorous psychometric validation. During the face validity assessment, no items were removed. However, during the content validity evaluation, 2 items were deleted, resulting in 27 items for further analysis. Exploratory factor analysis led to the removal of an additional 2 items, reducing the number to 25 items. Three factors were extracted, which collectively explained 81.65% of the total variance. Confirmatory factor analysis confirmed a good model fit, with all indices meeting the recommended thresholds. Reliability assessments demonstrated high internal consistency and stability, with Cronbach's alpha calculated at 0.932 and McDonald's omega at 0.996.

CONCLUSION

The Persian version of the HIP-25 exhibits strong psychometric properties, including high validity and reliability. It is a robust tool for assessing the quality of life among Iranian women with HPV, and it can be effectively utilized in clinical and research settings to better understand and address the psychosocial impacts of HPV.

Pidotimod plus recombinant human interferon α-2b suppository boosts HPV clearance in high-risk patients following loop electrosurgical excision procedure

OBJECTIVE

To assess human papillomavirus (HPV) negative conversion, vaginal microecological recovery, and serum inflammatory factor levels in patients with high-risk HPV infection treated with pidotimod (PDT) plus recombinant human interferon α-2b (rh-IFN-α2b) suppository after loop electrosurgical excision procedure (LEEP).

METHODS

A total of 97 patients with high-risk HPV infection who underwent LEEP from March 2020 to May 2023 were retrospectively selected. Among these cases, 45 treated with rh-IFN-α2b suppository were assigned as control group, while the other 52 treated with PDT + rh-IFN-α2b suppository were assigned as combined group. HPV negative conversion, side effects (fever, nausea, abdominal discomfort, and vaginal burning sensation), vaginal microecology recovery (vaginal pH, Nugent score), and serum inflammatory markers (interleukin [IL]-4, IL-12, and interferon [IFN]-γ) were compared between the two groups. Furthermore, univariate and multivariate analyses were performed to identify factors associated with failure to achieve negative conversion.

RESULTS

The combined group demonstrated a higher HPV negative conversion rate, treatment response rate, and vaginal microecological recovery rate (lower vaginal pH and Nugent score) compared to the control group. Also, post-treatment IL-4 levels were lower, while IL-12 and IFN-γ were higher in the combined group. The side effects in the two groups were similar. Univariate and multivariate analyses revealed that HPV type and treatment modality were associated with HPV negative conversion failure, but were not independent predictors.

CONCLUSIONS

PDT plus rh-IFN-α2b suppository can effectively improve HPV negative conversion, accelerate vaginal microecology recovery, and modulate serum inflammatory responses in high-risk HPV patients after LEEP.

Maternal human papillomavirus infection and offspring neurodevelopmental disorders

BACKGROUND

Human papillomavirus (HPV) infection can lead to multiple comorbidities in women, including mental health problems. However, few studies have examined the association between maternal HPV infection and the risk of neurodevelopmental disorders in their offspring.

AIM

We aimed to investigate the association between maternal HPV infection and risk of attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) among their offspring.

DESIGN AND METHODS

Data from the Taiwan National Health Insurance Research Database were used for analysis. Offspring of mothers with HPV infection were identified as the index group, and a demographic-matched group (offspring of mothers without HPV infection) was selected as the controls. The primary outcome was the risk of ADHD or ASD. Cox regression models with multiple adjustments were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

We included 7762 individuals in the index group and 31 048 in the control group. After adjusting for potential confounding factors, the index group had a higher risk of ADHD (HR: 1.39, 95% CI: 1.15-1.67) than the controls. Importantly, the risk remained significant when HPV infection was diagnosed either before (HR: 1.29, 95% CI: 1.05-1.59) or during pregnancy (HR: 1.79, 95% CI: 1.28-2.51). No increased risk of ASD was identified in the index group compared to the control group.

CONCLUSIONS

This study highlights the importance of preventing and treating HPV infection during and before pregnancy. Clinicians should be aware of the association between maternal HPV infection and ADHD in their offspring.

Enhancing Cervical Cancer Screening: New Diagnostic Methodologies, Triage, and Risk Stratification in Prevention and Treatment

Human papillomavirus (HPV) is a well-established etiological factor in the development of precancerous cervical lesions and cervical cancer. This narrative review synthesizes current evidence on the global prevalence, genotype distribution, and pathophysiological mechanisms of HPV infection, emphasizing regional epidemiological variations that influence prevention and treatment strategies. Particular attention is given to high-risk HPV genotypes, their role in carcinogenesis, and the impact of co-infections and the cervicovaginal microbiota on infection persistence and disease progression. Advances in diagnostic methodologies, including E6/E7 oncoprotein detection, DNA methylation, and microRNA-based assays, are examined in the context of improving screening accuracy and early detection. Furthermore, the review explores the psychological implications of HPV diagnosis and underscores the importance of integrating psychosocial support into clinical management. Given the challenges associated with screening coverage, the potential of self-sampling techniques, particularly in resource-limited settings, is discussed as a means to enhance accessibility and participation in cervical cancer prevention programs. By providing a comprehensive overview of these interrelated factors, this review highlights the necessity of a multidisciplinary approach that integrates novel diagnostic strategies, targeted prevention efforts, and supportive care to mitigate the burden of HPV-associated diseases.

Information-seeking Behavior of Iranian Young Adults (18-28 Years Old) Regarding HPV on Social Media: A Preventive Approach to HPV

Background

Health information-seeking behavior refers to individuals' targeted actions to satisfy their health information needs and search for relevant disease-related information. Nowadays, social media platforms provide a great opportunity for meeting health information needs and delivering preventive education regarding human papillomavirus (HPV). The purpose of this study is the information-seeking behavior of Iranian young adults (18-28 years old) regarding HPV on social media, a preventive approach to HPV.

Methods

The present descriptive-analytical study was conducted in 2023 among Iranian boys and girls aged 18-28 years. A multistage cluster sampling method was used to select 3840 participants. The data collection tool was Longo's Health Information-Seeking Behavior Questionnaire. The collected data were analyzed using the SPSS software.

Results

The results showed that Iranian youth aged 18-28 were more inclined to seek information on social media about the transmission routes and preventive measures for HPV. The primary informational need regarding transmission was "I want to know the main route of HPV transmission is through vaginal and anal intercourse?", and regarding prevention, it was "Can condoms prevent HPV infection?" Additionally, the findings indicated that young individuals sought information about HPV after their first sexual encounter. Most of the information needs of the youth were fulfilled through YouTube, Instagram, and WhatsApp, mainly in video format. Approximately 85.10% of the youth were satisfied with the information obtained from social media. The results revealed a significant and positive relationship between the health information needs of young adults (18-28 years old) in the area of HPV and personal factors. Gender, age, marital status, education level, history of HPV infection, and engaging is unprotected extramarital sex were identified as significant influential factors on the level of information needs of young individuals, especially regarding HPV preventive measures (P < 0.05).

Conclusion

Health authorities and disease control and prevention centers need to harness the potential of social media in meeting the informational needs of youth and providing education and awareness, especially concerning the transmission and prevention of HPV.

Comparative Study of 5-Aminolevulinic Acid-Mediated Photodynamic Therapy and the Loop Electrosurgical Excision Procedure for the Treatment of Cervical High-Grade Squamous Intraepithelial Lesions

The loop electrosurgical excision procedure (LEEP) is a common treatment for cervical intraepithelial neoplasia (CIN). Photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (ALA) is a non-invasive modality that has been used for treating precancerous diseases and HPV infections. This comparative study evaluated the efficacy and safety of ALA PDT and the LEEP in the treatment of cervical high-grade squamous intraepithelial lesions (HSILs). Patient records were reviewed and HSIL patients with HPV infections (24-51 years old) who underwent PDT or LEEP treatment were selected. Efficacy was analyzed blindly based on HPV-DNA, cytology, and colposcopy-directed biopsy obtained at 6 months after treatment. Treatment-related discomfort and side effects were also analyzed. Cure rates of 88.1% and 70.0% were achieved for the PDT group and LEEP group (p < 0.05), respectively. HPV-negative conversion rates of 81.0% and 62.0% were achieved for the PDT group and LEEP group (p < 0.05), respectively. The overall lesion remission rate of the PDT group was 19% higher than that of the LEEP group. The incidence of side effects was much lower in the PDT group. These results show that ALA PDT is a feasible non-invasive treatment for cervical HSIL.

A predictive model for residual lesions after LEEP surgery in CIN III patients

Background and aims

The residual lesions after Loop Electrosurgical Excision Procedure (LEEP) contributes to poor prognosis in patients with Cervical Intraepithelial Neoplasia Grade 3 (CIN3). The aim of this study is to establish an effective clinical predictive model for residual lesions in CIN3 patients after LEEP.

Methods

A retrospective analysis was performed on 436 CIN3 patients who underwent total hysterectomy within 3 months after LEEP. Based on the post-hysterectomy pathologic, the patients were divided into the no residual group and residual group. Clinical parameters were compared between the two groups, and univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for residual lesions in CIN3 patients after LEEP. Using R software, a nomogram model was established and its effectiveness was evaluated using calibration plots.

Results

There were 178 cases in the residual group and 258 cases in the no residual group. The two groups had no significant difference in general characteristics (p > 0.05). It was found that Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and the Gland involvement were independent risk factors for residual lesions in CIN3 patients after LEEP (all p < 0.05). The consistency index (C-index) of the nomogram model for predicting residual lesions was 0.975 (0.962-0.988).

Conclusion

The Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and Gland involvement are independent risk factors related to residual tissue after LEEP surgery in CIN3 patients. The constructed nomogram can effectively predict the presence of residual tissue after LEEP surgery in CIN3 patients and has good practical value.