Association between torquetenovirus in vaginal secretions and infertility: An exploratory metagenomic analysis

PROBLEM

The association of viruses with infertility remains incompletely evaluated.

METHOD OF STUDY

Vaginal secretions from 46 women seeking treatment in the Center for Reproductive Medicine and Infertility at Weill Cornell Medicine were tested for viruses by metagenomic analysis by lab personnel blinded to all clinical data.

RESULTS

Torquetenovirus (TTV) was identified in 16 women, alphapapillomavirus in seven women and most were positive for bacteriophages. Twelve of the subjects were fertile and sought to freeze their oocytes for future implantation. These women were all negative for TTV. In contrast, 16 of the 34 women (47.1%) being treated for infertility were TTV-positive (p = .0035). Evaluating the women by cause of infertility, five of nine women (55.6%) whose male partner had inadequate sperm parameters and six of 14 women (42.9%) with defective ovulation were TTV positive (p = .0062 and p = .0171, respectively, vs. the fertile women). Alphapapillomavirus was identified in one (8.3%) fertile woman, five (35.7%) women with ovulation deficiency, and one (11.1%) woman with male factor infertility. These differences were not statistically significant. There were no differences in bacteriophage families or the presence of Lactobacillus phages between fertile or infertile women or between different causes of infertility. There was a negative association between TTV detection and Lactobacillus crispatus dominance in the vaginal microbiota (p = .0184), but no association between TTV detection and the presence of alphapapillomavirus or Candida species.

CONCLUSION

Detection of TTV in the vagina might be a biomarker for specific causes of infertility.

Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

BACKGROUND

Cervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause.

AIM

To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum).

DESIGN AND SETTING

Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019.

METHOD

Non-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50-64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening).

RESULTS

The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen.

CONCLUSION

HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.

The impact of HPV vaccination on the prevention of oropharyngeal cancer: A scoping review

INTRODUCTION

HPV-associated oropharyngeal cancer (OPC) has one of the most rapidly rising incidences of any cancer in high-income countries. HPV vaccination is being tested to prevent HPV-associated OPC.

OBJECTIVE

To determine the effect of Human Papilloma Virus (HPV) vaccination on the prevention of OPC in adults worldwide.

BASIC RESEARCH DESIGN

Scoping review conducted using PRISMA-ScR Checklist.

METHOD

An electronic literature search identified relevant records. Titles and abstracts were screened to assess eligibility by two researchers, and data from relevant full-text articles were extracted and synthesised.

RESULTS

Three-hundred-and-forty-three studies were identified, with eleven articles meeting the inclusion criteria. The most common study design was cross-sectional (n = 7), the most common location was the US (n = 6) and data collection periods spanned 2004 to 2020. One article found unvaccinated participants had a 19 times increased risk of developing OPC compared with those who had been vaccinated against HPV. The remaining papers showed that prevalence of HPV-vaccine-type oral infection was significantly lower in vaccinated participants than unvaccinated participants, with a reduction of oral HPV detection ranging from 72% to 93%. This reduction varied by sex.

CONCLUSIONS

There is evidence to suggest that HPV vaccination reduces oral HPV infection and decreases the incidence of HPV-associated OPC. There is substantial need for further research which directly examines the relationship between HPV vaccination status and subsequent OPC development.

Expression of Programmed Death Ligand 1 in Penile Cancer is of Prognostic Value and Associated with HPV Status

PURPOSE

PD-L1 (programmed death ligand 1) inhibits T-cell function and prevents tumor eradication. This is facilitated by PD-L1 positive tumor cells and PD-L1 positive immune cells, and can be prevented by anti-PD-1 (programmed death 1)/PD-L1 immunotherapy. In advanced penile cancer there is a need for new therapeutic strategies. We investigated PD-L1 expression in penile cancers and compared PD-L1 expression with disease specific survival, lymph node metastases at diagnosis and high risk HPV status in a large patient cohort.

MATERIALS AND METHODS

A total of 213 primary tumors were immunohistochemically stained for PD-L1 and scored for tumor (percentage), stroma (binary) and PD-L1 positive tumor infiltrating macrophages. Additionally, PD-L1 positive tumors were scored for expression pattern, that is diffuse or predominantly present at the tumor-stroma margin.

RESULTS

Staining was successful in 200 tumors, of which 75% were high risk HPV negative. Median followup was 62 months. Of 200 tumors 96 (48%) were PD-L1 positive (scored 1% or greater), of which 59 (62%) had a marginal expression pattern and 79 (82%) were high risk HPV negative (p = 0.03). Compared to PD-L1 negative tumors, the PD-L1 expression patterns had different prognostic values in the whole cohort as well as in the high risk HPV negative subgroup. On multivariable analyses a marginal expression pattern was associated with absent lymph node metastases (OR 0.4) while diffuse expression was associated with poor survival (HR 2.58). These results were more prominent in the high risk HPV negative subgroup (OR 0.25, HR 3.92).

CONCLUSIONS

PD-L1 was expressed in 48% of penile carcinomas and mainly in high risk HPV negative tumors. The pattern of expression was a prognostic factor as marginal expression was associated with absent lymph node metastases and diffuse expression was associated with poor survival.