Marie-Hélène Mayrand

Introduction and Hypothesis Perceived benefits are crucial for maintaining adherence to pelvic floor muscle training (PFMT). However, the timeline for expected responses and the factors influencing PFMT effectiveness remain unclear. Our study aimed to (1) determine when older women with urinary incontinence (UI) can expect a clinically important reduction in leakage from PFMT, and (2) identify factors associated with the time needed to achieve this reduction. Methods This is a pooled analysis from a randomized controlled trial supporting the non-inferiority of group-based versus individual PFMT. Participants included 362 older women with stress or mixed UI following a structured 12-week PFMT program, delivered in group sessions or individually. Primary Outcomes: Time to achieve minimal (50%) and incremental (70%) clinically important differences in weekly incontinence episodes were assessed using Kaplan–Meier estimates. Secondary Outcomes: Factors that potentially influenced treatment response, including age, body mass index, parity, comorbidities, UI duration, severity and type, pelvic floor strength, and PFMT delivery mode were analysed using ordinal logistic regression. Results A total of 328 (91%) women provided usable leakage report data. Median minimal and incremental clinically important differences were achieved by the 4th and 6th weeks of treatment. Improvements continued until the last treatment session. Age, UI duration, severity, pelvic floor strength, and group-based intervention were related to later treatment response. Conclusions In older women with stress or mixed urinary incontinence, a clinically significant reduction in leakage can be achieved by the 4th week of PFMT. Early PFMT intervention and post-treatment exercise adherence favours optimal outcomes. Trial Registration NCT02039830.

Background:Among women whose cervical specimens tested positive for high-risk human papillomaviruses (hrHPV) via the Hybrid Capture 2 assay in the Canadian Cervical Cancer Screening Trial (CCCaST), we assessed hrHPV genotype concordance between BD Onclarity HPV Assay and Roche's Linear Array, overall and stratified by hrHPV viral load. We also evaluated the performance of cytology, cytology combined with hrHPV genotyping (Onclarity assay) for HPV16/18 and non-HPV16/18 types, and hrHPV genotyping triage strategies for the detection of cervical intraepithelial neoplasia grade 2 or 3 and worse (CIN2+/CIN3+).Methods:Standard measures (expected agreement, agreement, and κ values) were used to compare Onclarity to the reference test, Linear Array. Twenty-four triage strategies were evaluated by calculating their sensitivities, specificities, and positive and negative predictive values for CIN2+ and CIN3+ detection.Results:Among 734 hrHPV+ samples tested, there was near perfect concordance irrespective of viral load between the Onclarity and Linear Array assays for the individual genotypes [human papillomaviruses (HPV) 16, 18, 31, 45, 51, 52] by Onclarity (κ values ranged from 0.92–0.98). Strategies with adequate specificity (>75%) and the highest sensitivities to detect CIN3+ among 617 women positive for hrHPV, were positivity to HPV16 and/or 31 (Sensitivity: 65.2%, Specificity: 76.9%) and HPV16 and/or 18 (Sensitivity: 58.7%, Specificity: 81.6%).Conclusions:While confirming the importance of HPV16, we found that HPV31 was comparable with HPV18 for the detection of CIN2/3+ in the triage of women positive for hrHPV.Impact:HPV31 may be an important genotype in the triage of women positive for hrHPV.

Supplementary Figure from Clinical Performance of the BD Onclarity Extended Genotyping Assay for the Management of Women Positive for Human Papillomavirus in Cervical Cancer Screening

Objectives: To compare topical imiquimod with CO ₂ laser therapy for the treatment of a first episode of vulvar high‐grade squamous intraepithelial lesions (vHSIL), to identify serious adverse effects of both treatment modalities, and to examine risk factors for treatment failure. Methods: This retrospective chart‐based cohort study included 47 patients initially treated with topical imiquimod or CO ₂ laser therapy between 2017 and 2021. The primary outcome was treatment failure, defined as the need for repeat treatment. Cumulative incidence curves were used to compare the probability of treatment failure over time by treatment group. Potential risk factors for treatment failure, including age, treatment type, lesion focality, and smoking, were examined using Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Results: Sixty‐six percent (31/47) of patients were initially treated with topical imiquimod and 34% (16/47) with CO ₂ laser. Both groups were similar in age, lesion focality, human papillomavirus vaccination, and smoking status. During a follow‐up of 62.3 person‐years, 52% (16/31) of patients treated with imiquimod and 56% (9/16) of patients treated with CO ₂ laser experienced treatment failure. Age over 52 years was associated with a higher risk of treatment failure (aHR 3.07, 95% CI 1.25–7.53). The association was positive but not significant for multifocal versus unifocal lesions and for smokers versus non‐smokers. No serious adverse effects were observed with either treatment modality. Conclusion: Topical imiquimod has similar efficacy and safety to CO ₂ laser therapy for initial the treatment of vHSIL. Older age is associated with an increased risk of treatment failure.

Human papillomavirus (HPV) can be vertically transmitted. Our objective was to measure the association between the mode of delivery and the detection of HPV in infants. We used data collected from pregnant women during the HERITAGE study. Self-collected vaginal samples from the first and third trimester were obtained for HPV testing. Specimens from oral, pharyngeal, conjunctival and anogenital mucosa were collected from infants 36–48 h after delivery and at 3 months of age. All samples were tested for HPV DNA by the Linear Array assay. Adjusted odd ratios (aOR) and 95% confidence interval (CI) were estimated using multivariate logistic regressions. From the 282 women revealed to be HPV-positive in both the first and third trimesters, 25 infants were born HPV-positive. The overall probability of transmission was 8.9% (25/282); 3.7% (3/81) in participants with a caesarean section and 10.9% (22/201) for those who delivered vaginally. Vaginal delivery increased the risk of HPV in infants compared to caesarean (aOR: 3.63, 95%CI: 1.03–12.82). Infants born after a caesarean with ruptured membranes were not at increased risk of HPV compared to infants born after an elective caesarean section with intact membranes (aOR: 1.31, 95%CI: 0.10–17.76). Our results support the hypothesis that transmission occurs mostly during the passage in the vaginal canal.

Recent evidence shows increased preterm birth risk with human papillomavirus-16 (HPV16) infection during pregnancy. This study aimed to measure the association between HPV16 viral load during pregnancy and preterm birth. We used data from participants in the HERITAGE study. The Linear Array assay was used for HPV DNA testing on vaginal samples collected during the first and third trimesters of pregnancy. The HPV16 viral load was measured with a real-time polymerase chain reaction. We used logistic regression to measure the associations between HPV16 viral load during pregnancy and preterm birth (defined as birth before 37 weeks of gestation). The adjusted odd ratios (aORs) and the 95% confidence intervals [CIs] were estimated with inverse probability treatment weighting of the propensity score. This study included 48 participants who tested positive for HPV16 during the first trimester of pregnancy. The aOR for the association between first-trimester HPV16 viral load (higher viral load categorized with a cutoff of 0.5 copy/cell) was 13.04 [95% CI: 1.58–107.57]). Similar associations were found using different cutoffs for the categorization of viral load during the first and third trimesters. Our findings suggest a strong association between a high HPV16 viral load during pregnancy and preterm birth, demonstrating a biological gradient that reinforces the biological plausibility of a causal association.

As Canadian provinces and territories prepare to transition to HPV-based primary screening for cervical cancer, failure to identify and address potential barriers to screening could hinder program implementation. We examined screening-eligible Canadians’ attitudes towards and knowledge of cervical screening. A nationally representative sample of screening-eligible Canadians (N = 3724) completed a web-based survey in the summer of 2022. Oversampling ensured that half of the sample were underscreened for cervical cancer (>3 years since previous screening or never screened). The participants completed validated scales of cervical cancer, HPV, and HPV test knowledge and HPV test and self-sampling attitudes and beliefs. Between-group differences (underscreened vs. adequately screened) were calculated for scales and items using independent sample t-tests or chi-square tests. The underscreened participants (n = 1871) demonstrated significantly lower knowledge of cervical cancer, HPV, and the HPV test. The adequately screened participants (n = 1853) scored higher on the Confidence and Worries subscales of the HPV Test Attitudes and Beliefs Scale. The underscreened participants scored higher on the Personal Barriers and Social Norms subscales. The underscreened participants also endorsed greater Autonomy conferred by self-sampling. Our findings suggest important differential patterns of knowledge, attitudes, and beliefs between the underscreened and adequately screened Canadians. These findings highlight the need to develop targeted communication strategies and promote patient-centered, tailored approaches in cervical screening programs.

The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.