[Background and Objectives] Women with autoimmune inflammatory rheumatic diseases (AIIRDs) are more vulnerable to human papillomavirus (HPV) infection and HPV-related cervical cancers, however, the HPV screening and vaccination rate was low. We conducted a real-world survey to evaluate the awareness and status of HPV vaccination in Chinese AIIRDs patients. [Methods] Female patients with AIIRDs aged ≥ 9 years were enrolled between 1 April 2024 and 31 Aug 2024. Eligible participants completed a predefined 41-item questionnaire, which was distributed via social media invitations and in-person recruitment at outpatient clinics. We evaluated the demographics, rheumatic disease history, awareness of HPV infection and vaccination, HPV testing and vaccination status and willingness to receive HPV vaccine These factors were then compared between SLE and RA patients. [Results] A total of 562 participants with a median age of 34.9 (IQR 29.7–42.6) years completed the questionnaires. The awareness rates of HPV infection and vaccination were 82.0% and 85.9%, respectively. However, only 69.2% participants recognized the increased risk of cervical cancer associated with HPV, and just 52.3% had undergone cervical cancer screening in the past 5 years. Although 72.2% expressed willingness to receive the HPV vaccine, the actual vaccination rate was only 23.0%. Among the respondents, there were 334 SLE patients and 98 RA patients. Compared to RA patients, SLE patients were younger, had higher awareness of HPV vaccination, but a lower vaccination rate. [Conclusion] Patients with AIIRDs, SLE in particular, demonstrate high awareness of HPV infection and vaccination, as well as strong willingness to receive HPV vaccine. However, cervical cancer screening and actual HPV vaccination rates remain low.

BACKGROUND:The paradigm of cervical cancer screening is undergoing a significant global shift. Meanwhile, China has been advancing its national immunization strategy for human papillomaviruses (HPV). However, large-scale, real-world epidemiological studies that systematically characterize the distribution of HPV genotypes across various cervical cytological findings remain limited. This study aims to evaluate the prevalence and genotype distribution of HPV infection in China over the past five years and to assess the epidemiological patterns across different cervical cytology grades, which may inform the optimization of screening protocols and vaccination policies in the Chinese population. METHODS:De-identified data from 1,191,312 women aged 20-79 years undergoing routine co-testing for HPV genotypes and cervical cytology across 26 provinces in China from January 2020 to December 2024 were analyzed. Cervical exfoliated cell samples were collected and tested for 23 HPV genotypes using the same DNA test kit and liquid-based cytology test under the same procedure. HPV genotypes were classified based on cervical cancer risk: high-risk (HR-HPV) and low-risk (LR-HPV). Cervical cytology categories were classified as negative for intraepithelial lesion or malignancy (NILM), and atypical squamous cells of undetermined significance or worse (ASC-US+). Weighted prevalence of HPV infection was standardized by age group and province. The distribution of HPV genotypes was stratified by cytology grades. RESULTS:The overall weighted prevalence of any-type HPV infection was 17.0% (95% CI: 16.8-17.3%), with HR-HPV at 13.1% and LR-HPV at 6.0%. Regarding regional variations, women from the northeastern and northwestern regions exhibited the highest prevalence of any-type HPV infection and HR-HPV infection. The most prevalent HPV genotypes were HPV 52 (3.36%), HPV 16 (2.56%), and HPV 58 (2.46%). And the most common co-infection pairs were HPV 52-HPV 53, HPV 16-HPV 52, HPV 16-HPV 58. HPV infection prevalence increased significantly with cytological abnormality, from 11.4% in NILM to 73.0% in ASC-US+. HPV infection in the NILM group showed a bimodal age distribution, with prominent peaks observed in the 20-24 and 60-64 years. Notably, a U-shaped distribution was seen for HR-HPV in women with ASC-US+. The genotype distribution shifted from dominance by HPV 52 and 58 in the NILM group to HPV 16 in the ASC-US+ group. CONCLUSION:This nationwide study indicates a considerable burden of HPV infection in China, distinguished by the prominent prevalence of genotypes HPV 52 and HPV 58 in addition to the globally dominant HPV 16. Dynamic changes in the prevalence and genotype distribution of HPV infection across cytology grades suggest the importance of genotype-specific risk stratification in cervical cancer prevention strategies. These findings provide evidence supporting the implementation of national HPV vaccination and cervical cancer screening programs in China.

NECESSITY AND SIGNIFICANCE OF ESTABLISHING GUIDELINES FOR CERVICAL CANCER PREVENTION AND TREATMENT IN CHINA Cervical cancer remains a significant threat to the health and lives of Chinese women.In 2022 alone,national cancer registry data reported 150700 new cervical cancer cases and 55 700 deaths,with a global age-standardised incidence rate of 13.83/100 000 and a mortality rate of 4.54/100 000,repre-senting 6.58％and 5.89％of all female cancer cases and deaths,respectively.

Cervical cancer is one of the main malig-nant tumours threatening women's health.In 2022,there were 661000 new cases and 348 000 deaths from cervical cancer world-wide.1 In China,there were about 150 700 new cases and 55 700 deaths from cervical cancer in 2022.

What is already known about this topic?:Previous studies have indicated a possible association between reproductive tract infections (RTIs) and high-risk human papillomavirus (HPV) infection, but the evidence is still inconclusive.What is added by this report?:This multicenter study found significantly higher positive rates of HPV, including general HPV, high-risk HPV, and HPV 16/18 infections, among women who tested positive for single or multiple RTIs compared to women who tested negative for RTIs in gynecological outpatient clinics.What are the implications for public health practice?:Infection with HPV, especially high-risk types, is linked to RTIs and imbalances in the vaginal microbiota. Implementing standardized protocols for identifying and treating RTIs could support the establishment of a healthy vaginal microenvironment. This, in turn, may offer a novel approach to preventing cervical cancer.

INTRODUCTION Anal high-grade squamous intraepithelial lesion(HSIL)refers to the precancerous lesions of anal squamous cell carcinoma(ASCC).Anal cancer is often asymptomatic in its early stage,and most of the disease is found in advanced stage with poor prognosis.In recent years,the incidence of anal cancer has been increasing worldwide,1-3 drawing more attention to the precancerous condi-tion of anal intraepithelial neoplasia(AIN).

Background To investigate the prevalence of common sexually transmitted infections (STIs) and the association of STI/human papillomavirus co-infection in young and middle-aged women with previous abnormal cervical findings referred for colposcopy. Methods 719 cervical-swab cytobrush specimens were obtained from women aged ≤ 50 years who were referred for colposcopy at Peking University First Hospital due to previous abnormal cervical findings. HPV 21 typing and a panel of pathogenic STIs were tested for using the 21 HPV GenoArray Diagnostic Kit (HBGA-21PKG; HybriBio, Ltd., Chaozhou, China) and a nucleic acid STI detection kit (HybriBio Ltd. Guangzhou, China), after which colposcopy with multipoint positioning biopsy was performed. Results The overall prevalence of STIs among HPV positive women with previous abnormal cervical cancer screening results was 63.7% (458/719), with Ureaplasma parvum serovar 3, Ureaplasma parvum serovar 6 and herpes simplex virus type 2 having significantly higher prevalence among high-risk HPV positive patients (19.3%, Χ 2 = 5.725, P = 0.018; 21.5%, Χ 2 = 4.439, P = 0.035; 5.7%, Χ 2 = 4.184, P = 0.048). Among patients positive for the high-risk human papillomavirus, the prevalence of Neisseria gonorrhoeae infection in human papillomavirus 16/18 positive patients was significantly higher than that in other patients (2.5%, Χ 2 = 4.675; P = 0.043). Histopathologically, Chlamydia trachomatis infection was more frequently detected in lower than or equal to low-grade squamous intraepithelial lesion infection status (13.0%, Χ 2 = 3.368; P = 0.041). Conclusions The high prevalence of HPV coinfection with other sexually transmitted pathogens, particularly Ureaplasma parvum serovar 3, Ureaplasma parvum serovar 6, and herpes simplex virus type 2, calls for routine STI screening and effective STI prevention and management in patients with abnormal cervical cancer screening results.

OBJECTIVE:To evaluate HPV-negative cervical high-grade precancerous lesions or cancer in China.METHODS:Histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were searched in a multicentric clinical study. All patients underwent cobas HPV testing, liquid-based cytology, DNA ploidy analysis, and colposcopy-guided biopsy. According to clinical practice, patients underwent p16ink4a staining and cone biopsy. Comparisons were made between HPV-negative and -positive patients for clinical characteristics.RESULTS:The study found 61 cases of cobas HPV-negative CIN2+ among 797 cases of histologically confirmed CIN2+, including 38 CIN2, 20 CIN3, and 3 invasive cancers. The prevalence of HPV-negative CIN2+ and CIN3+ was 7.7% (95% confidence interval [CI] 5.8-9.5) and 5.7% (95% CI 3.5-8.0), respectively. Among 24 cases with p16 staining, 20 showed p16 positivity. The proportions of normal or minor abnormalities in terms of colposcopy, cytology, and DNA ploidy were higher in HPV-negative cases than in HPV-positive cases. When adding cytology to the screening of symptomatic or previously HPV-positive women, the prevalence of HPV-negative CIN2+ or CIN3 would decrease by approximately 50%.CONCLUSION:Less than one-tenth of CIN2+ are missed by HPV-only screening, and they have smaller lesions than HPV-positive cases. Colposcopy should be considered for symptomatic or previously HPV-positive women with HPV-negative results.

What is already known about this topic?:The effective implementation of cervical cancer examination programs requires improved cervical cancer screening coverage and quality. What is added by this report?:The detection rate of ≥high-grade squamous intraepithelial lesions (HSIL) in 6 hospitals was 19.6%. Not having undergone screening in the last 5 years and abnormal screening results had a negative association with detection of ≥HSIL, and abnormal screening results would increase the risk of detection by 75% compared with normal screening results. Additionally, low-grade, high-grade, and cancer of colposcopic impression were associated with a higher risk for detecting ≥HSIL. What are the implications for public health practice?:It is essential to disseminate health knowledge about cervical cancer control to women in order to increase their awareness and screening rates. Additionally, it is necessary to further strengthen the training of professional staff to improve the quality of cervical cancer prevention, including screening, colposcopic examination, and follow-up for target female populations.

世界卫生组织(WHO)在2020年向世界发出加速消除子宫颈癌的全球战略,实现该目标,需要在2030年达到"90-70-90"的目标[1].其中提出对90％确诊为癌前病变的女性要做到规范治疗.因此,不仅要推动人乳头瘤病毒(HPV)疫苗的接种和积极扩大子宫颈癌筛查的覆盖面,更重要的是如何实现对子宫颈上皮内病变进行规范的精细化管理.现提出子宫颈上皮内病变管理中需要注意的难点.

IntroductionHuman papillomavirus (HPV) infection, especially persistent high-risk HPV, is associated with cervical cancer. Female reproductive tract microecological disorders and lower genital tract infections have been increasingly correlated with HPV infection and cervical lesions. Due to their common risk factors and transmission routes, coinfection with other sexually transmitted infections (STIs) has become a concern. Additionally, the clinical significance of Mycoplasma subtypes appear to vary. This study aimed to assess the correlations between common STIs and HPV infection, and to investigate the clinical significance of Mycoplasma subtypes.MethodsWe recruited 1,175 patients undergoing cervical cancer screening at the Peking University First Hospital gynecological clinic from March 2021 to February 2022 for vaginitis and cervicitis tests. They all received HPV genotyping and detection of STIs, and 749 of them underwent colposcopy and cervical biopsy.ResultsAerobic vaginitis/desquamative inflammatory vaginitis and STIs (mainly single STIs) were found significantly more often in the HPV-positive group than in the HPV-negative group. Among patients with a single STI, rates of infection with herpes simplex virus type 2 or UP6 in the HPV-positive group were significantly higher than in the HPV-negative group (ORadj: 1.810, 95%CI: 1.211–2.705, P=0.004; ORadj: 11.032, 95%CI: 1.465–83.056, P=0.020, respectively).DiscussionThrough detailed Mycoplasma typing, a correlation was found between different Mycoplasma subtypes and HPV infection. These findings suggest that greater attention should be paid to detecting vaginal microecological disorders in those who are HPV-positive. Further, lower genital tract infections, including both vaginal infections and cervical STIs, are significantly more common among women who are HPV-positive and who thus require more thorough testing. Detailed typing and targeted treatment of Mycoplasma should become more routine in clinical practice.

Background This study aims to evaluate the value of p16 INK4a immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus-negative patients in Beijing, China. Methods In this study, we evaluated the value of p16 INK4a immunostaining, as well as cytology and colposcopy, for predicting high-grade squamous intraepithelial lesions (HSIL) in human papillomavirus (HPV)-negative patients by comparing the methods with the haematoxylin and eosin (H&E) staining pathological diagnosis of HPV-negative patients. Results Of 122 patients negative for the high-risk HPV (hrHPV) subtype, 26 (21.3%) underwent colposcopically directed multiple punch cervical biopsies with H&E pathological diagnoses of HSIL and above (HSIL+), 11 patients (9.0%) had cervical intraepithelial neoplasia (CIN)2, nine patients (7.4%) had CIN3 and six patients (4.9%) had infiltrating carcinomas. Cytology, colposcopy and p16 INK4a immunostaining had 52.4%, 38.5% and 92.3% sensitivity, respectively, and 76.2%, 94.8% and 99% specificity, respectively. The positive predictive value of the cytology, colposcopy and p16 INK4a immunostaining was 31.4%, 66.7% and 96%, respectively, and the negative predictive value was 88.5%, 85.1% and 97.9%, respectively. Compared with H&E staining, the kappa of the cytology, colposcopy and p16 INK4a immunostaining was 0.327, 0.323 and 0.926, respectively. Conclusion Positive p16 INK4a immunostaining is very strongly consistent with an H&E diagnosis of CIN2+, and it can be used as an objective detection index for HSIL+ diagnoses of HPV-negative patients with CIN2+.

目的 了解高海拔欠发达地区部分女性对人乳头瘤病毒(HPV)和HPV疫苗的认知情况,以及主要影响接种HPV疫苗的因素,为更好地开展HPV疫苗接种、预防子宫颈癌的发生提供参考依据.方法 于2019年1-11月选取青海西宁和玉树州的206例女性进行问卷调查,收集资料,了解其对HPV以及HPV疫苗的认知情况,并对影响调查对象认知的主要因素进行分析.结果 206例调查者中,66.50％的女性听说过HPV,13.11％的女性没有听说过;52.43％的女性听说过HPV疫苗;43.20％的女性没有听说过HPV疫苗.结论 高海拔地区部分女性对HPV知识及HPV疫苗的知晓率偏低,这与地区差异、文化程度、经济状况等均是影响因素.应加强宣传指导,普及相关知识,提高子宫颈癌的一级预防,降低子宫颈癌患病率.

BACKGROUND Cervical squamous cell carcinoma (SCC) is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion (HSIL). Usually, the cancer metastasizes through lymphatic or hematogenous dissemination, but rarely spreads upward into the uterus. Here, we report a case of cervical HSIL extending into the endometrium and finally progressing to SCC in the uterine cavity. CASE SUMMARY A 57-year-old postmenopausal woman visited our department and requested a routine cervical check-up. Four years ago, she had undergone a cervical loop electrosurgical excision procedure because of HSIL found during the gynecological examination, and she had not been checked again since. This time, a relapse of the cervical HSIL was diagnosed along with uterine pyometra and endometrial polyps. After 2 wk of antibiotic treatment, a laparoscopic hysterectomy was performed, and the final pathological examination revealed that the cervical HSIL had spread directly upward into the uterine cavity, gradually developing into cervical SCC in the endometrium. CONCLUSION Cervical HSIL/SCC can directly spread upward into the uterus with the most common symptoms of pyometra and cervical stenosis. More attention should be given to the early detection and prevention of this disease.

What is already known about this topic?:Human papillomavirus (HPV) type-specific strategies play a key role in the prevention of cervical intraepithelial neoplasia (CIN), but evidence on the HPV type-specific prevalence in CIN is limited.What is added by this report?:This multicentric study estimates the prevalence of high-risk HPV types in CIN cases and the associations of HPV infection patterns with high-grade CIN in China in 2017-2018.What are the implications for public health practice?:Population-based prevention strategies should give preference to HPV-16 and 18, and strategies for non-16/18 high-risk HPV are essential for the elimination of cervical cancer.

BackgroundThis study aimed to explore the cluster patterns of cervical cancer screening strategies for detecting high-grade precancerous lesions in terms of benefits, costs, and efficiency.MethodsA total of 2,065 referral women aged 25–64 years were recruited and underwent human papillomavirus (HPV) testing, liquid-based cytology with manual reading, and cytology with artificial intelligence (AI)-assisted reading. All women were assessed by colposcopy and histological examination. We formed 14 screening strategies based on primary cytology screening, primary HPV screening incorporating HPV-16/18 genotyping triage, cytology triage, or both, and co-testing. The primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+). The hierarchical clustering method was applied to multifaceted indicators, and then, the resulting clusters were described in terms of benefits, costs, efficiency, and their interaction. This study was registered (No. ChiCTR2000034131).ResultsThe relative sensitivity of HPV-based strategies compared with cytology alone with the threshold of LSIL+ ranged from 0.68 to 1.19 for CIN2+ detection and from 0.72 to 1.11 for CIN3+ detection, whereas the relative specificity ranged from 0.55 to 1.43 for CIN2+ detection and from 0.51 to 1.51 for CIN3+ detection. Five significant clusters according to the trade-off among benefits, costs, and efficiency were identified. The cluster including four primary HPV screening strategies showed the optimal balance. HPV testing with HPV-16/18 genotyping and AI-based cytology triage presented the optimal trade-off for CIN3+ detection relative to cytology alone in terms of relative sensitivity (1.06), relative specificity (0.72), colposcopies for 1 CIN3+ (3.7 vs. 3.1), a load of follow-up for women with HPV-positive and normal cytology (7.0% vs. 22.3%), and the work of manual cytology reading (35.1% vs. 100%).ConclusionsOur study provided clinical and methodological evidence on the choice of HPV-based screening strategies. The cluster including primary HPV screening with genotyping and cytology triage showed an optimal balance among benefit, cost, and efficiency.

目的 探讨≥50岁子高级别鳞状上皮内病变(HSIL)及以上病变(HSIL+)患者子宫颈锥切术后宫颈管搔刮术(ECC)在预测HSIL+残留/复发中的作用.方法 回顾性分析2013年1月至2019年12月在北京大学第一医院≥50岁行子宫颈锥切术,且在锥切术后行ECC,并有至少6个月随访结果的151例患者的临床资料,分析锥切术后ECC预测HSIL+残留/复发的作用.结果 151例患者中,锥切术后HSIL+残留/复发率为13.91％(21/151),其中切缘阴性者为7.27％(8/110),切缘阳性者为31.71％(13/41),二者比较,差异有统计学意义(P=0.00);锥切术后ECC阴性患者HSIL+残留/复发率为6.35％(8/126),阳性患者为52.00％(13/25),二者比较,差异有统计学意义(P=0.00);在切缘及锥切术后ECC双阴性患者、任一阳性患者、双阳性患者中HSIL+残留/复发率分别为4.00％(4/100)、22.22％(8/36)和60.00％(9/15),三者比较,差异有统计学意义(P=0.00).在切缘阴性及切缘阳性患者中,锥切术后ECC阴性与阳性者HSIL+残留/复发率比较,差异均有统计学意义(P=0.00及P=0.01);在锥切术后ECC阴性及阳性者中,切缘阴性与阳性者HSIL+残留/复发率比较,差异均无统计学意义(P=0.06及P=0.43).结论 ≥50岁女性子宫颈HSIL锥切术后ECC阳性者中HSIL+残留/复发风险极高,应加强管理.

子宫颈高级别上皮内病变是子宫颈癌的前驱病变,包括子宫颈高级别鳞状上皮内病变、原位腺癌.对高级别上皮内病变的规范管理是子宫颈癌二级预防的重要内容.中国优生科学协会阴道镜和宫颈病理学分会(CSCCP)专家组结合国内外最新进展和中国国情,制定了本共识,共识中阐释子宫颈高级别上皮内病变的定义、转归、阴道镜评估的意义、治疗方法、管理流程、治疗后的管理、术后并发症的处理及子宫颈病变治疗后HPV疫苗接种的相关问题等,规范子宫颈高级别上皮内病变的管理,以便对临床医师起到指导作用.

适龄妇女定期子宫颈癌筛查,并对筛查异常者进行进一步管理,最大限度地检出及治疗子宫颈.癌前病变,是预防子宫颈浸润癌的首要目标.但在临床上管理筛查异常者时,需对筛查低级别异常及高级别异常实施分层管理,由此产生的复杂性可能会导致临床医生管理认识上的混乱[1],往往存在着对低级别异常者管理过度或对高级别异常者管理不足问题,均不利于子宫颈癌的防控.