In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This crosssectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged 21 years with lesions clinically suggestive of ICC. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin-embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPV-positive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551=570 women with ICC; squamous cell carcinoma was observed in 476=570 (83.5%) cases. The HPV-positivity rate in ICC cases was Key words: human papillomavirus, invasive cervical cancer, sub-Saharan Africa Abbreviations: ADC: adenocarcinoma; CI: confidence interval; DEIA: DNA enzyme immune assay; FIGO: federation of gynecology and obstetrics; HPV: human papillomavirus; ICC: invasive cervical cancer; LiPA 25 : line probe assay using 25 type-specific hybridization probes; SCC: squamous cell carcinoma; PCR: polymerase chain reaction Conflicts of interest: LD declares to have received institutional grants from GlaxoSmithKline group of companies and also declares to have received institutional grants from another pharmaceutical company (there is also one pending grant). Further, LD declares to have received payment for lectures and also receives royalties for a book chapter. IA declares to have received payment from GlaxoSmithKline group of companies for travel, food and accommodation and also declares to have served as a member of IDMC for other clinical studies. IA also has received payment for participating at a workshop. RA declares to have received payment from GlaxoSmithKline group of companies towards administrative and laboratory fees and also declares to have received payment for public lectures on cervical cancer. GD declares that her institution (University of Pretoria) received payments (direct and indirect costs) for including patients into the current trial as well as payments for travel for the purpose of meetings. TS declares to have received institutional grants, travel support and honorarium for lectures and articles written for the GlaxoSmithKline group of companies and other pharmaceutical companies; TS is also part of the HPV advisory board. LS declares to have received institutional grant. EW declares to have received payment from GlaxoSmithKline group of companies towards administrative and laboratory fees and travel support for this study. He also declares to have received payments for a cervical cancer advocacy project and for conducting a training ...

Cervical cancer remains an important cause of morbidity and mortality in South Africa (SA). [1] The age-standardised incidence rate of cervical cancer in southern Africa is approximately 27/100 000, [2] and most cases are diagnosed in late stages. Persistent infection with oncogenic human papillomavirus (HPV) is an essential step in the development of invasive cervical cancer. [3] HPV is highly infectious, but does not cause disease in all cases, and most individuals will clear infections. Since HPV is almost exclusively an epithelial disease, most transient HPV infections do not confer longterm immunity owing to a poor immune response. A national cervical cancer prevention programme was launched in SA in 2000, offering three Papanicolaou smears in a woman's lifetime, starting after the age of 30 at 10-year intervals, but has had limited success in reducing the incidence of HPV-associated disease. Some provinces in SA have fairly well-developed cytology screening services, but there is poor uptake of prevention services for cancer. Among women with abnormal cytology, there is also significant loss to follow-up after the initial screening test. [4] Since the introduction of effective HPV vaccines, a primary preventive strategy became available to combat the epidemic. Currently there are two vaccines registered in SA: the bivalent vaccine Cervarix, containing virus-like particles (VLPs) for HPV types 16 and 18, and the quadrivalent vaccine Gardasil, containing VLP antigens for HPV types 16 and 18 as well as non-oncogenic HPV types 6 and 11. VLPs are combined with an adjuvant, which leads to an improved immune response and long-term efficacy. Both vaccines have been extensively tested in large populations, and have also been found to be safe and immunogenic among African populations. [5] The bivalent HPV vaccine has also shown sustained immune responses in HIV-positive women, and was well tolerated. [6] Local reactions such as pain, swelling and redness can occur, as may systemic adverse events including fever, nausea, dizziness, fatigue, headache and myalgia. Cost-effectiveness studies have shown universal, femaleonly HPV vaccination before exposure to be an effective and economically viable option in developed countries. [7] Recently there has been increasing emphasis on the inclusion of low-and middle-income countries in the drive to reduce the global cancer burden. Evidence from qualitative studies suggests that South Africans will support introduction of HPV vaccination, but that education remains a key ingredient in any roll-out. [8] Adolescent health was identified as an area for development in the SA National Health Initiative Green Paper, with preventive health an important part of this plan. This focus is linked to a re-engineered primary healthcare plan and a newly developed school health programme (SHP). In May 2013, Dr Aaron Motsoaledi, national Minister of Health, announced during the health budget speech that: '... we shall commence to administer the HPV vaccines as part of our SHP ... '. This courage...

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to...