Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

ObjectiveTo compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. MethodsA Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). ResultsAt commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be ‘cost-effective’ vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective.ConclusionsHPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

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Objetivo: informar dos casos de tumor adenomatoide (TA) del tracto genital femenino y efectuar una revisión de la literatura, con énfasis en sus aspectos histopatológicos y diagnóstico diferencial.Presentación de los casos: se informan dos casos de TA del tracto genital femenino, diagnosticados mediante estudios histológicos y de inmunohistoquímica de piezas quirúrgicas. El primero corresponde a una paciente de 39 años que consultó por hemorragia uterina, a quien se le realizó diagnóstico clínico y ecográfico de miomatosis uterina, para el cual se le practicó histerectomía y cuyo estudio patológico demostró un tumor adenomatoide del cuerpo uterino. El segundo caso se presentó en una paciente de 26 años con masa de ovario izquierdo, cuyo material histológico fue remitido para consulta con diagnóstico inicial de tumor de seno endodérmico.Discusión: el TA es un tumor benigno de origen mesotelial, infrecuente en el tracto genital femenino, cuyo tratamiento sólo requiere cirugía conservadora. Su diagnóstico diferencial incluye tumores malignos primarios y metastáticos, tanto del cuerpo uterino como del ovario, que de acuerdo con su estado clínico, requieren para su manejo cirugía oncológica y quimioterapia y/o radioterapia complementarias.