The 2006 Consensus Guidelines reflect recent data from large clinical trials and advances in technology and are designed to assist clinicians of all subspecialties.
In this cross-sectional study, 53 cervicovaginal lavage samples (CVL) from 41 women were analyzed for the chemokines interleukin-8 (IL-8), regulated-on-activation normal T-expressed and secreted (RANTES) factor, and macrophage inflammatory protein-1alpha (MIP-1alpha) by enzyme-linked immunosorbent assay (ELISA). IL-8 was detected in 81% of CVL, whereas RANTES was detected in 32%, and MIP-1alpha in 15% of the CVL. The mean levels of IL-8, RANTES, and MIP-1alpha in positive samples were 396 pg/ml, 102 pg/ml, and 34 pg/ml, respectively. IL-8 levels correlated positively with IL-1beta and IgG in a subset of CVL samples. RANTES levels correlated positively with complement protein levels. Additionally, the levels of RANTES, but not MIP-1alpha, reached levels reported in previous studies of the effects of beta chemokines to inhibit HIV replication. These results suggest that measuring chemokines in CVL specimens can provide important information regarding immune responses in the genital tract.
Cervical cancer prevention guidelines are benchmarked to risk of cervical precancer. In younger age cohorts, vaccination against high-risk types of human papillomavirus (HPV) has reduced HPV 16/18 prevalence and cervical intraepithelial neoplasia. Lower prevalence of precancer will impair the sensitivity of cytology and colposcopy, but negative predictive value will rise. Training and skills maintenance will become more difficult as abnormalities become less common. Primary screening with HPV assays will become more attractive but will require HPV genotyping as most positive HPV tests will reflect non-16/18 infections with lower oncogenicity. Screening will begin later and will occur at longer intervals. Colposcopy and treatment thresholds will become more stringent. Historical data sets will become inappropriate for guidelines development. As women immunized using nonavalent vaccine reach screening age, these trends will become still more pronounced.
History and demographic information are inadequately sensitive for use in triage of women with borderline cytologic findings. Colposcopy or triage using human papillomavirus DNA tests remain indicated.
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