Downloaded from http://sti.bmj.com/ on June 1, 2015 - Published by group.bmj.com
Epidemiology 14
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Centers for Disease Control and Prevention. Gonoccocal Isolate Surveillance Project (GISP) Protocol. Updated July 2010. http://www.cdc.gov/std/gisp/ GISP-Protocol07-15-2010.pdf (accessed 25 Nov 2013). Monteiro EF, Lacey CJN, Merrick D. The interrelation of demographic and geospatial risk factors between four common sexually transmitted diseases. Sex Transm Infect 2005;81:41–6. Public Health England. Gonoccocal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan for England and Wales: Informing the Public Health Response. February 2013. http://webarchive.nationalarchives.gov.uk/ 20131210195211/http://www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/ 1302GonoccocalResistancetoAntimicrobialsSurveillance/ (accessed 25 Sep 2014).
LETTER
Anogenital preinvasive and invasive lesions in the Limpopo Province of South Africa Anogenital preinvasive and invasive lesions are known to have been on the increase in the industrialised world since the 1970s.1 The increase in anal squamous cell carcinomas and Kaposi’s sarcomas (KS) has often been associated with the HIV epidemic, especially among men having sex with men. KS and non-Hodgkin’s lymphoma are virusrelated (KS-associated herpes virus and Epstein–Barr, respectively) AIDS-defining illnesses.2 Among anogenital cancers, only cervical cancer is listed as AIDS-defining illness. A large proportion of anogenital preinvasive and invasive lesions are human papillomavirus (HPV)-related, with a variable proportion of low-grade and high-grade (HG) HPV. HPV is a necessary cause of cervical cancer.3 Vulvar carcinomas are either HPV-related or not.4 The proportion of HR-HPV involvement in anal squamous carcinoma varies widely.5 The role of HIV as a risk factor varies mainly according to the organ involved.6–7 In the Limpopo Province of South Africa, anogenital pathology was biopsydiagnosed only occasionally before 2010. Between January 2010 and June 2014, 324 cases were reported; 125 (38.6%)
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Ohnishi M, Golparian D, Shimuta K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea? Detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother 2011;55:3538–45. Carnicer-Pont D, Smithson A, Fina-Homar E, et al. First cases of Neisseria gonorrhoeae resistant to ceftriaxone in Catalonia, Spain, May 2011. Enferm Infecc Microbiol Clin 2012;30:218–19. World Health Organisation. Global action plan to control and spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. 2012. http://ecdc.europa.eu/en/ healthtopics/gonorrhoea/response-plan/pages/response-plan.aspx (accessed 21 Feb 2014).
were HIV infected. This is more than double the prevalence of HIV infection in the general population.8 Seventy-five per cent of the cases were females; among perianal lesions 56% were in females. A subset of 162 was immunostained with anti-p16INK4a, a surrogate biomarker of HG-HPV. Overexpression was found in 64.8% of preinvasive and 79.3% of invasive lesions. The HIV serostatus did not affect the proportion of p16 overexpression. The mean age at diagnosis of invasive anogenital cancers was, on average, 13 years younger in HIV-infected persons. The latest issue of the National Cancer Registry (NCR) dates back to 2007; therefore, we have no current national data to compare with.9 The comparison of the 2000 with the 2007 NCR issue showed no increase in reported biopsy-diagnosed cases, constituting 0.9% of all cancers.9 Our data indicate a clear increase especially of vulvar lesions. The challenge in settings like ours where cervical screening is mainly opportunistic is to sensitise all health professionals, when the opportunity arises, to focus on the cervix and on the anogenital system in both genders, especially in the young and HIV infected. Louis-Jacques van Bogaert Correspondence to Dr Louis-Jacques van Bogaert, National Health Laboratory Service and University of Limpopo, Post Net Suite 7, Private Bag x8689, Groblersdal 0470, Polokwane 0700, South Africa; [email protected] Competing interests None. Ethics approval
Mohammed H, et al. Sex Transm Infect 2015;91:287–293. doi:10.1136/sextrans-2014-051756
Provenance and peer review Not commissioned; internally peer reviewed.
To cite van Bogaert L-J. Sex Transm Infect 2015;91:293. Received 7 August 2014 Revised 9 September 2014 Accepted 25 September 2014 Sex Transm Infect 2015;91:293. doi:10.1136/sextrans-2014-051807
REFERENCES 1 2
3
4
5
6
7
8
9
Engstrom PF, Arnoletti JB, Benson AIB, et al. Anal carcinoma. J Natl Compr Canc Netw 2010;8:106–20. Strickler HD. Does HIV/AIDS have a biological impact on the risk of human papillomavirus-related cancers? J Natl Cancer Inst 2009;101:1103–5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12–19. van der Avoort IA, Shirango H, Hoevenaars BM, et al. Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol 2006;25:22–9. Chirkut S. Anal human papillomavirus and anal squamous cell cancer in people living with HIV/AIDS: implications for southern Africa. S Afr J Infect Dis 2014;29:12–18. Frisch M, Biggar JR, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst 2000;92:1500–10. Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS 2009;23:875–85. Statistics South Africa. Statistical Release PO301-4 and PO302. Mid-year population estimates 2013. http:// www.statssa.gov.sa National Cancer Registry. National Health laboratory Service. Johannesburg: National Health Laboratory Service, 2007.
293
Downloaded from http://sti.bmj.com/ on June 1, 2015 - Published by group.bmj.com
Anogenital preinvasive and invasive lesions in the Limpopo Province of South Africa Louis-Jacques van Bogaert Sex Transm Infect 2015 91: 293
doi: 10.1136/sextrans-2014-051807 Updated information and services can be found at: http://sti.bmj.com/content/91/4/293
These include:
References Email alerting service
This article cites 7 articles, 3 of which you can access for free at: http://sti.bmj.com/content/91/4/293#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Epidemiology 14
15
16
Centers for Disease Control and Prevention. Gonoccocal Isolate Surveillance Project (GISP) Protocol. Updated July 2010. http://www.cdc.gov/std/gisp/ GISP-Protocol07-15-2010.pdf (accessed 25 Nov 2013). Monteiro EF, Lacey CJN, Merrick D. The interrelation of demographic and geospatial risk factors between four common sexually transmitted diseases. Sex Transm Infect 2005;81:41–6. Public Health England. Gonoccocal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan for England and Wales: Informing the Public Health Response. February 2013. http://webarchive.nationalarchives.gov.uk/ 20131210195211/http://www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/ 1302GonoccocalResistancetoAntimicrobialsSurveillance/ (accessed 25 Sep 2014).
LETTER
Anogenital preinvasive and invasive lesions in the Limpopo Province of South Africa Anogenital preinvasive and invasive lesions are known to have been on the increase in the industrialised world since the 1970s.1 The increase in anal squamous cell carcinomas and Kaposi’s sarcomas (KS) has often been associated with the HIV epidemic, especially among men having sex with men. KS and non-Hodgkin’s lymphoma are virusrelated (KS-associated herpes virus and Epstein–Barr, respectively) AIDS-defining illnesses.2 Among anogenital cancers, only cervical cancer is listed as AIDS-defining illness. A large proportion of anogenital preinvasive and invasive lesions are human papillomavirus (HPV)-related, with a variable proportion of low-grade and high-grade (HG) HPV. HPV is a necessary cause of cervical cancer.3 Vulvar carcinomas are either HPV-related or not.4 The proportion of HR-HPV involvement in anal squamous carcinoma varies widely.5 The role of HIV as a risk factor varies mainly according to the organ involved.6–7 In the Limpopo Province of South Africa, anogenital pathology was biopsydiagnosed only occasionally before 2010. Between January 2010 and June 2014, 324 cases were reported; 125 (38.6%)
17
18
19
Ohnishi M, Golparian D, Shimuta K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea? Detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother 2011;55:3538–45. Carnicer-Pont D, Smithson A, Fina-Homar E, et al. First cases of Neisseria gonorrhoeae resistant to ceftriaxone in Catalonia, Spain, May 2011. Enferm Infecc Microbiol Clin 2012;30:218–19. World Health Organisation. Global action plan to control and spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. 2012. http://ecdc.europa.eu/en/ healthtopics/gonorrhoea/response-plan/pages/response-plan.aspx (accessed 21 Feb 2014).
were HIV infected. This is more than double the prevalence of HIV infection in the general population.8 Seventy-five per cent of the cases were females; among perianal lesions 56% were in females. A subset of 162 was immunostained with anti-p16INK4a, a surrogate biomarker of HG-HPV. Overexpression was found in 64.8% of preinvasive and 79.3% of invasive lesions. The HIV serostatus did not affect the proportion of p16 overexpression. The mean age at diagnosis of invasive anogenital cancers was, on average, 13 years younger in HIV-infected persons. The latest issue of the National Cancer Registry (NCR) dates back to 2007; therefore, we have no current national data to compare with.9 The comparison of the 2000 with the 2007 NCR issue showed no increase in reported biopsy-diagnosed cases, constituting 0.9% of all cancers.9 Our data indicate a clear increase especially of vulvar lesions. The challenge in settings like ours where cervical screening is mainly opportunistic is to sensitise all health professionals, when the opportunity arises, to focus on the cervix and on the anogenital system in both genders, especially in the young and HIV infected. Louis-Jacques van Bogaert Correspondence to Dr Louis-Jacques van Bogaert, National Health Laboratory Service and University of Limpopo, Post Net Suite 7, Private Bag x8689, Groblersdal 0470, Polokwane 0700, South Africa; [email protected] Competing interests None. Ethics approval
Mohammed H, et al. Sex Transm Infect 2015;91:287–293. doi:10.1136/sextrans-2014-051756
Provenance and peer review Not commissioned; internally peer reviewed.
To cite van Bogaert L-J. Sex Transm Infect 2015;91:293. Received 7 August 2014 Revised 9 September 2014 Accepted 25 September 2014 Sex Transm Infect 2015;91:293. doi:10.1136/sextrans-2014-051807
REFERENCES 1 2
3
4
5
6
7
8
9
Engstrom PF, Arnoletti JB, Benson AIB, et al. Anal carcinoma. J Natl Compr Canc Netw 2010;8:106–20. Strickler HD. Does HIV/AIDS have a biological impact on the risk of human papillomavirus-related cancers? J Natl Cancer Inst 2009;101:1103–5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12–19. van der Avoort IA, Shirango H, Hoevenaars BM, et al. Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol 2006;25:22–9. Chirkut S. Anal human papillomavirus and anal squamous cell cancer in people living with HIV/AIDS: implications for southern Africa. S Afr J Infect Dis 2014;29:12–18. Frisch M, Biggar JR, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst 2000;92:1500–10. Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS 2009;23:875–85. Statistics South Africa. Statistical Release PO301-4 and PO302. Mid-year population estimates 2013. http:// www.statssa.gov.sa National Cancer Registry. National Health laboratory Service. Johannesburg: National Health Laboratory Service, 2007.
293
Downloaded from http://sti.bmj.com/ on June 1, 2015 - Published by group.bmj.com
Anogenital preinvasive and invasive lesions in the Limpopo Province of South Africa Louis-Jacques van Bogaert Sex Transm Infect 2015 91: 293
doi: 10.1136/sextrans-2014-051807 Updated information and services can be found at: http://sti.bmj.com/content/91/4/293
These include:
References Email alerting service
This article cites 7 articles, 3 of which you can access for free at: http://sti.bmj.com/content/91/4/293#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
