The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

/pdf/sexually-transmitted-diseases-treatment-guidelines-4zaqk3joit.pdf

Sexually transmitted diseases treatment guidelines.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607614160.pdf

Human papillomavirus and cervical cancer

Of the many types of human papillomavirus (HPV), more than 30 infect the genital tract. The association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Although HPV is essential to the transformation of cervical epithelial cells, it is not sufficient, and a variety of cofactors and molecular events influence whether cervical cancer will develop. Early detection and treatment of precancerous lesions can prevent progression to cervical cancer. Identification of precancerous lesions has been primarily by cytologic screening of cervical cells. Cellular abnormalities, however, may be missed or may not be sufficiently distinct, and a portion of patients with borderline or mildly dyskaryotic cytomorphology will have higher-grade disease identified by subsequent colposcopy and biopsy. Sensitive and specific molecular techniques that detect HPV DNA and distinguish high-risk HPV types from low-risk HPV types have been introduced as an adjunct to cytology. Earlier detection of high-risk HPV types may improve triage, treatment, and follow-up in infected patients. Currently, the clearest role for HPV DNA testing is to improve diagnostic accuracy and limit unnecessary colposcopy in patients with borderline or mildly abnormal cytologic test results.

Human Papillomavirus and Cervical Cancer

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18-30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR-11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.

Sexually transmitted diseases treatment guidelines, 2010.

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

Sexually transmitted diseases treatment guidelines, 2015.

ObjectivesThe Bethesda 2001 Workshop was convened to evaluate and update the 1991
Bethesda System terminology for reporting the results of cervical cytology.
A primary objective was to develop a new approach to broaden participation
in the consensus process.ParticipantsForum groups composed of 6 to 10 individuals were responsible for developing
recommendations for discussion at the workshop. Each forum group included
at least 1 cytopathologist, cytotechnologist, clinician, and international
representative to ensure a broad range of views and interests. More than 400
cytopathologists, cytotechnologists, histopathologists, family practitioners,
gynecologists, public health physicians, epidemiologists, patient advocates,
and attorneys participated in the workshop, which was convened by the National
Cancer Institute and cosponsored by 44 professional societies. More than 20
countries were represented.EvidenceLiterature review, expert opinion, and input from an Internet bulletin
board were all considered in developing recommendations. The strength of evidence
of the scientific data was considered of paramount importance.Consensus ProcessBethesda 2001 was a year-long iterative review process. An Internet
bulletin board was used for discussion of issues and drafts of recommendations.
More than 1000 comments were posted to the bulletin board over the course
of 6 months. The Bethesda Workshop, held April 30-May 2, 2001, was open to
the public. Postworkshop recommendations were posted on the bulletin board
for a last round of critical review prior to finalizing the terminology.ConclusionsBethesda 2001 was developed with broad participation in the consensus
process. The 2001 Bethesda System terminology reflects important advances
in biological understanding of cervical neoplasia and cervical screening technology.

/pdf/the-2001-bethesda-system-terminology-for-reporting-results-325g8pn54p.pdf

The 2001 Bethesda System: terminology for reporting results of cervical cytology.

The Bethesda System for reporting the results of cervical cytology was introduced in 1988 and revised in 1991 using the actual laboratory and clinical experience with the system. After 10 years of widespread use and advances in biologic understanding of cervical neoplasia, it was felt important to reexamine this terminology. After extensive internet web-based discussion groups on various aspects of the System, a workshop was held at the National Cancer Institute in Bethesda, Maryland, with participation from a broad range of constituents including cytologists, pathologist, clinicians, epidemiologists, patient advocates, and attorneys. This consensus statement is the report of this workshop. The following table (Table 1) is an abstract of the consensus statement.

The 2001 Bethesda system: Terminology for reporting results of cervical cytology

OBJECTIVE: To evaluate the effectiveness of the AutoPap System in detecting abnormal and normal cervical smears when used in a primary screening/quality control mode, as compared with currently established laboratory practices. STUDY DESIGN: Slides were obtained prospectively and were initially processed in the routine fashion with cytotechnologist screening followed by 10% random quality control rescreening. Slides were then processed on the AutoPap System and allocated into the following groups: (1) approximately 25% of the lowest-ranking slides were placed in the laboratory's archives as within normal limits; (2) the remaining approximately 75% of slides were subjected to manual screening. Approximately 15% of the highest-ranking slides in this group underwent quality control rescreening. For each slide needing manual screening, the cytotechnologist was supplied with a report giving the ranking score of that slide. All discrepant slides for either adequacy or diagnosis were subjected to a truth-determination process. The results obtained from the two arms of the protocol were then compared. RESULTS: The AutoPap System assisted arm of the study was superior to the current practice arm for the identification of abnormal slides at the level of atypical squamous cells of undetermined significance and above (ASCUS+), low grade squamous intraepithelial lesion (LSIL) and higher LSIL+. AutoPap System-assisted practice was equivalent to current practice for the identification of unsatisfactory and satisfactory but limited by slides. All results showed statistical significance. In addition, AutoPap System-assisted practice in the study indicated improved specificity of diagnosis. CONCLUSION: AutoPap System-assisted practice shows superior sensitivity and specificity when compared to current practice. Its clinical use as a primary screening device should improve the overall practice of cervical cytology as well as provide potential enhancement in overall laboratory productivity.

The AutoPap system for primary screening in cervical cytology. Comparing the results of a prospective, intended-use study with routine manual practice.

Our understanding of preinvasive HPV-associated squamous lesions supports only two conceptual divisions: HPV infection and true precancer. Transient infections generally regress over the course of 1–2 years, and lesions with HPV persistence are associated with an increased risk of developing a cancer precursor (precancer) or invasive cancer. This concept led to the introduction of the two-tiered nomenclature of low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL), by the Bethesda System (TBS) in 1988. The 2014 Bethesda update maintains this dichotomous reporting terminology for the squamous intraepithelial lesions. Since the focus of cervical cancer screening is primarily the detection of HSIL, this chapter has been substantially expanded to include problematic patterns and mimics that may lead to locator and/or interpretation errors of non-neoplastic changes as HSIL/ASC-H or vice versa.

https://link.springer.com/content/pdf/10.1007%2F978-3-319-11074-5_5.pdf

Marianne U. Prey

Papers

The 2001 Bethesda System: terminology for reporting results of cervical cytology.

The 2001 Bethesda system: Terminology for reporting results of cervical cytology

The AutoPap system for primary screening in cervical cytology. Comparing the results of a prospective, intended-use study with routine manual practice.

Epithelial Cell Abnormalities: Squamous

Cervical Cytology Practice Guidelines. American Society of Cytopathology.