Background Cervical intraepithelial neoplasia (CIN) recurrence after loop electrosurgical excision procedure (LEEP) remains a clinically consequential barrier to cervical cancer prevention, and risk stratification tools tailored to real-world practice are limited in China. This study developed and internally validated a clinical prediction nomogram for histologically confirmed CIN2+ recurrence after LEEP. Methods A retrospective single-center cohort was assembled of women treated with LEEP for CIN2+ between January 2018 and October 2024. Candidate predictors included demographic and reproductive factors, smoking, HPV vaccination, prior cervical treatment, transformation zone type, LEEP pathology (including adenocarcinoma in situ [AIS] and margin status), pre-/post-treatment high-risk HPV measures, and neutrophil-to-lymphocyte ratio (NLR). Time-to-recurrence was analyzed using Cox regression with hierarchical domain modeling. A nomogram was constructed from the final multivariable model and evaluated for discrimination and calibration. Results Among 2,230 women (median follow-up 31.8 months, IQR 19.6–43.5), 334 developed CIN2+ recurrence (15.0%), with a median time to recurrence of 15.6 months (IQR 8.2–24.3). Persistent HPV infection occurred in 50.6% of women with recurrence versus 23.1% without recurrence ( p < 0.001). Persistent HPV infection (same genotype pre-/post-LEEP) was the strongest independent predictor (adjusted hazard ratio [aHR] 2.51, 95% CI 1.99–3.16). Additional independent predictors included unvaccinated status (aHR 1.54, 95% CI 1.08–2.20), multiple positive margins (aHR 1.52, 95% CI 1.08–2.14), AIS versus CIN2 (aHR 1.48, 95% CI 1.03–2.12), prior cervical treatment (aHR 1.38, 95% CI 1.04–1.84), single positive margin (aHR 1.38, 95% CI 1.02–1.87), and higher NLR (per one-unit increase: aHR 1.21, 95% CI 1.02–1.44). Model discrimination increased across hierarchical models from 0.516 (model 1) and 0.562 (model 3) to 0.619 in the final model. Risk stratification separated low-, intermediate-, and high-risk groups with observed 24-month recurrence rates of 6.2%, 14.8%, and 31.5%, respectively ( p for trend <0.001). Conclusion In a contemporary Chinese single-center cohort, genotype-defined persistent HPV infection and margin burden were dominant determinants of CIN2+ recurrence after LEEP, with vaccination status and NLR providing additional stratification. The resulting nomogram offers a pragmatic framework for risk-adapted surveillance, pending external multicenter validation.

Sexually transmitted infections (STIs) are prevalent worldwide and pose a significant challenge to national healthcare systems. Human papillomavirus (HPV) annually causes over 600,000 cases and 350,000 deaths from cervical cancer (CC). Coinfections with HPV and other STIs often potentiate the development of dysplastic processes and CC. The role of STI and HPV coinfection in carcinogenesis and the impact of multiple HPV infections on the development of CC have been poorly studied. Aim of the study : to assess the prevalence and risks of carcinogenesis in various variants of coinfection with human papillomavirus and other sexually transmitted infection agents. Materials and methods . A total of 9,310 HPV-positive women with STIs and/or other diseases were examined. Detection of 14 HPV genotypes was performed using PCR. The diagnosis of cervical intraepithelial neoplasia (CIN) was established based on extended colposcopy and cytological examination. Methods: PCR, clinical, epidemiological, and statistical methods. Results and discussion . In case of coinfection with STIs, the prevalence of HPV genotypes 16, 18, and 45 had statistically significant differences (32.0%, 9.7%, and 11.4%, respectively, p<0.001). The prevalence of HPV type 16 was characterized by an asymmetric distribution between STIs, demonstrating maximum values for urogenital candidiasis, anogenital warts, and chlamydial infection (40.7–36.8%) and lower values for anogenital herpes and cytomegalovirus infection (28.3–26.8%, p=0.02). The prevalence of CIN in the group of patients with STIs (11.8%) significantly exceeded the indicator in all examined patients (5.0%, p<0.001). The combination of STIs with a single HPV type was the most common coinfection (92%). The presence of multiple HPV infections during coinfection with STIs in patients in the study group did not increase the risk or severity of CIN (p>0.05). Conclusion . The prevalence of HPV among patients with STIs (30.7%) was significantly higher than in the comparison group (p<0.001). In HPV and STI coinfections, a high prevalence of HPV type 16 (25–40.7%) and CIN of varying severity (3.7–16.7%) was observed. A potentially high risk of carcinogenesis cannot be excluded in cases of HPV coinfections with mycoureaplasmosis and anogenital herpes infection due to the significant prevalence of CIN (12.1–14.1%), comparable to the prevalence of CIN in chlamydial infection (16.7%, p>0.05). The obtained results are consistent with existing data on the negative impact of the association of HPV and chlamydial infection on the risk of neoplasia development and complement the existing knowledge base in terms of assessing the impact of HPV coinfections with mycoureaplasmosis, anogenital herpes, anogenital warts, as well as multiple HPV infections on the risk of carcinogenesis.

Tissue-resident memory (TRM) cells represent important immune sentinels that mount rapid recall responses to pathogens and cancers. However, there are limited data in humans on genital tract TRM collected by clinically feasible sampling methods, limiting a full understanding of their role in immunity and clinical disease. We used flow cytometry and single cell RNA sequencing (scRNAseq) to characterize T cells isolated from ectocervical biopsies and endocervical cytobrushes collected from women attending a colposcopy clinic in Winnipeg, Canada. The ectocervix generally contained a higher frequency and abundance of immune cells and T-cells compared to the endocervix. CD4+ and CD8+ TRM were more approximately 5-times more frequent and abundant in the ecto- compared to endocervix, even after accounting for higher T-cell recovery from the ectocervix. Phenotypically, CD4+ TRM showed higher Th17- and comparable regulatory-associated marker expression compared to non-TRM in both the ecto- and endocervix. Cervical dysplasia and ectropion were both associated with several immune cell differences in the ecto- and endocervix including lower CD4+ TRM. Single-cell RNAseq analyses confirmed broad CD69 and core TRM-related gene expression and captured several heterogeneous CD4+ and CD8+ TRM subsets with diverse gene expression and pathways associated with host immunity, homeostasis, and nonimmune cell interactions. Our data suggest that TRM are more abundant in ecto- versus endocervical samples, which may reflect differences in commonly used sampling methods. Location and heterogeneous expression profiles underscore the need to better understand their role in microbial interactions, inflammation, and genital infection susceptibility in women.

MRST: Diagnostic model of cervical intraepithelial neoplasia based on multimodal image fusion and Swin Transformer

Multi-centre clinical validation of the NeuMoDx HPV assay for ASC-US / LSIL triage.

The aim of this study was to evaluate changes in the vaginal microbiota and biomarkers among high-risk human papillomavirus (hrHPV)-positive women, those with hrHPV accompanied by mucositis, and patients with cervical intraepithelial neoplasia (CIN) and to establish a novel predictive model. Vaginal samples from 102 women were categorized into four groups: control group (n = 26), hrHPV-positive group (n = 22), hrHPV-positive with mucositis group (n = 26), and CIN group (n = 28). Microbiota analysis was performed using the PacBio platform with full-length 16S rDNA gene sequencing. The vaginal microbiota in the hrHPV-positive, hrHPV-positive with mucositis, and CIN groups showed significant differences compared with the healthy control group. The microbial richness in the hrHPV-positive group was significantly different from both the CIN group and healthy controls. Compared with the control group, the hrHPV-positive group exhibited significantly increased relative abundances of Bifidobacterium, Escherichia-Shigella, Hoylesella and nominally increased abundances of Gardnerella, Prevotella, along with a significant decrease in Lactobacillus. No statistically significant differences were retained between the hrHPV-positive group and the hrHPV-positive with mucositis group after FDR correction for the top 10 genera. Compared with the hrHPV-positive with mucositis group, the CIN group demonstrated significantly reduced levels of Pseudomonas, nominally decreased levels of Bifidobacterium and Faecalibacterium, whereas Glutamicibacter and Sporosarcina were nominally enriched. A random forest model was constructed to predict risk across groups and demonstrated good predictive performance, suggesting that vaginal microbiota may serve as valuable indicators for predicting cervical lesion risk. During hrHPV infection, significant alterations occur in the vaginal microecology, primarily characterized by an increase in pathogenic bacteria and a reduction in beneficial bacterial populations.

The Intersecting Effects of Biomedicine and Patriarchy on the Social Lives of Women Undergoing Cervical Cancer Prevention.

Gynecologic conditions in the context of incarceration: A scoping review.

Accurate grading of cervical intraepithelial neoplasia (CIN1-3) from colposcopic images is clinically critical yet challenging due to subtle inter-grade morphology and substantial imaging variability. We propose an attention-guided mixture-of-experts (MoE) framework that ensembles five pretrained DenseNet-121 experts and employs an attention mechanism over pooled intermediate features to drive a gating network that adaptively weights expert outputs for each image. Operating on feature representations rather than raw pixels allows the gating network to perform input-specific expert selection and improves robustness to ambiguous cases. Using the Intel & MobileODT cervical screening dataset with a strict patient-wise 70/10/20 split, we report mean performance over five runs with 95% confidence intervals. On the independent test set, the proposed MoE achieves 74.0% ± 1.6 accuracy and 72.1% ± 1.8 F1, with per-class AUCs of 0.88 (CIN1), 0.82 (CIN2), and 0.85 (CIN3). The method yields statistically significant improvements over single-network DenseNet-121 baselines and alternative MoE backbones (MobileNet, EfficientNet, ShuffleNet) (p < 0.01). Ablation studies show that attention-guided gating contributes approximately 5-8% absolute accuracy gain over uniform weighting, and that five experts provide the optimal accuracy-efficiency balance. We further present attention visualizations and limited external validation to assess interpretability and generalizability. Although performance remains below that of recent transformer-ensemble models evaluated on smaller or less diverse test sets, the modular and interpretable MoE architecture offers a practical foundation for integrating segmentation or transformer-based experts to advance clinical utility. Code and trained models will be released to support reproducibility.

The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Only a small percentage of high-risk (HR) HPV infections progress to cervical precancer and cancer. Recent research indicates the potential association between the variation of vaginal microbiota and the acquisition and persistence of human papillomavirus (HPV) infection. However, the association of STIs with HPV cervical infection and cervicovaginal lesions has not yet been fully elucidated. The aim of this study was to assess how G. vaginalis is associated with HPV infection and cervical dysplasia, and the beneficial role of Lactobacillus. A total of 723 women aged between 17 and 79 years were studied. A complete cervico-vaginal swab for a cervico-vaginal cytological examination (Pap test) and the simultaneous identification, by Real-Time PCR, of the presence of HR-HPV and other STI pathogens, was conducted. The HPV positive women were 37.2%, with a prevalence significantly different in the various age groups. The most frequent genotype was HPV-16, while G. vaginalis was found in 369 women, in which 51.8% of cases occurred together with HPV-HR, highlighting a significant association between the two infections (p < 0.001). Moreover, a marked reduction in HR-HPV infection was observed in the presence of Lactobacillus. (p < 0.001). All-grade lesions were significantly associated with G. vaginalis and detected in 65.4% of G. vaginalis-positive samples (p < 0.01). The results of this study strengthen the hypothesis of the association between HPV infections and microbiota in cervical lesions. Not applicable.

Nearly 90% of cervical cancer and related fatalities occur in low-income and middle-income countries and low-resourced areas within developed countries. In the 1980s, self-sampling was introduced to reach this vulnerable population and those with behavioral aversion to clinician-based screening. Currently, dozens of self-sampling devices have been studied for cervical cancer screening. Here, we consolidated data from an extensive peer-reviewed literature search to summarize the prevalence, accuracy, and acceptance rates of cervical cancer screening self-sampling devices worldwide. We focused, when available, on samples detecting high-risk human papilloma virus (HPV) in cervical intraepithelial neoplasia grade 2 or more. The most studied and commonly accepted devices described in our review include the Evalyn Brush (N=73,986), Delphi Screener (n=28,020), FLOQSwab (N=13,638), Viba-Brush (N=25,565), and Digene Brush (N=12,150). Compared with clinician-based collection, samples derived from self-sampling devices had no significant difference in accurate detection of high-risk HPV. These self-sampling devices have thus been shown to effectively achieve broader global coverage for cervical cancer screening, particularly for limited-access areas. The use of self-sampling devices in populations with low resources and aversion to clinician-based sampling could have a major influence on detection of high-risk HPV and dysplasia, potentially reducing incidence of cervical cancer worldwide.

Background Prophylactic Human Papillomavirus (HPV) vaccines prevent high-grade cervical lesions, but their role as adjuvant therapy after conization for high-grade cervical intraepithelial neoplasia (CIN2+) remains uncertain, particularly regarding vaccine type, timing, and margin status. This review aimed to quantify the effect of adjuvant HPV vaccination on CIN2+ recurrence after conization and to determine whether vaccine valency, timing of administration (before vs after surgery), and cone margin status modify this effect. Methods We performed a PROSPERO-registered (CRD420251042109) systematic review and meta-analysis of randomized trials and cohort studies comparing HPV vaccination versus no vaccination in women treated with conization and/or loop electrosurgical excision procedure (LEEP) for histologically confirmed CIN2+. The primary outcome was recurrent CIN2+; secondary outcomes were HPV persistence/reinfection and vaccine-related adverse events. Random-effects models were used to pool risk ratios (RRs), with preplanned subgroup analyses by vaccine valency (bivalent, quadrivalent, nonavalent), timing of vaccination (before vs after conization), and cone margin status (positive vs negative), alongside sensitivity and GRADE certainty assessments. Results Seventeen studies (four randomized controlled trials [RCTs], thirteen cohorts), including 33,181 women (6,665 vaccinated; 26,516 unvaccinated), met inclusion criteria. Overall, adjuvant HPV vaccination was associated with a 62% relative reduction in CIN2+ recurrence (pooled RR 0.38, 95% confidence interval [CI] 0.29-0.51; I² = 58.6%). Subgroup analyses showed similar benefit across valencies (bivalent RR 0.50, quadrivalent RR 0.37, nonavalent RR 0.41; p for subgroup difference = 0.94), vaccination before versus after conization (RR 0.57 vs 0.72; p = 0.35), and in both margin-negative (RR 0.34) and margin-positive (RR 0.40) women (p = 0.63). Data on HPV persistence suggested a predominantly prophylactic mechanism (prevention of new/re-infection rather than clearance), and no new safety signals emerged. Conclusions Adjuvant prophylactic HPV vaccination meaningfully lowers CIN2+ recurrence after conization across vaccine types and clinical subgroups, supporting its integration into routine post-excisional care for eligible women as a low-burden strategy to reduce repeat procedures, preserve reproductive potential, and help avert progression to cervical cancer. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251042109 , identifier CRD420251042109.

Head-to-head comparison of the MyGene human papillomavirus-sexually transmitted infection assay versus the Cobas 4800 human papillomavirus test for detecting high-grade cervical intraepithelial neoplasia.

Given the increasing adoption of self-sampling in cervical cancer screening, it is essential to evaluate the performance of human papillomavirus (HPV) tests in this context. The aim of the present work was to assess the accuracy of the Papilloplex high-risk (HR)-HPV test on self-taken samples. Women provided a clinician-taken cervical sample (CS), a urine sample and a vaginal swab according to the VALidation of HUman papillomavirus assays and collection Devices for Self-samples and urine samples protocol. Relative sensitivity and specificity for the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) of the Papilloplex HR-HPV assay on self-taken samples versus CS were assessed. Additionally, type-specific concordance and viral load signals (expressed in Ct (crossing thershold) values) between the two self-taken sample types and the CS were evaluated. At the manufacturers' cut-off, the assay showed a relative clinical sensitivity and specificity for CIN2+of 0.95 (95% CI 0.88 to 1.03) and 0.95 (95% CI 0.88 to 1.03) for urine versus CS. Corresponding values for vaginal samples versus CS were 1.05 (95% CI 1.01 to 1.09) and 0.81 (95% CI 0.74 to 0.89). Cut-off optimisation led to relative sensitivity and specificity that included unity for vaginal swabs. Median Ct values were lower in vaginal swabs versus CS, although higher in urine versus CS samples. No relationship between mean Ct values and disease outcome was observed. The clinical sensitivity of the Papilloplex HR-HPV test was similar on self-collected vaginal swabs and urine compared with CS; clinical specificity on urine was similar to CS yet lower on vaginal samples. Cut-off optimisation resulted in a similar assay specificity on vaginal swabs and CS with no significant detriment to sensitivity.

AI-assisted diagnosis of cervical dysplasia from cervicography images.

The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions. This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did not receive excisional treatment for cervical intraepithelial lesions between 2009 and 2022 was enrolled. Adverse pregnancy outcomes (preterm delivery and pregnancy loss) in women with and without HIV, untreated or treated for cervical dysplasia, were recorded and analysed. The significance of the obtained results was judged at the 5% level. The study was conducted at all Academic Model Providing Access to Healthcare-Kenya satellite sites, which offer cervical cancer screening and treatment for cervical dysplasia in western Kenya. The Moi Teaching and Referral Hospital was also included. A cohort of 488 women aged between 20 years and 49 years, with and without HIV, diagnosed and treated for high-grade cervical intraepithelial neoplasia, and those followed up for low-grade cervical intraepithelial neoplasia between 2009 and 2022, were included. The study was interested in adverse pregnancy outcomes, particularly pregnancy loss and preterm delivery following cervical excision treatment for high-grade cervical intraepithelial lesions. After adjustment for confounding factors, excisional treatment involving the uterine cervix-particularly cold knife conisation-was associated with higher odds of adverse pregnancy outcomes (OR 13.1; 95% CI 1.1 to 137.1; p=0.032). A prior history of adverse pregnancy outcomes was also strongly associated with subsequent adverse outcomes after treatment (OR 37.7; 95% CI 13.8 to 102.7; p<0.001). In contrast, maternal HIV infection was not independently associated with adverse pregnancy outcomes after adjustment (p=0.125). Adverse pregnancy outcomes after excisional treatment of the uterine cervix for high-grade squamous intraepithelial lesions are multifactorial and were associated with cold knife conisation and prior adverse pregnancy outcomes, while maternal HIV infection was not independently associated with adverse outcomes.

Cervical conization is the standard treatment for cervical intraepithelial neoplasia. However, its effects on pregnancy outcomes remain controversial. Using data from the Korean National Health Insurance System, this population-based retrospective cohort study evaluated the relationship between cervical conization and adverse pregnancy outcomes between 2006 and 2022. Altogether, 199,826 singleton primiparous women aged 19 years or older were included, of whom 18,602 had undergone conization prior to pregnancy. The adjusted odds ratios for obstetric complications were estimated using multivariable logistic regression. Conization was associated with an elevated risk of cervical incompetence (adjusted odds ratios [aOR] 3.15; 95% confidence interval [CI] 3.01-3.30), preterm labor (aOR 1.44), preterm premature rupture of membranes (aOR 1.67), placenta previa, gestational diabetes, and intrauterine growth restriction. The subgroup analysis revealed that women who underwent both conization and cerclage had substantially higher risks of preterm labor and preterm premature rupture of membranes than did those who did not receive cerclage. The results point to a heightened obstetric risk following cervical conization, emphasizing the need for tailored prenatal care and continued prospective investigation.

Primary human papillomavirus (HPV) testing has the best tradeoff of benefits and harms for cervical screening but requires triage to determine management among HPV positives. We conducted a prospective observational study to evaluate triage of women who are HPV-positive using dual stain (DS) and HPV genotyping. We included 9,645 consecutive women who are HPV-positive undergoing cervical screening in two periods between 2015 and 2017 in the organized cervical screening program at Kaiser Permanente Northern California. Absolute risk and clinical performance of DS and cytology for detection of cervical intraepithelial neoplasia grade 3 and greater (CIN3+) were estimated overall and by HPV genotype and by age. Cumulative absolute risk of CIN3+ was modeled over 5 years using a prevalence-incidence mixture model, which allows estimating risk accounting for differences in disease ascertainment, surveillance intervals, and compliance. The baseline risk of CIN3+ was 9.4% and 0.8% for women testing positive and negative for DS, respectively, and 6.9% and 2.0% for women testing positive and negative for cytology, respectively. Sensitivity, specificity, and predictive values for CIN3+ detection were better for DS compared with cytology over 5 years (P < .001 for all comparisons). Risk in women with HPV16-positive/negative for intraepithelial lesion or malignancy was substantially higher than the risk in women with HPV16-positive/DS-negative (7.5% v 2.9%, P < .001). DS had better triage performance compared with cytology in all age groups and in women positive for HPV types other than HPV16 or HPV18. Long-term reassurance of low risk among DS negatives suggests that DS detects molecular changes earlier in the carcinogenic pathway than cytology. DS has better risk stratification than cytology overall, within HPV risk strata, and across all screening age groups and is a better option for triage of vaccinated populations.

Objective.Bioimpedance spectroscopy (BIS) has emerged as a promising technique for screening cervical intraepithelial neoplasia (CIN) since the electrical properties vary with the pathological status of cervical tissues. In this study, we aimed to evaluate the ability of CIN screening using multiple features extracted from BIS measurements collected with a multi-electrode BIS probe.Approach.This study enrolled 161 patients with gynecological diseases, including 44 with and 117 without cervical dysplasia. Upon the histological diagnosis, the samples were classified as normal, CIN I, and CIN II with p16 positive (p16(+))/CIN III. Complex impedance spectra ofin vitrocervical conization tissues were measured using the BIS probe. A Cole-Cole plot was generated from each patient's data measured on the conized cervix, and various features were extracted. Receiver operating characteristic (ROC) curves were generated, and the area under each ROC curve (AUC) was calculated.Main results.As a result, fifteen features from Cole-Cole plots differed significantly (p<0.01) between normal cervices and CIN. The AUCs based on multiple features, as determined by multivariable logistic regression, were 0.93 for normal cervix vs CIN I, 0.99 for normal cervix vs CIN II p16(+)/CIN III, and 0.94 for normal cervix vs CIN. These AUCs were improved by 14.8%, 7.6%, and 8.0%, respectively, compared with the results based on features extracted from only the real part of the impedance spectra.Significance.In conclusion, CIN can be accurately diagnosed using multiple features extracted from the impedance spectrum ofin vitrocervical samples. Particularly, this method was highly accurate in classifying CIN II p16(+)/CIN III, which has a higher risk of progression to cancer.

PD-L1 expression in cervical cancer tissue is strongly associated with the expression of CD73/TGF-β1, the percentage of CD8+/PD-1+ T cells and disease progression.