Adverse pregnancy and neonatal outcomes associated with <i>Neisseria gonorrhoeae:</i> systematic review and meta-analysis.

ObjectiveTo examine associations between Neisseria gonorrhoeae (NG) infection during pregnancy and the risk of preterm birth, spontaneous abortion, premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum.Data sourcesWe searched Medline, EMBASE, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature for studies published between 1948 and 14 January 2020.MethodsStudies were included if they reported testing for NG during pregnancy and compared pregnancy, perinatal and/or neonatal outcomes between women with and without NG. Two reviewers independently assessed papers for inclusion and extracted data. Risk of bias was assessed using established checklists for each study design. Summary ORs with 95% CIs were generated using random effects models for both crude and, where available, adjusted associations.ResultsWe identified 2593 records and included 30 in meta-analyses. Women with NG were more likely to experience preterm birth (OR 1.55, 95% CI 1.21 to 1.99, n=18 studies); premature rupture of membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9); perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46, n=9); low birth weight (OR 1.66, 95% CI 1.12 to 2.48, n=8) and ophthalmia neonatorum (OR 4.21, 95% CI 1.36 to 13.04, n=6). Summary adjusted ORs were, for preterm birth 1.90 (95% CI 1.14 to 3.19, n=5) and for low birth weight 1.48 (95% CI 0.79 to 2.77, n=4). In studies with a multivariable analysis, age was the variable most commonly adjusted for. NG was more strongly associated with preterm birth in low-income and middle-income countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than in high-income countries (OR 1.38, 95% CI 1.04 to 1.83, n=11).ConclusionsNG is associated with a number of adverse pregnancy and newborn outcomes. Further research should be done to determine the role of NG in different perinatal mortality outcomes because interventions that reduce mortality will have the greatest impact on reducing the burden of disease in low-income and middle-income countries.Prospero registration numberCRD42016050962

Human Papillomavirus prevalence and associated risk factors in women with cervical pre-cancer and cancer in Switzerland at the beginning of the cantonal vaccination programmes: The CIN3+plus study

Background / Objectives The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2007. To monitor the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to determine the prevalence of HPV and examine associated risk factors in women with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) in Switzerland. Methods We conducted a cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status (according to the Swiss neighbourhood index of socioeconomic position, Swiss-SEP) in the CIN3+plus group with the Swiss National Cohort (SNC) in 2014 and compared risk factors for HPV infection with the Swiss Health Survey (SHS) in 2012. Results We included 768 biopsies from 767 women aged 17-81 years with CIN3+ in 2014 and 2015. Of these, 745 (97.0%) were positive for any HPV type, 5 (0.7%) were negative and 18 (2.3%) were not evaluable. Overall, 475/768 (61.8%) biopsies contained HPV 16 and/or 18 and 687 (89.5%) contained an oncogenic HPV type covered by the nonavalent HPV vaccine (16, 18, 31, 33, 45, 52, 58). In 2015, 273 women completed a questionnaire. Compared with the SNC, fewer women with CIN3+ were born in Switzerland (49.0 vs. 63.4%; p<0.001) and more were single (48.9 vs. 28.1%; p<0.001), but mean Swiss-Sep index was similar (64.6±10.8 vs. 65.2±10.9; p=0.135). Amongst women with CIN3+, higher proportions reported ≥2 sexual partners in the last 12 months (15.4% vs. 4.1%), smoking (38.5% vs. 22.0%) and hormonal contraception use in the last 12 months (35.5% vs. 22.4%) than women in the SHS. Conclusion This is the first study of HPV in women with CIN3+ covering all three language regions in Switzerland. Women with CIN3+ have levels of socioeconomic position that are similar to the Swiss general population but higher levels of some risk factors for HPV. Surveillance of HPV types in CIN3+ lesions is feasible and can be used to measure the future impact of HPV vaccination on clinical outcomes

P36-05 HPV prevalence and associated risk factors in women with cervical pre-cancer and cancer in Switzerland at the beginning of the cantonal vaccination programmes: The CIN3+plus study

Background / Objectives The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2007. To monitor the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to determine the prevalence of HPV and examine associated risk factors in women with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) in Switzerland. Methods We conducted a cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status (according to the Swiss neighbourhood index of socioeconomic position, Swiss-SEP) in the CIN3+plus group with the Swiss National Cohort (SNC) in 2014 and compared risk factors for HPV infection with the Swiss Health Survey (SHS) in 2012. Results We included 768 biopsies from 767 women aged 17-81 years with CIN3+ in 2014 and 2015. Of these, 745 (97.0%) were positive for any HPV type, 5 (0.7%) were negative and 18 (2.3%) were not evaluable. Overall, 475/768 (61.8%) biopsies contained HPV 16 and/or 18 and 687 (89.5%) contained an oncogenic HPV type covered by the nonavalent HPV vaccine (16, 18, 31, 33, 45, 52, 58). In 2015, 273 women completed a questionnaire. Compared with the SNC, fewer women with CIN3+ were born in Switzerland (49.0 vs. 63.4%; p<0.001) and more were single (48.9 vs. 28.1%; p<0.001), but mean Swiss-Sep index was similar (64.6±10.8 vs. 65.2±10.9; p=0.135). Amongst women with CIN3+, higher proportions reported ≥2 sexual partners in the last 12 months (15.4% vs. 4.1%), smoking (38.5% vs. 22.0%) and hormonal contraception use in the last 12 months (35.5% vs. 22.4%) than women in the SHS. Conclusion This is the first study of HPV in women with CIN3+ covering all three language regions in Switzerland. Women with CIN3+ have levels of socioeconomic position that are similar to the Swiss general population but higher levels of some risk factors for HPV. Surveillance of HPV types in CIN3+ lesions is feasible and can be used to measure the future impact of HPV vaccination on clinical outcomes