Has the time come for Croatia to introduce chlamydia screening among the adolescent population?

Uvod: Infekcije uzrokovane klamidijom ubrajaju se u najčešće spolno prenosive bolesti, posebno kod populacije mlađe od 25 godina. Često su asimptomatske, pa infekcija ostane neprepoznata i neliječena i može dovesti do razvoja komplikacija. Odgovornost za nadzor nad klamidijskom infekcijom je na javnom zdravstvu jer provedba preventivnih programa s ciljem pravovremenog otkrivanja i liječenja infekcije sprječava razvoj komplikacija. Cilj je ovoga rada bio utvrditi učestalost infekcije bakterijom Chlamydia trachomatis u Splitsko-dalmatinskoj županiji, analizirati učestalost s obzirom na dob i spol, te na osnovu rezultata zaključiti je li vrijeme da Republika Hrvatska uvede probir na klamidiju među adolescentskom populacijom. Metode: Za potrebe ovoga rada analizirani su šestogodišnji podaci rutinskog testiranja na bakteriju C.trachomatis u Nastavnom zavodu za javno zdravstvo Splitsko-dalmatinske županije (NZJZ-SDŽ). Testiranja su napravljena PCR metodom na sustavu Cobas 4800 (Roche). Rezultati: U šestogodišnjem razdoblju (2015. - 2020.) ukupno je testirano 45 431 pacijenata na DNK C.trachomatis, te je otkriveno 1 010 (2,2 %) pozitivnih uzoraka. U skupini osoba mlađih od 25 godina testirano je samo 5 886 uzoraka (13,0 % od ukupnog broja testiranih), a među njima je bilo 6,1 % pozitivnih na klamidiju (5,7 % od testiranih žena i 9,0% od testiranih muškaraca, mlađih od 25 godina). Kod osoba starijih od 25 godina bilo je tek 1,6 % pozitivnih na klamidiju (1,4 % žena i 3,2 % muškaraca). Zaključak: Prema rezultatima naše studije, prevalencija klamidijske infekcije u adolescenata znatno je viša od 3,0 %, što ukazuje na neophodnost i ekonomsku opravdanost uvođenja probira na klamidiju među adolescentskom populacijom u Hrvatskoj.Background: Infections caused by chlamydia are among the most common sexually transmitted diseases, especially in population younger than 25 years. They are often asymptomatic, so infection remains unrecognized and untreated. Control of chlamydial infection is a public health responsibility, and implementation of chlamydial screening allows timely detection, early treatment of infection and prevention of complications. The aim of this study was to determine the incidence of Chlamydia trachomatis infection in Split-Dalmatia County, to analyse the incidence regarding to age and gender, and based on the results to conclude has the time come for Croatia to introduce chlamydia screening among the adolescent population. Methods: For the purposes of this paper, six-year data from routine testing for C. trachomatis at the Teaching Institute for Public Health of Split-Dalmatia County (TIPH-SDC) were analysed. The tests were performed by PCR method on the Cobas 4800 system (Roche). Results: In the six-year period (2015–2020), a total of 45,431 patients were tested for C.trachomatis, and 1,010 (2.2%) were positive. In the group of persons younger than 25 years, only 5,886 samples were taken (13.0% of the total number tested). Among them, 6.1% were positive for chlamydia (5.7% of tested women and 9.0% of tested men, younger than 25 years). In the age group older than 25 years, only 1.6% patients were positive for chlamydia (1.4% of women and 3.2% of men). Conclusion: According to the results of our study, the prevalence of chlamydial infection in adolescent population is significantly higher than 3.0%, which indicates the necessity and cost-effectiveness for introduction of chlamydia screening among adolescent population in Croatia

HUMAN PAPILLOMAVIRUS (HPV) PREVALENCE AND GENOTYPES DISTRIBUTION IN THE GENERAL FEMALE POPULATION OF SPLIT AND DALMATIA COUNTY

Pozadina / Ciljevi: Prema Hrvatskom nacionalnom registru karcinoma i najnovijim podacima za Hrvatsku, u 2017. godini incidencija raka vrata maternice bila je 14,3 / 100 000, a stopa smrtnosti bila je 5,1 / 100 000. O prevalenci i distribuciji HPV tipova u Hrvatskoj se vrlo malo zna. Postoji samo nekoliko studija, temeljenih na rezultatima laboratorijskih ispitivanja povezanih sa uzorcima vrata maternice odabranih žena, koje su njihovi ginekolozi uputili u laboratorij na HPV DNK testiranje, bilo s normalnim ili abnormalnim Papa testom. Cilj ovog istraživanja bio je utvrditi prevalenciju HPV-a i raširenost distribucije HPV genotipova u općoj ženskoj populaciji južne Hrvatske (Splitsko-dalmatinska županija). Metode: Proveli smo prospektivnu studiju o prevalenciji i raspodjeli tipova HPV-a u ambulantnih žena. Podaci su prikupljeni tijekom rutinskih kontrolnih pregleda od strane nepovezane skupine ginekologa na području Županije. Pristranosti su uklonjene jer su ginekolozi poslali uzorke za testiranje na HPV svih onih žena koje su dolazile na redoviti ginekološki pregled u unaprijed određene dane tijekom razdoblja od godinu dana. Žene su bile isključene ako su patile od težih bolesti. hr-HPV otkriven je u eksfoliranim cervikalnim stanicama upotrebom PCR testa u stvarnom vremenu odobrenog od FDA-a (Cobas 4800 HPV test) na temelju istodobnog individualnog genotipiziranja za HPV-16 i HPV-18 i skupnog otkrivanja 12 drugih HPV-a. Rezultati: Ukupno je ocijenjeno 1050 žena u dobi od 16 do 74 godine koje su dolazile na rutinske ginekološke preglede. 107 (10,2%) njih je bilo pozitivno na hr-HPV. Od ukupnog broja testiranih žena, 304 (29%) su mlađe od 29 godina, a 746 (71%) starije od 30 godina. hr-HPV infekcija bila je razvijenija kod žena u dobi manjoj od 29 godina (59/304 (19,4%)) u usporedbi s skupinom starijom od 30 godina (48/746 (6,4%)). Među 107 HPV pozitivnih uzoraka, otkrivena je sljedeća raspodjela genotipa: HPV-16 u 35,5%, HPV-18 u 6,5% slučajeva, dok su ostali tipovi HPV-a utvrđeni u 83% pozitivnih uzoraka. U 25% pozitivnih uzoraka pronađeno je više HPV infekcija. U ovom istraživanju otkrili smo značajnu povezanost između HPV infekcije i abnormalne citologije, otkrivanja urogenitalne mikoplazme, bakterije Gardnerella vaginalis i bakterije Chlamydia trachomatis. Zaključci: Podaci iz ove studije o prevalenciji i distribuciji HPV genotipova u općoj ženskoj populaciji južne Hrvatske mogli bi biti korisni za bolju organizaciju probirnih programa i cijepljenja protiv raka vrata maternice u ovoj regiji i u cijeloj Hrvatskoj.Background/Objectives: According to the Croatian National Cancer Registry and the latest data for Croatia, in 2017 cervical cancer incidence were 14.3/100.000, and mortality rate were 5.1/100.000. Very little is known about prevalence and distribution of HPV types in Croatia. There are only few studies, based on laboratory test results, related to cervical samples of selected women, referred by their gynecologists to laboratory for HPV DNA testing, with either normal or abnormal Pap smear. The aim of this study was to determine the prevalence of HPV and HPV genotypes distribution in the general female population of Southern Croatia (Split and Dalmatia County). Methods: We performed a prospective study about HPV prevalence and type distribution of outpatient women. Data were collected during routine check-up exams by an unaffiliated group of gynecologists across the County. Biases were eliminated because the gynecologists sent samples for HPV testing of all those women who came for regular gynecological examination on specific predetermined days over a period of one year. Women were excluded if they suffered from more severe diseases. hr-HPV was detected in cervical exfoliated cells, by using a real-time FDA approved PCR assay (Cobas 4800 HPV Test) based on concurrent individual genotyping for HPV-16 and HPV-18 and pooled detection of 12 other HPVs. Results: A total of 1050 women aged 16-74 years, attending routine gynecological visits, were evaluated. 107 (10.2%) of them were hr-HPV positive. Out of total of number of tested women, 304 (29%) were ≤29 years old and 746 (71%) were ≥30 years old. hr-HPV infection was higher in women aged ≤29 years (59/304 (19.4%)) in compare with group older than 30 years (48/746 (6.4%)). Among 107 HPV positive samples, following genotype distribution was detected: HPV-16 in 35.5%, HPV-18 in 6.5% cases, while the other HPV types were established in 83% of positive samples. Multiple HPV infections were found in 25% of positive specimens. In this study, we found a significant association between HPV infection and the abnormal cytology, detection of urogenital mycoplasma, Gardnerella vaginalis, and Chlamydia trachomatis. Conclusions: Data from this study on the prevalence and distribution of HPV genotypes in general female population of southern Croatia could be valuable for better organization of HPV-based cervical cancer screening and vaccination programme in this region and in Croatia

HUMAN PAPILLOMAVIRUS (HPV) PREVALENCE AND GENOTYPES DISTRIBUTION IN THE GENERAL FEMALE POPULATION OF SPLIT AND DALMATIA COUNTY

Pozadina / Ciljevi: Prema Hrvatskom nacionalnom registru karcinoma i najnovijim podacima za Hrvatsku, u 2017. godini incidencija raka vrata maternice bila je 14,3 / 100 000, a stopa smrtnosti bila je 5,1 / 100 000. O prevalenci i distribuciji HPV tipova u Hrvatskoj se vrlo malo zna. Postoji samo nekoliko studija, temeljenih na rezultatima laboratorijskih ispitivanja povezanih sa uzorcima vrata maternice odabranih žena, koje su njihovi ginekolozi uputili u laboratorij na HPV DNK testiranje, bilo s normalnim ili abnormalnim Papa testom. Cilj ovog istraživanja bio je utvrditi prevalenciju HPV-a i raširenost distribucije HPV genotipova u općoj ženskoj populaciji južne Hrvatske (Splitsko-dalmatinska županija). Metode: Proveli smo prospektivnu studiju o prevalenciji i raspodjeli tipova HPV-a u ambulantnih žena. Podaci su prikupljeni tijekom rutinskih kontrolnih pregleda od strane nepovezane skupine ginekologa na području Županije. Pristranosti su uklonjene jer su ginekolozi poslali uzorke za testiranje na HPV svih onih žena koje su dolazile na redoviti ginekološki pregled u unaprijed određene dane tijekom razdoblja od godinu dana. Žene su bile isključene ako su patile od težih bolesti. hr-HPV otkriven je u eksfoliranim cervikalnim stanicama upotrebom PCR testa u stvarnom vremenu odobrenog od FDA-a (Cobas 4800 HPV test) na temelju istodobnog individualnog genotipiziranja za HPV-16 i HPV-18 i skupnog otkrivanja 12 drugih HPV-a. Rezultati: Ukupno je ocijenjeno 1050 žena u dobi od 16 do 74 godine koje su dolazile na rutinske ginekološke preglede. 107 (10,2%) njih je bilo pozitivno na hr-HPV. Od ukupnog broja testiranih žena, 304 (29%) su mlađe od 29 godina, a 746 (71%) starije od 30 godina. hr-HPV infekcija bila je razvijenija kod žena u dobi manjoj od 29 godina (59/304 (19,4%)) u usporedbi s skupinom starijom od 30 godina (48/746 (6,4%)). Među 107 HPV pozitivnih uzoraka, otkrivena je sljedeća raspodjela genotipa: HPV-16 u 35,5%, HPV-18 u 6,5% slučajeva, dok su ostali tipovi HPV-a utvrđeni u 83% pozitivnih uzoraka. U 25% pozitivnih uzoraka pronađeno je više HPV infekcija. U ovom istraživanju otkrili smo značajnu povezanost između HPV infekcije i abnormalne citologije, otkrivanja urogenitalne mikoplazme, bakterije Gardnerella vaginalis i bakterije Chlamydia trachomatis. Zaključci: Podaci iz ove studije o prevalenciji i distribuciji HPV genotipova u općoj ženskoj populaciji južne Hrvatske mogli bi biti korisni za bolju organizaciju probirnih programa i cijepljenja protiv raka vrata maternice u ovoj regiji i u cijeloj Hrvatskoj.Background/Objectives: According to the Croatian National Cancer Registry and the latest data for Croatia, in 2017 cervical cancer incidence were 14.3/100.000, and mortality rate were 5.1/100.000. Very little is known about prevalence and distribution of HPV types in Croatia. There are only few studies, based on laboratory test results, related to cervical samples of selected women, referred by their gynecologists to laboratory for HPV DNA testing, with either normal or abnormal Pap smear. The aim of this study was to determine the prevalence of HPV and HPV genotypes distribution in the general female population of Southern Croatia (Split and Dalmatia County). Methods: We performed a prospective study about HPV prevalence and type distribution of outpatient women. Data were collected during routine check-up exams by an unaffiliated group of gynecologists across the County. Biases were eliminated because the gynecologists sent samples for HPV testing of all those women who came for regular gynecological examination on specific predetermined days over a period of one year. Women were excluded if they suffered from more severe diseases. hr-HPV was detected in cervical exfoliated cells, by using a real-time FDA approved PCR assay (Cobas 4800 HPV Test) based on concurrent individual genotyping for HPV-16 and HPV-18 and pooled detection of 12 other HPVs. Results: A total of 1050 women aged 16-74 years, attending routine gynecological visits, were evaluated. 107 (10.2%) of them were hr-HPV positive. Out of total of number of tested women, 304 (29%) were ≤29 years old and 746 (71%) were ≥30 years old. hr-HPV infection was higher in women aged ≤29 years (59/304 (19.4%)) in compare with group older than 30 years (48/746 (6.4%)). Among 107 HPV positive samples, following genotype distribution was detected: HPV-16 in 35.5%, HPV-18 in 6.5% cases, while the other HPV types were established in 83% of positive samples. Multiple HPV infections were found in 25% of positive specimens. In this study, we found a significant association between HPV infection and the abnormal cytology, detection of urogenital mycoplasma, Gardnerella vaginalis, and Chlamydia trachomatis. Conclusions: Data from this study on the prevalence and distribution of HPV genotypes in general female population of southern Croatia could be valuable for better organization of HPV-based cervical cancer screening and vaccination programme in this region and in Croatia

HUMAN PAPILLOMAVIRUS (HPV) PREVALENCE AND GENOTYPES DISTRIBUTION IN THE GENERAL FEMALE POPULATION OF SPLIT AND DALMATIA COUNTY

Pozadina / Ciljevi: Prema Hrvatskom nacionalnom registru karcinoma i najnovijim podacima za Hrvatsku, u 2017. godini incidencija raka vrata maternice bila je 14,3 / 100 000, a stopa smrtnosti bila je 5,1 / 100 000. O prevalenci i distribuciji HPV tipova u Hrvatskoj se vrlo malo zna. Postoji samo nekoliko studija, temeljenih na rezultatima laboratorijskih ispitivanja povezanih sa uzorcima vrata maternice odabranih žena, koje su njihovi ginekolozi uputili u laboratorij na HPV DNK testiranje, bilo s normalnim ili abnormalnim Papa testom. Cilj ovog istraživanja bio je utvrditi prevalenciju HPV-a i raširenost distribucije HPV genotipova u općoj ženskoj populaciji južne Hrvatske (Splitsko-dalmatinska županija). Metode: Proveli smo prospektivnu studiju o prevalenciji i raspodjeli tipova HPV-a u ambulantnih žena. Podaci su prikupljeni tijekom rutinskih kontrolnih pregleda od strane nepovezane skupine ginekologa na području Županije. Pristranosti su uklonjene jer su ginekolozi poslali uzorke za testiranje na HPV svih onih žena koje su dolazile na redoviti ginekološki pregled u unaprijed određene dane tijekom razdoblja od godinu dana. Žene su bile isključene ako su patile od težih bolesti. hr-HPV otkriven je u eksfoliranim cervikalnim stanicama upotrebom PCR testa u stvarnom vremenu odobrenog od FDA-a (Cobas 4800 HPV test) na temelju istodobnog individualnog genotipiziranja za HPV-16 i HPV-18 i skupnog otkrivanja 12 drugih HPV-a. Rezultati: Ukupno je ocijenjeno 1050 žena u dobi od 16 do 74 godine koje su dolazile na rutinske ginekološke preglede. 107 (10,2%) njih je bilo pozitivno na hr-HPV. Od ukupnog broja testiranih žena, 304 (29%) su mlađe od 29 godina, a 746 (71%) starije od 30 godina. hr-HPV infekcija bila je razvijenija kod žena u dobi manjoj od 29 godina (59/304 (19,4%)) u usporedbi s skupinom starijom od 30 godina (48/746 (6,4%)). Među 107 HPV pozitivnih uzoraka, otkrivena je sljedeća raspodjela genotipa: HPV-16 u 35,5%, HPV-18 u 6,5% slučajeva, dok su ostali tipovi HPV-a utvrđeni u 83% pozitivnih uzoraka. U 25% pozitivnih uzoraka pronađeno je više HPV infekcija. U ovom istraživanju otkrili smo značajnu povezanost između HPV infekcije i abnormalne citologije, otkrivanja urogenitalne mikoplazme, bakterije Gardnerella vaginalis i bakterije Chlamydia trachomatis. Zaključci: Podaci iz ove studije o prevalenciji i distribuciji HPV genotipova u općoj ženskoj populaciji južne Hrvatske mogli bi biti korisni za bolju organizaciju probirnih programa i cijepljenja protiv raka vrata maternice u ovoj regiji i u cijeloj Hrvatskoj.Background/Objectives: According to the Croatian National Cancer Registry and the latest data for Croatia, in 2017 cervical cancer incidence were 14.3/100.000, and mortality rate were 5.1/100.000. Very little is known about prevalence and distribution of HPV types in Croatia. There are only few studies, based on laboratory test results, related to cervical samples of selected women, referred by their gynecologists to laboratory for HPV DNA testing, with either normal or abnormal Pap smear. The aim of this study was to determine the prevalence of HPV and HPV genotypes distribution in the general female population of Southern Croatia (Split and Dalmatia County). Methods: We performed a prospective study about HPV prevalence and type distribution of outpatient women. Data were collected during routine check-up exams by an unaffiliated group of gynecologists across the County. Biases were eliminated because the gynecologists sent samples for HPV testing of all those women who came for regular gynecological examination on specific predetermined days over a period of one year. Women were excluded if they suffered from more severe diseases. hr-HPV was detected in cervical exfoliated cells, by using a real-time FDA approved PCR assay (Cobas 4800 HPV Test) based on concurrent individual genotyping for HPV-16 and HPV-18 and pooled detection of 12 other HPVs. Results: A total of 1050 women aged 16-74 years, attending routine gynecological visits, were evaluated. 107 (10.2%) of them were hr-HPV positive. Out of total of number of tested women, 304 (29%) were ≤29 years old and 746 (71%) were ≥30 years old. hr-HPV infection was higher in women aged ≤29 years (59/304 (19.4%)) in compare with group older than 30 years (48/746 (6.4%)). Among 107 HPV positive samples, following genotype distribution was detected: HPV-16 in 35.5%, HPV-18 in 6.5% cases, while the other HPV types were established in 83% of positive samples. Multiple HPV infections were found in 25% of positive specimens. In this study, we found a significant association between HPV infection and the abnormal cytology, detection of urogenital mycoplasma, Gardnerella vaginalis, and Chlamydia trachomatis. Conclusions: Data from this study on the prevalence and distribution of HPV genotypes in general female population of southern Croatia could be valuable for better organization of HPV-based cervical cancer screening and vaccination programme in this region and in Croatia

Prevalence of Human Papillomavirus (HPV) among Females in the General Population of the Split and Dalmatia County and Its Association with Genital Microbiota and Infections: A Prospective Study

We conducted a prospective study with the aim of determining HPV prevalence and type distribution in the general female population of Southern Croatia (SDC), and to detect the presence of other microorganisms in the lower part of the female reproductive system and their possible influence on the frequency of HPV infection. Data were collected during routine check-up exams. All participants were examined by a gynecologist, and cervico-vaginal scrapings/swabs were collected, for cytological (Pap smear) and microbiological (for bacterial growth, genital mycoplasmas, chlamydia, and HPV) analysis. Informed consent was obtained from all participants with accompanying questionnaire. A total of 1050 asymptomatic women living in SDC participated in the study during a one-year period, and 107 of them (10.2%) had HR-HPV infection. We found that the presence of some bacteria (Ureaplasma, Chlamydia, and Gardnerella) in the lower part of the female genital system has a positive correlation with the frequency of HPV infection and, consequently, a possible influence on faster progression to cervical dysplasia caused by HPV. We consider that inclusion of screening for sexually transmitted infections as monitoring in women with HPV infection could help to find women at risk of cervical cancer progression