The performance of human papillomavirus high-risk DNA testing in the screening and diagnostic settings.

OBJECTIVE: We sought to evaluate the performance of the human papillomavirus high-risk DNA test in patients 30 years and older. MATERIALS AND METHODS: Screening (n=835) and diagnosis (n=518) groups were defined based on prior Papanicolaou smear results as part of a clinical trial for cervical cancer detection. We compared the Hybrid Capture II (HCII) test result with the worst histologic report. We used cervical intraepithelial neoplasia (CIN) 2/3 or worse as the reference of disease. We calculated sensitivities, specificities, positive and negative likelihood ratios (LR+ and LR-), receiver operating characteristic (ROC) curves, and areas under the ROC curves for the HCII test. We also considered alternative strategies, including Papanicolaou smear, a combination of Papanicolaou smear and the HCII test, a sequence of Papanicolaou smear followed by the HCII test, and a sequence of the HCII test followed by Papanicolaou smear. RESULTS: For the screening group, the sensitivity was 0.69 and the specificity was 0.93; the area under the ROC curve was 0.81. The LR+ and LR- were 10.24 and 0.34, respectively. For the diagnosis group, the sensitivity was 0.88 and the specificity was 0.78; the area under the ROC curve was 0.83. The LR+ and LR- were 4.06 and 0.14, respectively. Sequential testing showed little or no improvement over the combination testing. CONCLUSIONS: The HCII test in the screening group had a greater LR+ for the detection of CIN 2/3 or worse. HCII testing may be an additional screening tool for cervical cancer in women 30 years and older.

Predictive factors for vaginal douching and tampon use among US women: Are these behaviors risk factors for bacterial vaginosis and trichomonas?

The use of feminine products such as vaginal douches, tampons, and sanitary napkins are common among women. Despite the results of some studies that suggest an association between douching and bacterial vaginosis, douching remains a topic that is understudied. The possibility of an association between tampon use and infection has not been significantly investigated since the toxic shock outbreak in the 1980s. The first objective of our study was to evaluate demographic, reproductive health, and sexual behavior variables to establish an epidemiologic profile of menstruating women who reported douching and women who reported using sanitary napkins only. The second objective of our study was to evaluate whether the behaviors of douching and using tampons were associated with an increased risk of bacterial vaginosis or trichomonas. We analyzed these factors, using logistic regression, among the 3,174 women from the NHANES cross sectional data from 2001-2004, who met the inclusion criteria determined for our study. We established an epidemiologic profile for women who had the highest frequency of douching reported as women who were age 36-49, had a high school education or GED, black race, not taking oral contraceptives, reported vaginal symptoms in the last month, two or more sexual partners in the last year, or tested positive for bacterial vaginosis or trichomonas. The profile for those who had the highest frequency of exclusive sanitary napkin use included women with less than a high school education, married women, women classified as black or "other" in race, and women who were not on oral contraceptives. While we were able to establish a significant increase in the odds of douching among women who tested positive for bacterial vaginosis or trichomonas, we did not find any significant difference in the odds of exclusive napkin use and testing negative for bacterial vaginosis or trichomonas.^