ANTİOKSİDAN VAJİNAL JEL KULLANIMI HPV KLİRENSİNİ ve SİTOLOJİK REGRESYONU DESTEKLER Mİ ?

Abstract

Serviks kanseri, dünyada en sık görülen jinekolojik malignitelerdendir. Prekanseröz lezyonların taramayla erken saptanması tedavi için fırsat sunmaktadır. Serviks kanserlerinin %99,7’sinde saptanan HPV, uygun tarama ve koruyucu yaklaşımlarla önlenebilir. Son yıllarda antioksidan içerikli vajinal ürünlerin HPV eradikasyonunu hızlandırabileceği öne sürülmekle birlikte, bu konuda yeterli klinik kanıt bulunmamaktadır. Bu çalışmada, antioksidan etkili vajinal jelin HPV negatifleşmesi, sitolojik regresyon üzerine etkisinin değerlendirilmesi amaçlanmıştır. 19 Mayıs Üniversitesi’nde yürütülen bu çalışmada Ocak 2017 – Aralık 2022 tarihleri arasında Pap-smear ile HPV testinde ASC-US, LSIL, HSIL ve onkojenik HPV pozitifliği saptanan hastalar incelendi. Hastalar antioksidan vajinal jel kullanan ve kullanmayan olmak üzere iki gruba ayrıldı. Başlangıç ve 12–18 ay sonraki kontrol HPV ve sitoloji sonuçları karşılaştırıldı. Kontrol HPV testinde negatiflik oranı jel kullanmayan grupta %56,1, jel kullanan grupta %52,6 olup, gruplar arasında anlamlı fark saptanmadı. Sitolojik takipte iki grupta regresyon gözlenmekle birlikte, jel kullanan grupta intraepitelyal lezyon oranlarının belirgin olarak azalmadığı ve sitolojik iyileşmenin jel kullanmayan grupla benzer seyrettiği görüldü. Sitolojik değişim kategorilerinde de gruplar arasında istatistiksel olarak anlamlı fark bulunmadı. Klinik pratikte yaygın olarak tercih edilmesine rağmen, literatürdeki sınırlı çalışmalardan farklı olarak, çalışmamızda antioksidan etkili vajinal jel kullanımının HPV negatifleşmesine veya sitolojik anormalliklerin gerilemesine anlamlı katkı sağladığına dair kanıt elde edilememiştir. Bu ürünlerin etkinliğini ortaya koymak için geniş örneklemli, uzun süreli, prospektif randomize çalışmalar gereklidir.

Keywords

• HPV eradikasyonu
• servikal displazi
• vajinal antioksidan
• sitoloji regresyonu
• tarama

Supporting Institution

Çalışmamız herhangi bir kurum tarafından desteklenmemiştir.

Ethical Statement

Çalışmamıza Ondokuz Mayıs Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından 2023/472 nolu kararla 27.12.2023 tarihli toplantılarında etik onay verilmiştir. Bu makale yazarlardan Kübra Geyik Şengül’ün ‘HPV ve Sitoloji Anormalliği Bulunan Olgularda Antioksidan Vajinal Jel Kullanımı Sonrası Bulguların Değerlendirilmesi’ adlı tıpta uzmanlık tezinden oluşturulmuştur.

Thanks

Yazarların beyan edecekleri herhangi bir teşekkür yoktur.

Does the use of antioxidant vaginal gel support hpv clearance and cytological regression?

Abstract

Cervical cancer is one of the most common gynecological malignancies worldwide. Early detection of precancerous lesions through screening offers an opportunity for treatment. HPV, detected in 99.7% of cervical cancers, can be prevented with appropriate screening and preventive approaches. Although it has been suggested in recent years that vaginal products containing antioxidants may accelerate HPV eradication, there is insufficient clinical evidence on this matter. This study aimed to evaluate the effect of an antioxidant vaginal gel on HPV negativity and cytological regression. This study, conducted at a tertiary healthcare facility, examined patients who tested positive for ASC-US, LSIL, HSIL, and oncogenic HPV via Pap smear between January 2017 and December 2022. Patients were divided into two groups: those using and those not using antioxidant vaginal gel. Baseline and 12-18 month follow-up HPV and cytology results were compared. The negativity rate in the control HPV test was 56.1% in the group not using the gel and 52.6% in the group using the gel, with no significant difference between the groups (p=0.599). Although regression was observed in both groups during cytological follow-up, the intraepithelial lesion rates did not significantly decrease in the group using the gel, and cytological improvement was similar to that of the group not using the gel. There was also no statistically significant difference between the groups in the cytological change categories (p=0.686). Despite being widely preferred in clinical practice, and unlike the limited studies in the literature, our study did not find evidence that the use of antioxidant vaginal gels significantly contributed to HPV negativity or regression of cytological abnormalities. Large-scale, long-term, prospective randomized studies are needed to determine the effectiveness of these products.

Keywords

• HPV eradication
• cervical dysplasia
• vaginal antioxidant
• cytology regression
• screening

Supporting Institution

Our study was not supported by any institution.

Ethical Statement

This study received ethical approval from the Clinical Research Ethics Committee of Ondokuz Mayıs University (Decision No: 2023/472), granted during the meeting held on 27 December 2023. This article is derived from the medical specialty thesis of Kübra Geyik Şengül, titled “Evaluation of Findings After the Use of Antioxidant Vaginal Gel in Cases with HPV Positivity and Cytological Abnormality.”

Thanks

None to declare.

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