Quality of life in women with HPV and accurary of direct visual anal inspection with acetic acid and lugol compared to high-resolution anoscopy to diagnose intraepithelial anal lesion

Marinho, Geyson Alves; Oliveira, Matheus Gomes de; Silveira, Raquel Kelner; Silva, Anna Christina Cabral Cordeiro da; Melo Filho, Djalma Agripino de; Heraclio, Sandra de Andrade

doi:10.1590/1806-93042021000100014

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100014 copy

Quality of life in women with HPV and accurary of direct visual anal inspection with acetic acid and lugol compared to high-resolution anoscopy to diagnose intraepithelial anal lesion

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to describe life quality of women with HPV and analyze the accuracy of anal visual inspection with acetic acid and lugol compared to high-resolution anoscopy in the detection of anal intraepithelial lesions.

Methods:

diagnostic evaluation study conducted with adult solid-organ transplant recipients and/or diagnosed with HIV and/or with a history of anogenital neoplasia, attended at the High Resolution Anoscopy outpatient clinic between April and December 2018. To calculate the accuracy parameters, 87 women participated: 44 with lesions and 43 without them. The 44 women with lesions were also subjected to a descriptive study to assess their life quality using the SF-36 questionnaire.

Results:

it was observed that almost half of the women in the study practiced vaginal, anal and oral intercourse without condom. History of HPV infection and anogenital neoplasia were the most prevailing with percentages of 81% and 72.7%, respectively. In five out of the eight domains of SF-36 they did not perform well in regard to life quality. Visual inspection with acetic acid and lugol presented sensitivity of 22.7% and specificity of 100%.

Conclusion:

unsatisfactory life quality was evidenced. Direct visual inspection with acetic acid and lugol should not be used in trials to spot intraepithelial HPV lesions, for it presents low sensitivity.

Key words:
Papillomavirus infections; Screening; Anus neoplasms; Quality of life

Variables	N=44^* * When the total does not match, there was loss of information from the variable.	%
Race/color (self-reported)
Brown	18	40.9
Black	15	34.1
White	8	18.2
Others	3	6.8
Age
Minimum	24
Maximum	79
Average ± standard deviation	43.82 ± 13.04
Median	42
Origin
Urban	34	77.3
Rural	10	22.1
Stable relationship
Yes	32	72.7
No	12	27.3
Education Level
Illiterate to elementar school	11	25.6
Elementary school to incomplete High School	15	34.9
High School to College (not necessarily complete)	17	39.5
Socioeconomic Stract (Brazil Criterion)
A	-	-
B1	1	2.3
B2	3	7.0
C1	6	14.0
C2	21	48.8
D and E	12	27.9

Variables	N=44^* * When the total does not match, there was a loss of information from the variable.	%
Begining of sexual life (complete years)
Minimum	14
Maximum	30
Average ± pattern deviation	18.68 ± 3.65
Average	18
Sexual Sexual orientation
Heterossexual	44	100.0
Homossexual	-	-
Frequency of sexual intercourse in the last six months
Daily	5	13.2
A few times a week	19	50.0
A few times a month	13	34.2
Not once	1	2.6
Sexual activities
All	21	47.7
Vaginal	11	25.0
Anal and vaginal	8	18.2
Oral e vaginal	3	6.8
Anal e oral	1	2.3
Number of partners in the last six months
1	32	72.7
2 or more	4	9.1
None	8	18.2
Use of protection
Always	9	20.5
Sometimes	8	18.2
Rarely	6	13.6
Never	21	47.7
History of STDs
HPV	34	81.0
Syphilis	1	2.4
No	7	16.6

Variables	N=44^* * When the total does not match, there was loss of information from the variable.	%
Basis diagnosis
HIV/Aids	6	13.4
Transplant	6	13.6
History of anogenital neoplasia	32	72.7
Regular use of medicines in the last six months
Corticosteroid	1	2.3
Immunosuppressant	5	11.6
Antiretroviral	6	14.0
Does not use	31	72.1
Habits (current)
Alcohol abuse	4	9.1
Smoking	2	4.5
Comorbidities (referred to by a doctor)
Hypertension	12	27.3
Diabetes mellitus	-	-
Hyperlipidemia	8	18.2

Exam	Presence of perianal or anal canal lesion by high resolution anoscopy			Accuracy	Sensitivity (CI95%)	Specificity (CI95%)	PPV (CI95%)	NPV (CI95%)	NLR (CI95%)
Presence of perianal or anal canal lesion by direct visualization	Yes	No	Total	60.9	22.7 (12-36.8)	100.0 (93.3-100.0)	100.0 (74.1-100.0)	55.8 (44.6-66.6)	0.8 (0.0-0.95)
Yes	10	-	10
No	34	43	77
Total	44	43	87

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E-mail: revista@imip.org.br

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[1] Authors' contribution

Marinho GA: conception and structuring of the project, sampling, tabbing and data analysis, writing, critical review of intellectual content final approval of the version submitted to publishing. Oliveira MG: conception and structuring of the project, sampling, tabbing and data analysis, writing. Silveira RK: conception and structuring of the project, sampling, tabbing and data analysis, writing, critical review and review of intelectual content. Silva ACCC: data collection, writing, critical and intelectual review. Melo Filho DA: tabbing and data analysis and interpretation. Heraclio AS: project struturing, critical review of intellectual content and approval of final version.