Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial

Rachel Masch ^1,2, Gabriel Conzuelo-Rodriguez ², Jameson A Mitchell ³

¹Department of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai Hospital, New York, New York, United States of America.
²Basic Health International, Pittsburgh, Pennsylvania, United States of America.
³Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America.
⁴Obstetrics, Gynecology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
⁵Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
⁶Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
⁷Hospital Primero de Mayo, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador.
⁸Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America.
⁹Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.

⁰Department of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai Hospital, New York, New York, United States of America.

Plos Global Public Health +

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July 10, 2024

View abstract on PubMed

Summary

Cervical ablation treatments for precancer do not increase the risk of sexually transmitted infections (STI) or vaginitis. Non-gas cryotherapy and thermal ablation are safe alternatives to gas-based cryotherapy, with adherence to post-treatment care being crucial for preventing infections.

Area Of Science

Gynecology
Infectious Diseases
Public Health in Low- and Middle-Income Countries (LMIC)

Background

Concerns exist regarding infection risks associated with cervical precancer ablation treatments in LMICs.
Limited data currently substantiates these concerns.
Cervical intraepithelial neoplasia grade 2 or higher (CIN2+) requires effective and safe treatment options.

Purpose Of The Study

To evaluate the incidence of sexually transmitted infections (STI) and vaginitis following three different ablation treatments for CIN2+.
To compare the safety profiles of CO2 gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA) regarding gynecologic infections.
To assess the impact of post-treatment adherence on infection rates.

Main Methods

Secondary analysis of a randomized non-inferiority trial (NCT03084081) involving 864 women with CIN2+.
Collection of samples at baseline and 6 weeks post-treatment to assess for STIs (Chlamydia trachomatis, Neisseria gonorrhea, Trichomonas vaginalis) and vaginitis (Bacterial vaginosis, Candida albicans).
Comparison of infection incidence across three ablation treatment arms and between adherent and non-adherent patient groups.

Main Results

None of the evaluated ablation treatments (CO2 gas-based cryotherapy, non-gas cryotherapy, TA) increased the risk of STIs or vaginitis.
The incidence of gynecologic infections did not significantly increase from baseline to 6-week follow-up across all treatment groups.
Women not adhering to post-treatment recommendations showed a higher incidence of STIs compared to those who adhered.

Conclusions

Cervical ablation treatments for CIN2+ are safe concerning STI and vaginitis incidence.
Non-gas cryotherapy and thermal ablation are safe alternatives to gas-based cryotherapy regarding gynecologic infection rates.
Adherence to post-treatment care is important for minimizing STI risk after cervical ablation.

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