Novel and Emerging Strategies
Emerging Testing Strategies
Biospectroscopy. Biospectroscopy is the examination of the wavelength of light reflected from specimens of living tissue or body fluids (Kelly 2011). This technique has been investigated as a screening tool for cervical cancer. A review of biospectroscopy as a screening tool for precancerous abnormalities of the cervix noted that it can identify different grades of dysplasia (Purandare 2013). Another study found that biospectroscopy was superior to the Pap test for identifying cervical abnormalities (Gajjar 2013). Further research is needed before biospectroscopy is incorporated into cervical screening programs.
DNA methylation testing. DNA methylation analysis is a promising new technology for HPV testing. Studies have found that the methylation status of certain sites within the DNA of HPV 16 are associated with CIN. This may allow a type of viral testing to predict actual risk for cervical abnormalities (Mir 2014). One study found that the combination of cervical cell testing (Pap test and colposcopy) and DNA methylation testing was highly effective for detecting high degrees of cervical dysplasia and cancer. DNA methylation testing plus colposcopy has been noted as a promising strategy for detecting cervical cancer and advanced CIN in HPV-positive women (De Strooper 2014).
At-home HPV testing. An at-home HPV test, called the UDoHPVTest, is available. This tests for HPV strains 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The cost of the test is $140. Purchase price includes laboratory analysis and a physician review, online storage of the test results, and free counseling and support. The manufacturer states that the test is as accurate as those performed at approved clinical laboratories because it uses comparable methodology. The test can be purchased at https://www.udotest.com/test/udo-hpv-test (UDo HPV Test 2014).
HPV immunotherapy. Positive results were obtained in a clinical trial of a new immunotherapeutic drug, VGX-3100, in women with biopsy-proven CIN II or CIN III associated with HPV types 16 or 18. The trial found that treatment with VGX-3100 resulted in significant regression of CIN II or CIN III to CIN I or no disease. In addition, the trial demonstrated significant clearance of HPV together with regression of cervical lesions in over 40% of treatment group participants, versus only 14.3% of control subjects. VGX-3100 works by eliciting a powerful immune response to specific vulnerable antigens expressed by HPV strains 16 and 18. Robust immune cell activity, as measured by CD4+ and CD8+ T-cell function and antibody titers, was detected in women who received VGX-3100, compared with those who received placebo (DDD 2014; Bagarazzi 2012; Gulzar 2004).
Carrageenan-based vaginal gel. Carrageenan is a compound extracted from edible red seaweeds; it is a complex sugar molecule that is widely used as a food additive. Carrageenan has been found to inhibit HPV infection in laboratory and animal studies (Yermak 1999; Rodríguez 2014). A randomized, controlled trial compared Carraguard, a carrageenan-based vaginal gel, plus condoms to placebo gel plus condoms for prevention of high-risk HPV infection. Among women who complied with use instructions for Carraguard, the prevalence of high-risk HPV infection was reduced by 38% (Marais 2011).
High-Dose Vitamin D Vaginal Suppositories
A trial compared vitamin D vaginal suppositories to a lactobacillus probiotic suppository for the treatment of cervical dysplasia. The vitamin D suppositories, which contained 12 500 IU vitamin D per dose, were used three nights per week for six weeks. The women in the trial suffered from either recurring chronic cervical fungal or bacterial infections, or CIN I or II dysplasia. The investigators reported that, compared with lactobacillus suppositories, vitamin D vaginal treatment showed “very good” anti-inflammatory effects, with patients reporting a high degree of satisfaction with the results of the vitamin D treatment, and only 7% experiencing persistence of fungal or bacterial infection. The authors concluded that vaginal vitamin D treatment had “good anti-dysplastic effects” against CIN I after six weeks. They cautioned that the safety of this vitamin D treatment during pregnancy is unknown (Schulte-Uebbing 2014).