{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:30:17Z","timestamp":1790299817452,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n This study aims to evaluate the longitudinal clearance rates of high\u2010risk human papillomavirus (hr\u2010HPV) and the incidence of clinical recurrence (defined by abnormal cytology or histologically confirmed cervical intraepithelial neoplasia; CIN) at 6 and 18\u2009months post\u2010loop electrosurgical excision procedure (LEEP), characterizing the mathematical boundaries within the complete cohort.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted at Siriraj Hospital, Mahidol University. We evaluated the clinical records of 145 patients diagnosed with CIN 2\u20133 who underwent LEEP between January 2021 and December 2024, analyzing clearance and clinical outcomes over an 18\u2010month surveillance window.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The baseline prevalence of hr\u2010HPV was 99.3% (\n n<\/jats:italic>\n \u2009=\u2009144\/145). At 6\u2009months post\u2010LEEP, the type\u2010specific viral clearance rate was 74.3% (\n n<\/jats:italic>\n \u2009=\u2009107\/144). At 18\u2009months, complete hr\u2010HPV negativity was 75.8% (47\/62) among the evaluable subcohort, representing a conservative baseline minimum of 32.6% (47\/144) when accounting for complete attrition bounds. The overall recurrence rate of CIN or cytological abnormalities was 11.1% (16\/144). Notably, 15 of 16 recurrences were detected at the 6\u2010month interval, of which 73.3% (11\/15) demonstrated concurrent hr\u2010HPV positivity (\n P<\/jats:italic>\n \u2009=\u20090.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Loop electrosurgical excision procedure facilitates significant viral clearance, but persistent hr\u2010HPV serves as a potent biomarker for clinical recurrence. Implementing mandatory HPV\u2010based testing at the 6\u2010month follow\u2010up window optimizes risk stratification, providing critical data to guide surveillance in the presence of follow\u2010up limitations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.71291","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:21:29Z","timestamp":1787037689000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clearance of high\u2010risk human papillomavirus in patients with cervical intraepithelial neoplasia 2\u20133 after the loop electrosurgical excision procedure with negative resection margins"],"prefix":"10.1002","author":[{"given":"Praew","family":"Sittichivapak","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7118-3340","authenticated-orcid":false,"given":"Pattama","family":"Chaopotong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"National Cancer Institute Department of medical services Ministry of public health Thailand.Hospital\u2010based cancer registry 2022.202438:3\u20134."},{"issue":"4","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.14740\/wjon1391","article-title":"Treatment outcomes of patients with cervical intraepithelial neoplasia or invasive carcinoma who underwent loop electrosurgical excision procedure","volume":"12","author":"Khunnarong J","year":"2021","journal-title":"World J Oncol"},{"issue":"12","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","DOI":"10.31083\/CEOG45966","article-title":"Clearance of human papillomavirus (HPV) and associated factors in patients with cervical HPV\u2010associated lesions after Conization","volume":"52","author":"Shan Y","year":"2025","journal-title":"Clin Exp Obstet Gynecol"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/02656736.2021.2010817","article-title":"Clearance of HR\u2010HPV within one year after focused ultrasound or loop electrosurgical excision procedure in patients with HSIL under 30","volume":"39","author":"Qin Y","year":"2022","journal-title":"Int J Hyperthermia"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/LGT.0000000000000525","article-title":"2019 ASCCP risk\u2010based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors","volume":"24","author":"Perkins RB","year":"2020","journal-title":"J Low Genit Tract Dis"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1080\/08941939.2018.1483449","article-title":"The clearance of high\u2010risk human papillomavirus is sooner after thin loop electrosurgical excision procedure (t\u2010LEEP)","volume":"32","author":"Zhang W","year":"2019","journal-title":"J Invest Surg"},{"issue":"1","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12905-023-02360-w","article-title":"Persistent HPV infection after conization of cervical intraepithelial neoplasia\u2013A systematic review and meta\u2010analysis","volume":"23","author":"Zhang Y","year":"2023","journal-title":"BMC Womens Health"},{"issue":"5","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.5468\/ogs.20049","article-title":"Risk factors for type\u2010specific persistence of high\u2010risk human papillomavirus and residual\/recurrent cervical intraepithelial neoplasia after surgical treatment","volume":"63","author":"Ouh YT","year":"2020","journal-title":"Obstet Gynecol Sci"},{"issue":"3","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.ygyno.2020.08.025","article-title":"Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5\u2010year follow\u2010up study","volume":"153","author":"Bogani G","year":"2020","journal-title":"Gynecol Oncol"},{"issue":"3","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0298520","article-title":"The residual rate of HPV and the recurrence rate of CIN after LEEP with negative margins: A meta\u2010analysis","volume":"19","author":"Lin Y","year":"2024","journal-title":"PLoS One"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1111\/aogs.12960","article-title":"Follow up with HPV test and cytology as test of cure, 6 months after conization, is reliable","volume":"95","author":"Asciutto KC","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/LGT.0000000000000526","article-title":"A systematic review of tests for postcolposcopy and posttreatment surveillance","volume":"24","author":"Clarke MA","year":"2020","journal-title":"J Low Genit Tract Dis"},{"issue":"1","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s13027-023-00545-4","article-title":"Post\u2010conization surveillance in an organized cervical screening program with more than 23,000\u2009years of follow\u2010up","volume":"18","author":"Sundqvist A","year":"2023","journal-title":"Infect Agent Cancer"},{"issue":"7","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","DOI":"10.1002\/cam4.70825","article-title":"Optimizing the follow\u2010up interval after successful cold knife Conization of CIN3: A 10\u2010year retrospective cohort study","volume":"14","author":"Fu K","year":"2025","journal-title":"Cancer Med"},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s12032-020-01363-z","article-title":"HR\u2010HPV viral load quality detection provide more accurate prediction for residual lesions after treatment: A prospective cohort study in patients with high\u2010grade squamous lesions or worse","volume":"37","author":"Chen L","year":"2020","journal-title":"Med Oncol"},{"key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12985-019-1252-3","article-title":"HPV16 persistent infection and recurrent disease after LEEP","volume":"16","author":"Bruno MT","year":"2019","journal-title":"Virol J"},{"issue":"10","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jogc.2023.06.006","article-title":"Role of HPV in the prediction of persistence\/recurrence after treatment for cervical 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