{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:25:53Z","timestamp":1776421553642,"version":"3.51.2"},"reference-count":15,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["UH3CA189883"],"award-info":[{"award-number":["UH3CA189883"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100016982","name":"Rising Tide Foundation","doi-asserted-by":"publisher","award":["CCR-17-800"],"award-info":[{"award-number":["CCR-17-800"]}],"id":[{"id":"10.13039\/501100016982","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Lui and Wan Foundation"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Although concerns have been raised regarding potential infection and morbidity in women undergoing ablation treatment for cervical precancer in low- and middle-income countries (LMIC), there is extremely limited data to substantiate this claim. This is a secondary analysis of a randomized non-inferiority trial (id: NCT03084081) that compares the efficacy and safety of three ablation treatments for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+): CO<jats:sub>2<\/jats:sub> gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA). Here, we present findings regarding the incidence of sexually transmitted infections (STI) and vaginitis post-treatment. Samples were collected at enrollment and again at 6 weeks post-treatment and assessed for STIs (<jats:italic>Chlamydia trachomatis<\/jats:italic> (CT), <jats:italic>Neisseria gonorrhea<\/jats:italic> (NG), and <jats:italic>Trichomonas vaginalis<\/jats:italic> (TV)) and vaginitis (Bacterial vaginosis (BV) and\/or <jats:italic>Candida albicans<\/jats:italic> (Candida)). This analysis reflects 864 women with baseline and 6-week follow-up data. None of the ablative treatments put women at increased risk for STIs (CT, NG, TV) or vaginitis (BV, Candida). While most women adhered to post-treatment recommendations (97%) and no difference by treatment arm was observed, the incidence of STIs at follow-up in women that did not adhere with a given recommendation was higher compared to their adherent counterparts. The incidence of gynecologic infection did not increase with any of the ablation treatments from baseline to the six-week follow-up. Non-gas cryotherapy and TA emerge as safe alternatives to gas-based cryotherapy with respect to gynecologic infection rates.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003333","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T17:41:37Z","timestamp":1720633297000},"page":"e0003333","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3761-858X","authenticated-orcid":true,"given":"Rachel","family":"Masch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4464-6095","authenticated-orcid":true,"given":"Gabriel","family":"Conzuelo-Rodriguez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3256-1702","authenticated-orcid":true,"given":"Jameson A.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karla","family":"Alfaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montserrat","family":"Soler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis F.","family":"Chavez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinfen","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Longhua","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dayana","family":"Marinela-Hernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd A.","family":"Alonzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Felix","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam L.","family":"Cremer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,7,10]]},"reference":[{"key":"pgph.0003333.ref001","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"F Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"pgph.0003333.ref002","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"pgph.0003333.ref003","unstructured":"World Health Organization. Global status report on noncommunicable diseases 2014. 2014. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/148114\/9789241564854_eng.pdf?ua=1."},{"key":"pgph.0003333.ref004","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ijgo.2012.10.014","article-title":"Meta-Analysis of the effectiveness of cryotherapy in the treatment of cervical intraepithelial neoplasia","author":"C Sauvaget","year":"2013","journal-title":"International Journal of Gynecology and Obstetrics. Int J Gynaecol Obstet"},{"key":"pgph.0003333.ref005","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1111\/tmi.13315","article-title":"Acceptability and safety of thermal ablation for the treatment of precancerous cervical lesions in Honduras","volume":"24","author":"M Sandoval","year":"2019","journal-title":"Tropical Medicine & International Health"},{"key":"pgph.0003333.ref006","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1002\/ijc.30101","article-title":"Use of thermo-coagulation as an alternative treatment modality in a \u2018screen-and-treat\u2019 programme of cervical screening in rural Malawi","volume":"139","author":"C Campbell","year":"2016","journal-title":"Int J Cancer"},{"key":"pgph.0003333.ref007","unstructured":"Guidelines Review Committee. WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. Who.int. World Health Organization; 2019. 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