{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T20:43:06Z","timestamp":1743540186204,"version":"3.40.3"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>\nBackground\n<\/jats:title>\n<jats:p>Women with MS (wwMS), particularly ones in low-income settings, and exposed to disease-modifying therapy (DMT), could have specific gynecological health-related issues.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>\nAim\n<\/jats:title>\n<jats:p>To assist policy making and lead further research by describing the current status of gynecological health and Pap test results in wwMS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>Cross-sectional study on wwMS living in Isfahan, Iran. Participants were surveyed and referred for a Pap test, results of which were compared with 1:2 age- and socioeconomic status-matched healthy controls (HC). Primary outcome was the degree of non-benign squamous\/glandular cell abnormalities. Secondary outcomes were presence of evidence of infection, and the degree of benign inflammatory\/reactive changes. Logistic regression models were utilized for analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>197 wwMS were included (mean age [SD], 41.2 [8.3]; median EDSS (IQR) 1.5 [0.5]). 74.1% reported having sexual activity more than once per week in the past year. For contraception, 21.6% and 16.8% used calendar-based methods and male condoms, respectively. 7% had contracted a gynecological infection in the past. Only 1% had received HPV vaccination. Compared to HC, benign reactive\/inflammatory changes in Pap tests were less frequently seen in the wwMS (OR: 0.3; 95% CI: 0.2, 0.4; <jats:italic>p<\/jats:italic> &lt;\u2009 0.001), while evidence of infection was seen more frequently (OR: 11.5, 95% CI: 3.3, 40; <jats:italic>p<\/jats:italic> &lt;\u2009 0.001). Results were consistent across DMT groups except anti-CD20 therapies. Additionally, the frequency of non-benign changes in wwMS was two times of that in the HC, but the study lacked adequate power to confirm statistical significance (1.5% vs. 0.8%, OR: 2; 95% CI: 0.4, 10.1; <jats:italic>p<\/jats:italic> =\u2009 0.39).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>\nConclusion\n<\/jats:title>\n<jats:p>There is room for improvement of the gynecological health status of wwMS who live in low-income settings. Also, findings support an immune dysfunction in the cervices of DMT-exposed wwMS. Additionally, further research is merited to determine the risk of changes of malignant potential in cervices of wwMS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320069","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T19:37:01Z","timestamp":1743190621000},"page":"e0320069","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gynecologic health of women with multiple sclerosis: An overview on the current status and findings of Pap tests in a low-income setting"],"prefix":"10.1371","volume":"20","author":[{"given":"Masoud","family":"Etemadifar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6812-3404","authenticated-orcid":true,"given":"Shima","family":"Shoeib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehri","family":"Salari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammadreza","family":"Etemadifar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2796-6791","authenticated-orcid":true,"given":"Nahad","family":"Sedaghat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"issue":"11","key":"pone.0320069.ref001","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/S1474-4422(06)70581-6","article-title":"Sex ratio of multiple sclerosis in Canada: a longitudinal study","volume":"5","author":"S-M Orton","year":"2006","journal-title":"Lancet Neurol"},{"issue":"2","key":"pone.0320069.ref002","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1212\/01.wnl.0000316802.35974.34","article-title":"Temporal trends in the incidence of multiple sclerosis: a systematic review","volume":"71","author":"A Alonso","year":"2008","journal-title":"Neurology"},{"issue":"2","key":"pone.0320069.ref003","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1177\/1352458517751049","article-title":"ECTRIMS\/EAN Guideline on the pharmacological treatment of people with multiple sclerosis","volume":"24","author":"X Montalban","year":"2018","journal-title":"Mult Scler"},{"issue":"7","key":"pone.0320069.ref004","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1001\/jamaneurol.2023.1184","article-title":"Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis","volume":"80","author":"T Kalincik","year":"2023","journal-title":"JAMA Neurol"},{"key":"pone.0320069.ref005","unstructured":"Institute for Quality and Efficiency in Health Care (IQWiG). 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