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Cervical cancer screening in north east Thailand using the visual inspection with acetic acid (VIA) test and its relationship to high-risk human papillomavirus (HR-HPV) status


Dr Chamsai Pientong, Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. Email:


Aim:  This study investigated the utility of visual inspection with acetic acid (VIA) as a method for cervical cancer screening in Thailand and examined the relationship of VIA to high-risk human papillomavirus (HR-HPV) status.

Methods:  Cervical cells were collected from 160 patients receiving a Pap smear. VIA was performed on the cervix of the patients by application of 5% acetic acid. HPV screening of DNA extracted from cytology samples was performed by PCR using the GP5+/6+ primer system followed by reverse line blot hybridization genotyping.

Results:  The majority (96.9%) of the patients were diagnosed with normal or inflammatory cytologic changes. 32.8% of normal cytology and 42.0% of inflammation cases showed positive acetowhite staining. 3.1%, 38.1% and 42.5% of subjects were positive for an abnormal Pap test, VIA test, and HPV DNA, respectively. VIA demonstrated 50% sensitivity and 66.7% specificity for abnormal histology with PPV and NPV values of 50% and 66.7%, respectively, whereas HPV DNA test showed 100% sensitivity. HPV16 was the most common (54.4%) and HR-HPV was detected in 36.3% of all cases. 48.5% of HR-HPV positive and 36.8% of HR-HPV negative cervices stained with acetowhite following the VIA test.

Conclusion:  The VIA test is a simple method for cervical cancer screening; however, a significant proportion of patients with normal or inflammatory cytology were positive by this test. Further, HR-HPV in women without acetowhite staining was demonstrated. Therefore, some form of HR-HPV detection test may be required for combination with cervical cell screening even in low-resource nations.

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