Cervical Intraepithelial Neoplasia Clinical Trial
Official title:
Use of Condoms in Prevention of Progression of Cervical Intraepithelial Neoplasia: A Randomized Controlled Trial.
Women who are diagnosed with CIN2 and who have a pregnancy wish are followed up 6 months
after the diagnosis with new examinations. The regression rate is based solely on the woman's
own ability to clear the cervical lesions. The use of condoms has shown a relatively good
protective effect against Human Papillomavirus (HPV) infection. It has furthermore been
indicated that condoms increase the regression rate of cervical lesions.
The hypothesis of this study is that the regression rate of cervical intraepithelial
neoplasia grade 2 (CIN2) increases when condoms are used consistently in the follow-up period
of 6 months.
Use of condoms has shown a considerable protective effect, when used correctly and
consistently, against several sexually transmitted infections (STI), including HIV virus,
trichomoniasis, chlamydia, and gonorrhea. It has been indicated that use of condoms also
offers a relatively good protection against HPV infections. It is furthermore indicated that
use of condoms in women with CIN may increase the regression rate of these lesions.
The aim of this randomized controlled trial is to determine if advising women to use condoms
during the follow-up period after a CIN2 diagnosis will increase the regression rate. The
advice is based on the presumption that condom use will prevent HPV-infection and reinfection
to some extent and thereby allow the immune system to clear the HPV-infection and "repair"
the CIN-lesion. Based on the literature, we expect regression in non-condom users to be
around 22% and regression in condom-users to be 2.5 times larger.
The clinical trial will be conducted as a randomized non-blinded controlled trial. The study
will be conducted at hospital- and gynecological outpatient clinics in Central Region Denmark
and Region Zealand.
The gynaecologists will obtain oral and written consent from women with an abnormal cytology
to allow the project physician to contact them by telephone. The written consent will be
compared to a list from the national pathology register for all diagnosed CIN2 in the
relevant regions. If there is a match between the two documents, the gynecologists will be
contacted to find out if the woman has been informed about the biopsy result and a follow-up
after 6 months has been decided. If this is the case, the woman will be included in the study
and randomized.
We expect 700 women to be randomized into an intervention- and a control arm. Women in the
intervention arm will receive information about the project by telephone by the project
physician. The intervention arm will thereafter be subdivided into a condom group and a
non-condom group based on the women's acceptance of the intervention. Women in the condom
group will be provided with free condoms for the entire study period. The project physician
will not contact women in the control group.
From the routine samples taken at the first visit and at the follow-up examination, an HPV
test will be requested from the pathology departments for the women in the condom group. The
women are also asked to fill out a questionnaire at the follow-up. The information from the
questionnaire is used to estimate compliance to the condom use and to have background
information about the women in the condom group.
The study is approved by the Data Protection Agency and the Ethical Committee of the Capital
Region of Denmark. The total period of time in which the trial is planned to include women is
one year having the last woman to her follow-up visit 18 months after the beginning of the
trial. The inclusion period is expected to commence 15.09.16 and end 15.09.17.
Randomization will be conducted electronically by the statistician of the department but
neither the investigator nor the patient will be blinded as it is not possible for this study
design. Data for the study will be collected from registers and from the questionnaires. All
final results from the study will be published in relevant international journals.
The project is supported by funds and we have received a sponsorship for condoms. The
sponsors had no influence on the study design, and will have no influence on the data
collection, analysis and reporting.
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