Vaginal Ultrasound Probes Should Be Covered With Condom To Reduce HPV Infection Risk Interview with:
Andrew Combs MD
Alan Fishman MD

Obstetrix Medical Group
San Jose, California What is the background for this study?

Response: Vaginal ultrasound is a common procedure in gynecology and obstetrics. To perform vaginal ultrasound, an ultrasound probe is placed in the vagina in order to get a close-up view of a woman’s pelvic organs. In non-pregnant women, this is the preferred method for ultrasound of the uterus and ovaries. In early pregnancy, vaginal ultrasound often yields better images of the developing embryo than abdominal ultrasound. In later pregnancy, vaginal ultrasound gives more accurate pictures of the cervix and placenta than abdominal ultrasound.

In order to prevent transmission of disease from patient to patient, it is mandatory to clean and disinfect the probe after each vaginal exam. The FDA has a list of “high level” disinfectants that neutralize or kill a variety of bacteria and viruses. Several manufacturers make disinfectant systems that are approved for disinfection of ultrasound probes.

It is also mandatory to cover the probe with a barrier during each exam. Various companies manufacture ultrasound probe covers intended to be barriers against infection. What are the main findings?

Response: Recent studies found that two widely-used disinfectants (glutaraldehyde and ortho-ophthalaldehyde) do not neutralize human papilloma virus (HPV) even though they are on the FDA list of high level disinfectants. HPV is the most common sexually transmitted infection in the USA, affecting over 8 million women of reproductive age. HPV is responsible for 60% of cervical cancer worldwide. Clearly, it is critical to neutralize this virus on vaginal ultrasound probes. A different high-level disinfectant system, sonicated hydrogen peroxide, was found to be highly effective at neutralizing HPV.

Other studies show that commercial ultrasound probe covers have a high rate of leakage, 8-81%. Condoms are safer probe covers, with leakage rates of 0.9 to 2%. What should clinicians and patients take away from your report?

Response: Providers who perform vaginal ultrasound should cover the probe with a condom rather than a commercial probe cover during the examination.
Providers should use sonicated hydrogen peroxide to disinfect the probe after each vaginal ultrasound examination.
Alternative disinfectants might be acceptable if they have proven capability to neutralize HPV. But simply being listed as a “high level” disinfectant does not guarantee that an agent is actually effective against HPV.

Patients having vaginal ultrasound may want to ask their provider about what practices the provider uses to disinfect and cover the ultrasound probe. What recommendations do you have for future research as a result of this study?

Response: We recommend that the FDA require testing against HPV in order for a chemical to be approved as a “high level” disinfectant.

We recommend that manufacturers of chemicals and equipment for cleaning ultrasound probes actually test their systems for the ability to neutralize HPV. Is there anything else you would like to add?

Response: To our knowledge, there have not been any reported cases of HPV being transmitted by vaginal ultrasound.
Our “call-to-action” is intended to encourage safer practices in order to prevent any such cases.
There is no reason for providers to wait for a proven case before adopting safest practices. Thank you for your contribution to the community.


A Proposal to Reduce the Risk of Transmission of Human Papilloma Virus via Transvaginal Ultrasound

Publication stage: In Press Accepted Manuscript

American Journal of Obstetrics & Gynecology

Published online: March 16 2016

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Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Andrew Combs MD, & Alan Fishman MD (2016). Vaginal Ultrasound Probes Should Be Covered With Condom To Reduce Infection Risk