HPV Virus Medical Research - Prognosis

Brown DR, Legge D, Qadadri B. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. darbrow@iupui.edu

BACKGROUND: Women evaluated for sexually transmitted diseases (STDs) may be at increased risk for human papillomavirus (HPV) infection, a condition associated with cervical dysplasia. The distribution of HPV types in such a population is unknown. GOAL: The goal was to determine the prevalence of HPV infection, the distribution of HPV types, and the type distribution in relation to cervical dysplasia in women in an STD clinic. STUDY DESIGN: Cervicovaginal lavage and Papanicolaou smear specimens were obtained from 295 women. Lavage specimens were analyzed for HPV by polymerase chain reaction/reverse blot strip assay. RESULTS: Cervical cytologic findings were abnormal for 19.7% of women. HPV DNA was detected in 49.2% of women (high-risk HPV in 42.4%). HPV positivity correlated with the degree of cytologic abnormality. In women with dysplasia, HPV types 16, 66, 83, 56, 52, and 59 were commonly detected. Specimens containing abundant HPV DNA occurred most often in women with dysplasia. CONCLUSIONS: HPV infection was common in women attending an STD clinic. Numerous individual HPV types were associated with cervical dysplasia, including "low-risk" types.

Infect Dis Obstet Gynecol. 2002;10(4):193-202.

Case-control study of vulvar vestibulitis risk associated with genital infections.

Smith EM, Ritchie JM, Galask R, Pugh EE, Jia J, Ricks-McGillan J. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA. elaine-smith@uiowa.edu

OBJECTIVE: To evaluate the risk of vulvar vestibulitis syndrome (VVS) associated with genital infections in a case-control study. METHODS: Diagnosed cases with VVS (n = 69) and age-frequency-matched healthy controls (n = 65) were enrolled from gynecology clinics in a university medical hospital during 1999. They were compared for potential risk factors and symptoms of disease. RESULTS: VVS cases had a significantly higher risk of physician-reported bacterial vaginosis (BV) (odds ratio, OR = 9.4), Candida albicans (OR = 5.7), pelvic inflammatory disease (PID) (OR = 11.2), trichomoniasis (OR = 20.6), and vulvar dysplasia (OR = l5.7) but no risk associated with human papillomavirus (HPV), ASCUS, cervical dysplasia, genital warts, chlamydia, genital herpes or gonorrhea. Genital symptoms reported significantly more often with VVS included vulvar burning (91 vs. 12%), dyspareunia (81 vs. 15%), vulvar itching (68 vs. 23%) and dysuria (54 vs. 19%) (p < 0.0001). CONCLUSION: A history of genital infections is associated with an increased risk of VVS. Long-term follow-up case-control studies are needed to elucidate etiologic mechanisms, methods for prevention and effective treatment.

Gynecol Obstet Invest. 2003;55(1):25-31.

Long-term administration of intravaginal dehydroepiandrosterone on regression of low-grade cervical dysplasia--a pilot study.

Suh-Burgmann E, Sivret J, Duska LR, Del Carmen M, Seiden MV. Divisions of Gynecologic Oncology and Hematology Oncology, Massachusetts General Hospital, Boston, Mass, USA. Betty.Suh-Burgmann@kp.org

Although many dysplastic cervical lesions regress spontaneously, treatment is common due to concern for progression. Lesions persist or progress in women whose immune systems are unable to clear infection by human papillomavirus (HPV). Dehydroepiandrosterone (DHEA) is an adrenal steroid that has both immune modulatory and tumor inhibitory activity. A pilot study was conducted to examine the feasibility, safety and potential efficacy of intravaginal DHEA in women with low-grade cervical dysplasia. Twelve women with low-grade dysplasia, confirmed by colposcopic exam, were given 150 mg of intravaginal micronized DHEA daily for up to 6 months. Follow-up evaluations of the cervix were done at 3 and 6 months of use. DHEA, DHEA-S, androstenedione and testosterone levels were also measured. By the end of the study period, 10 of the 12 women (83%) had no evidence of dysplasia; the remaining 2 had normal colposcopic exams but cytology showing atypical cells of undetermined significance. There were no serious side effects. Androstenedione levels were elevated at 3 months, whereas testosterone levels were unchanged over the course of treatment. The results suggest that intravaginal DHEA is safe and well tolerated and may promote regression of low-grade cervical lesions. Further study is needed to establish efficacy. Copyright 2003 S. Karger AG, Basel

Publication Types:
• Clinical Trial

Mroueh AM, Seoud MA, Kaspar HG, Zalloua PA. The American University of Beirut-Medical Center, Department of Obstetrics and Gynecology, Lebanon.

PURPOSE: The purpose of this study was to determine the prevalence of human papillomavirus (HPV), and more specifically of HPV 16, in a group of Lebanese women. MATERIALS AND METHODS: Type-specific prevalence of cervical HPV and the presence of cytological abnormalities were determined in a cohort of Lebanese women. The population included 1,026 women, 18-76 years, seeking routine gynecological care at a tertiary care center. Demographic and behavioral data were collected. HPV DNA was detected in cervical scrapes by polymerase chain reaction using consensus primers. Cervical cytological abnormalities were identified by Papanicoleau (Pap) smears. RESULTS: The mean age of our population was 40 +/- 11.3 years. General HPV DNA was detected in 50 patients (4.9%). The high-risk HPV type 16 DNA was detected in 31 patients (3%). Patients with HPV 16 were more likely to have an abnormal pap smear than those with negative tests (6.6% vs 1.6%, p < 0.05), and more likely, but not significantly, to be smokers (21.4% vs 18.4%, p = 0.5). The age-specific prevalence of HPV increased with age and peaked at 60-69 years. CONCLUSIONS: The prevalence of HPV in this small group of Lebanese women is similar to its prevalence in the Mediterranean countries. The presence of HPV, its known association with the development of cervical neoplasia, and the lack of a universal screening program for cervical cancer in our country should be used to enforce implementation of proper screening programs.

J Infect Dis. 2002 Oct 15;186(8):1169-72. Epub 2002 Sep 16.

Human papillomavirus DNA remains detectable longer than related cervical cytologic abnormalities.

Schiffman M, Wheeler CM, Castle PE; Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study Group. Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rm. 7066, EPS MSC 7234, Bethesda, MD 20892-7234, USA. schiffmm@mail.nih.gov

Cervical human papillomavirus (HPV) infections are at high risk of neoplastic progression if they persist. Persistence can be measured by repeated HPV DNA tests or by cytologic testing. Thus, it is useful to understand the relationship between these 2 measurements. To explore the relative timing of HPV DNA clearance versus cytologic regression, data were analyzed from 840 study participants who were followed-up by repeat thin-layer cytology and HPV testing by a hybrid capture test at 6-month intervals for 2 years. On average, HPV DNA detection persisted longer than related cytologic abnormalities (P<.001). HPV type-specific data from a subset of 448 women with complete polymerase chain reaction test data confirmed that HPV DNA persisted longer than cytologic abnormalities (P<.001). It appears that the natural history of HPV typically includes periods before and after cytologic abnormality, in which HPV DNA is the more sensitive indicator of infection.

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