Vulvovaginal human papillomavirus infections: clinical implications and management

Article Abstract:

The number of people infected with human papillomavirus (HPV) has increased dramatically during the past 20 years. Condylomata acuminatum (genital warts), which contain HPV, are present in many patients, but many more harbor asymptomatic HPV infection. Effective treatment depends on knowledge of the type of skin on which the virus grows: thus, warts on hair-bearing areas of the anogenital tract are more resistant to chemicals than are those on mucosa. The simplest treatment for HPV infection is bichloroacetic or trichloroacetic acid. The carbon dioxide laser, used when acid treatment fails, can destroy both large and microscopic invasions of HPV. Technical considerations are presented. Alpha-interferon, a substance produced by the body's own cells to fight infection, is also used to treat condylomata acuminata. Fifty-three percent of the patients in one study who received a single injection three times each week for three weeks had complete clearing of their lesion nine weeks after treatment ended. Alpha-interferon is also promising when used after laser treatment to prevent wart recurrence. Neoplasia (abnormal cell growth or differentiation) is believed to begin with HPV infection. Flat warts and cervical-intraepithelial neoplasia (CIN), a malignant condition, can be distinguished clinically. Certain HPV types are associated with each lesion, and a discussion is presented of these HPV subtypes. Vulva intraepithelial neoplasia (VIN) and invasive vulvar cancer are also linked to HPV. HPV is usually transmitted by sexual contact. Because of the association between HPV infection and malignancy, infected patients should be treated promptly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Condyloma acuminatum, Genital warts

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An evaluation of human papillomavirus testing for intermediate- and high-risk types as triage before colposcopy

Article Abstract:

A new test for human papilloma virus (HPV) strains may help determine whether women with abnormal Pap smears should undergo colposcopic examination and biopsy. Colposcopy is an endoscopic examination of the cervix and vagina. Certain strains of HPV have a strong association with cervical cancer. A group of 311 women with abnormal Pap smears were referred to colposcopy clinics. All women had a repeat Pap smear, swabs were taken for evaluation for HPV, and a colposcopic examination and biopsy were performed. Among 44 women with atypical cervical cells, a positive HPV test identified six out of 10 women with severely abnormal cervical cells. When combined with results of the repeat Pap smear, the HPV test increased the number of cases identified from 74% to 91%. However, the HPV test was negative in nine women with severely abnormal cells, including one case of invasive cancer.

Evaluation, Diagnosis, Cervix dysplasia, Cytodiagnosis

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Serologic response to the E4, E6, and E7 proteins of human papillomavirus type 16 in pregnant women

Article Abstract:

Pregnant women may have a lower immunologic response to human papillomavirus type 16 (HPV 16) than nonpregnant women. HPV 16 is a highly-contagious sexually transmitted virus that may cause cervical cancer. HPV infection of the genitals is more common during pregnancy. Researchers measured the immune response to HPV proteins in 77 pregnant and 85 nonpregnant women. Pregnant women had a reduced immune reaction to HPV, particularly to the HPV E4 protein. Reactivity to this protein was also associated with abnormal cervical changes detected by Pap smear.

Papillomaviruses, Papillomavirus, Pregnant women

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