Human Papilloma Virus - Hpv In Women

Human Papilloma Virus - Article in French

Human papillomaviruses (HPV) are the most prevalent sexually-transmitted agents worldwide. HPV are small circular double-stranded DNA epitheliotropic viruses that exhibit either cutaneous or mucosal specificity. Most HPV infections are self-limiting and are spontaneously cleared within months or years. However, infections may persist and result in a variety of benign, pre-malignant and malignant tumors. Cytological and histopathological abnormalities associated with HPV infections of the male and female lower anogenital tract include condylomata, low-grade and high-grade squamous intraepithelial lesions which are incipient cancers, and squamous cell carcinomas. The modal time between HPV infection occurring in the late teens or early 20 s and precancer peaking around 30 years of age is 7-10 years. Women detected with invasive cancers tend to be an average 10 years older than women with high-grade disease. The natural history of cervical cancer reveals that infection with high-risk types may lead to low-grade or high-grade intraepithelial lesions. High-grade lesions may progress to cervical carcinoma if not treated. The purpose of screening, in addition to detecting cervical cancers at an early stage, is to detect and remove high-grade lesions and thus prevent the potential progression to cervical carcinoma. Early detection of cervical neoplasia is possible with regular Pap smears performed from 21 to 70 years of age. In case of abnormal Pap smear, a biopsy performed under colposcopy will allow the diagnosis of cervical lesion. Cancer of the cervix is the second leading cause of cancer related deaths among women across the world (3,400 new cases in France in 2000).

J Low Genit Tract Dis. 2004 Jul;8(3):217-223.

Human Papillomavirus and Abnormal Pap Test Results in Vietnamese-American Women: A Pilot Case-Control Study.

Vo PD, Nguyen TT, Nguyen P, Hilton JF, Palefsky JM, Ma Y, McPhee SJ. 1School of Medicine, 2Division of General Internal Medicine and Vietnamese Community Health Promotion Project, 3Department of Epidemiology and Biostatistics, 4Department of Medicine, and 5Department of Adolescent Medicine, University of California, San Francisco, San Francisco, CA; and the 6Santa Clara Valley Health and Hospital System, Santa Clara, CA.

OBJECTIVE.: To evaluate the relationship between abnormal Pap test results and human papillomavirus (HPV) in Vietnamese-American women, who have the highest cervical cancer incidence in the United States. MATERIALS AND METHODS.: In 2001, we obtained specimens from 117 Vietnamese women, 24 with abnormal Pap test results including atypical squamous cells of undetermined significance (cases) and 93 with normal Pap test results (controls), as classified by the 1991 Bethesda System. We used L1 consensus primers MY09/MY11 to perform HPV polymerase chain reaction analysis and type-specific probes to perform genotyping. RESULTS.: Thirteen cases (54%) and 6 controls (6%) were HPV positive (p < .001). Ten of 24 cases (42%) and 0 controls (0%) had high-risk HPV types (16, 18, 45, 53, 56, or 66; p < .001). High-risk HPV types were significantly associated with increasing severity of Pap test results. CONCLUSIONS.: Compared with those with normal Pap test results, Vietnamese-American women with abnormal Pap test results were more likely to have high-risk HPV types. Higher cervical cancer incidence among these women is likely the result of less frequent Pap screening rates and not different biology.

nt J STD AIDS. 2005 Mar;16(3):247-51.

Human papillomavirus prevalence at the USA-Mexico border among women 40 years of age and older.

Giuliano AR, Papenfuss MR, Denman CA, de Zapien JG, Abrahamsen M, Hunter JB. The Moffitt Cancer Center and Research Institute, Tampa, Florida, USA. agiuliano@azcc.arizona.edu

The incidence of cervical cancer increases with age among USA Hispanics and women living in Latin America starting in the fourth decade of life. We conducted a study of women > or = 40 living at the USA-Mexico border to determine the prevalence and risk factors for human papillomavirus (HPV) infection detected by polymerase chain reaction. In all, 9.2% of participants tested HPV positive. Compared with women aged 50-59, odds ratios of 8.82 and 6.67 were observed for women > or = 60 and 40-49, respectively. Among women aged 40-49, both oncogenic and non-oncogenic HPV infections were detected; however, women > or = 60 were positive for predominantly oncogenic genotypes. HPV risk significantly increased with > or = 2 lifetime sexual partners in adjusted models. These data suggest that the prevalence of HPV infection may have a second peak among post-menopausal Hispanic women.

Br J Cancer. 2005 May 9;92(9):1794-9.

Human papillomavirus infection in women who develop high-grade cervical intraepithelial neoplasia or cervical cancer: a case-control study in the UK.

Grainge MJ, Seth R, Coupland C, Guo L, Rittman T, Vryenhoef P, Johnson J, Jenkins D, Neal KR. 1Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham Medical School, Nottingham NG7 2UH, UK.

Human papillomavirus (HPV) testing might identify older women who could be withdrawn from the cervical screening programme, or require less frequent screening. A case-control study using the United Kingdom cervical screening population was set up to help address this issue. Cases comprised 575 women who developed cervical intraepithelial neoplasia (CIN) grade 2 or worse over a 13-year period following a cytologically normal baseline smear, and were stratified by age group ('under 20', '20-39' and 40 years or over). Controls (n=601) were women who remained disease free over this interval and were the same age on average as cases. DNA was extracted from the baseline smears and tested for HPV by PCR using GP5+/6+ consensus primers. HPV+ samples were tested for HPV types 16 and 18 using specific PCR primers. In all, 27.0% of cases tested positive for HPV at baseline, compared with 15.4% of controls (odds ratio (OR)=2.00; 95% confidence interval (CI), 1.50-2.68). Among women aged 40 years or over, the OR for HPV 16 was 8.95 (95% CI, 2.63-30.4). These results support the need for further cervical screening of HPV- older women, as many of the cases were HPV- at baseline.British Journal of Cancer (2005) 92, 1794-1799. doi:10.1038/sj.bjc.6602538 www.bjcancer.com Published online 12 April 2005.

Med Arh. 2005;59(1):47-51.

Prevalence of human papillomavirus infection in Slovenian women with repeated Pap II smears

Human Papilloma Virus - Article in Bosnian

In the detection of precancerous lesions the cervical Papanicolaou smear screening is used in Slovenia and worldwide. Management of patients with repeat abnormal smears (Pap II) represents a great and complex clinical and public health problem. Repeated cytologic examinations are routine procedure in many countries, also in Slovenia, although the sensitivity of Pap smear testing in the detection of cervical intraepithelial neoplasia (CIN) II and III is relatively low. In cases of abnormal squamous cells and mildly dyskaryotic cells the presence of infections with high-risk HPV genotypes is being increasingly used as a complementary method to Pap smear testing. In the study we enrolled 148 cervical samples of women who within two years had three subsequent Pap II smears (abnormal squamous cells or mildly dyskaryotic cells). The prevalence of HPV infections was determined using three molecular tests: Hybrid Capture 2 (hc2) test and two variants of polymerase chain reaction (PCR-PGMY11/PGMY09 and PCR-CPI/CPIIG). HPV infection was detected in 25.7% of women. In women aged < or = 30 years a statistically significant higher prevalence of HPV infections was found (37.8%) than in women aged > 30 years (20.4%). Our findings show that repeat Pap smear as the method of follow-up and detection of precancerous lesions of the observed population do not provide relevant results due to low prevalence of HPV infections in Slovenia, which indirectly indicates low sensitivity and specificity of Pap smear testing. In the detection of HPV infections, molecular methods are thus sensitive screening tests to be used complementary to cytologic tests in women with abnormal squamous cells and mildly dyskaryotic cells.

Curr Opin Obstet Gynecol. 1993 Aug;5(4):521-6.

Sexually transmitted diseases in adult, non-pregnant women.

Hoyme UB. Department of Obstetrics and Gynaecology, University of Essen, Germany.

Most of the publications reviewed focus on human papillomavirus (HPV), and a small proportion on herpes simplex virus (HSV), Chlamydia trachomatis, as well as the syndromes of pelvic inflammatory disease and bacterial vaginosis. The present hypothesis associates cervical intraepithelial neoplasia (CIN)-1 with high oncogenic risk HPV types in less than 30% of cases; whereby CIN-2 and CIN-3 are associated with a 90% risk. However, on the basis of HPV types, four categories ['low risk' (HPV 6/11, 42, 43, 44); 'intermediate risk' (HPV 31, 33, 35, 51, 52, 58); 'high risk/HPV 16'; and 'high risk/HPV 18'] for the associated risk for a high-grade lesion or an invasive cancer can also be defined. In practice it appears efficient to re-evaluate patients with oncogenic types in association with low-grade cytology, as well as women with high-grade cytology or suspicious colposcopy in narrow intervals. Several reports have suggested that HPV genital infections are multifocal; however, HPV DNA was also found in the lymph nodes and in the granulocytes of women with cervical cancer, in ovarian and endometrial tissue, in tumours of the urinary bladder, and in mammary ductal carcinoma.

Publication Types:
• Review

Human Papilloma Virus - HPV in Women Links

Cervical Dysplasia Treatments - Descriptions of various procedures used in the treatment of cervical dysplasia. Includes LEEP, laser ablation, cone biopsy, and cryosurgery.

Stories from Survivors - From the "Eyes on the Prize" site - stories told by women who have overcome gynecological cancer.