Acetowhite staining and its significance in diagnosis of oral mucosal lesions in women with genital HPV infections

Abstract

White staining of genital mucosa after acetic acid application (3-5%) (acetowhiteness) has been commonly regarded as a sign of HPV infection, and acetic acid application is widely used as a routine diagnostic means to screen the HPV infections. However, the sensitivity and specificity of acetowhite staining to detect HPV infections has not been properly studied. The usefulness of acetic acid application in detecting oral HPV infections is not established. In this communication, the oral mucosal changes after acetic acid application were systematically recorded in 315 women prospectively followed-up for genital HPV infections, with special reference to smoking, alcohol consumption, histology, cytology and presence of HPV DNA. Strong and weak acetowhite staining were found in 2% and 38% of the patients, respectively. The mean age of these patients was 30.8 yr in contrast to 37.3 yr of the patients without acetowhite lesions, the difference being significant. In most cases, the staining was widely distributed over the buccal mucosa. Acetowhiteness on oral mucosa was seen significantly more frequently in smokers, but the staining did not show any correlation with alcohol consumption, histologic and cytologic findings, presence of HPV DNA or with glycogen content. The specificity of acetowhite staining to detect HPV DNA was 50%. Vacuolized cells were found significantly more often in PAS-positive biopsies. The mean day of the menstrual cycle of the acetic acid--positive and -negative patients at examination was 14.9 and 11.9, respectively. The results suggest that positive acetic acid staining in oral cavity should not be regarded as a diagnostic criteria for HPV infection.(ABSTRACT TRUNCATED AT 250 WORDS)