Atypical Squamous Cells of Undetermined Significance: Human Papillomavirus Testing in Adolescents

Abstract

The authors performed a medical chart review of all women diagnosed with atypical squamous cells of undetermined significance (ASCUS) between July 2002 and February 2004 to determine the presence of oncogenic human papillomavirus (HPV) according to patient age. Other risk factors were also noted. Cervical smears were evaluated using fluid-based thin-layer cytology (PreservCyt; Cytyc Corp., Marlborough, MA). Sufficient information for analysis was available in 527 women, of whom 357 (68%) were infected with oncogenic HPV types. Patient age and marital status were significantly associated with positive HPV results. The overall mean age of those with HPV was 25 years compared with 27.8 years for noninfected women, and women 19 years of age or younger were more often positive than those over 25 years of age (77% vs. 58%, P < 0.01). Eighty percent (n = 260) of women who had never been married were infected with HPV compared with 73% (n = 121) of those who had been married or were cohabiting (P = 0.02). A history of any sexually transmitted disease (STD) was more common in women with HPV infection (54% vs. 40%, P < 0.001). Among all STDs, only Chlamydia trachomatis had a significant influence on HPV positivity (P = 0.002). Oncogenic HPV was more common in women who were not using any form of contraception (46% vs. 39%, P < 0.007) and less common in women who had undergone tubal sterilization (P = 0.05) or who were using oral contraceptives (P = 0.15). Multivariate of possible risk factors for oncogenic HPV infection, including race, insurance status, smoking status, prior abnormal cervical cytology, and prior treatment for neoplasia. was performed. Patient age below 20, current smoking, and a history of C. trachomatis had a positive association with HPV infection. Women who had ever been treated for cervical neoplasia and current oral contraceptive users were more likely to have negative results for HPV infection. The protection of oral contraceptive was greatest among adolescents.