Abstract
We thank Dr. Castle for his constructive and contributory commentary (1) on our meta-analysis of human papillomavirus (HPV) persistence and cervical neoplasia. We agree that ascertaining HPV persistence may have clinical utility and that several issues must be addressed before persistence can be effectively implemented in cervical screening programs. As Dr. Castle mentioned a single HPV test is more sensitive but less specific than a single Papanicolaou test for the detection of cervical precancer and cancer. In fact HPV testing at a single time point has approximately 20-40 percent higher sensitivity than Papanicolaou testing and 5-10 percent lower specificity. Incorporating HPV persistence into routine cervical cancer screening may help to improve specificity without unduly reducing sensitivity by distinguishing women with short-term infections and therefore lower risk of cervical precancer and cancer from women with long-term infections and therefore higher risk. (excerpt)
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