Cervical Papillomavirus Infection Research Articles

Traditional Chinese Medicine Combined with Routine Nursing on Patients with Cervical Human Papillomavirus Infection

Cervical papillomavirus infection is a common disease in women. The risk of permanent infection is the main reason for cervical HPV and its advanced acanthosis. The last time, the incidence rate of cervical papillomavirus is only different from that of malignant tumor women. The trend of young tumors is more and more obvious. Therefore, the treatment of parasitic lesions is very important to prevent or reduce the occurrence of cervical HPV. This paper aims to study the effect of traditional Chinese medicine combined with routine nursing on patients with cervical human papillomavirus infection. The application of traditional Chinese medicine therapy to promote the postoperative rehabilitation of patients with cervical human papillomavirus infection has significant effect, which is of great significance for clinicians in the future work. In this paper, through the introduction of traditional Chinese medicine and traditional Chinese medicine oral and external use combined with routine nursing methods, through the follow-up experimental investigation method to study the cervical human papillomavirus infection rate and the effect of cervical human papillomavirus infection patients after operation, it is proved that the effect of traditional Chinese medicine oral and external use combined with routine nursing on cervical human papillomavirus infection patients is better. The results show that 54% of the cervical HPV infection rate makes people pay more and more attention to cervical HPV. The infection investigation and genotyping can effectively judge the prognosis of patients, which has extremely important clinical significance.

Prevalence and Type Distribution of Human Papillomavirus Recovered from the Uterine Cervix of Nigerian Women: A Systematic Review and Meta-Analysis

Background:Infection with an oncogenic type of human papillomavirus is a prerequisite for the development of precancerous cervical lesions and its subsequent progression to cervical cancer. With an alarming increase in the detection of other suspicious papillomavirus genotypes in both healthy and women with cervical lesions, there is a need for comprehensive data on cervical papillomavirus infection to address cervical cancer and other associated disease burden, especially in Sub-Sarahan Africa, where the bulk of the problem exists. The present study was conducted to develop comprehensive data on the prevalence and circulating genotypes of human papillomavirus in various risk categories in Nigeria. Methods:A systematic review and meta-analysis of peer-reviewed publications on cervical papillomavirus infection were performed. Relevant data were extracted from eligible studies published in PubMed, Web of Science, Embase, Scopus, and Google Scholar, from inception to July 31, 2019. The random-effect model was used to estimate the pooled prevalence. We identified 327 potential studies and pooled data from 18, involving 5697 women aged 15-86 years. Results:The overall pooled prevalence of cervical papillomavirus infection was 42% (95%CI: 30-54%) in the general population and 37% (95%CI: 25-50%) among women living with HIV/AIDs, with the predominance of genotypes 16, 18, 31, 35, 52, 58 and 45. The highest prevalence was observed in teenagers and young adults and the second peak in women 50 years and above. Conclusion:The prevalence of cervical human papillomavirus infection is cumulatively high in Nigeria and HIV is a strong co-factor. We, therefore, strongly recommend the co-screening of human papillomavirus and cervical cancer and integration of the intervention strategy into the existing HIV-care guideline in Nigeria.

Interferon lambda4 polymorphism is not associated with human papillomavirus infection outcome.

Interferon (IFN) lambdas are important specific components of the mucosal innate immune response. The IFN lambda 4 (IFNL4) dinucleotide polymorphism (ΔG/TT) determines the IFN lambdas and related Interferon-stimulated genes activation, in HCV and other chronic infections. Our group first reported that IFN Lambda response was impaired in high-risk Human Papillomavirus (HPV) cervical infections and in precancerous lesions. Accordingly, we sought to evaluate the possible role of the IFNL4 polymorphism in determining HPV infection outcome. The ΔG/TT alleles were not differently distributed in 221 women with high- or low-risk HPV infection, with HPV infection clearance or persistence, and with abnormal cytology.

Changes in myeloid-derived suppressor cells (MDSC), Treg and Th17 cells in peripheral blood of patients with cervical human papillomavirus (HPV) infection

Objective To investigate the changes in myeloid-derived suppressor cells (MDSC), regulatory T cells (Treg) and T helper 17 (Th17) cells in peripheral blood of patients with HPV infection and cervical diseases including ectopic cervical columnar epithelium (CE), cervical intraepithelial neoplasia (CIN) and cervical squamous cell carcinoma (CC), and to analyze the roles of MDSC, Treg and Th17 cells in the development of cervical diseases. Methods This study enrolled 120 HPV-positive patients with cervical diseases (18 cases of CE, 50 cases of CIN, 52 cases of CC), 20 HPV-negative patients with cervical diseases (10 cases of CE and 10 cases of CIN) and 20 healthy subjects from March 2011 to December 2016. Changes in MDSC, Treg and Th17 cells in peripheral blood of all patients were detected by flow cytometry. Results Percentages of MDSC, Treg and Th17 cells in peripheral blood of patients who were positive for HPV were significantly higher than those in HPV-negative patients (P<0.05). Besides, percentages of these cells gradually increased with the exacerbation of cervical disease (CE-CINⅠ-CINⅡ-CINⅢ-CC) (P<0.05). Patients who were infected with high-risk HPV had significantly higher percentages of MDSC, Treg and Th17 cells in peripheral blood than those infected with low-risk HPV (P<0.05). Changes of MDSC, Treg and Th17 cells in peripheral blood of HPV-positive patients with cervical cancer were related to International Federation of Gynecology and Obstetrics (FIGO) stage, tumor differentiation, lymph node metastasis and vascular invasion (P<0.05). MDSC, Treg and Th17 cells in peripheral blood of all patients were significantly reduced after treatment (P<0.05). Patients whose status changed from HPV-positive to HPV-negative following treatment also showed significantly decreased MDSC, Treg and Th17 cells in peripheral blood as compared with those who remained HPV-positive (P<0.05). MDSC, Treg and Th17 cells in peripheral blood of HPV-positive patients with cervical diseases were positively correlated (r=0.599, 0.677, 0.648; P<0.05). Conclusion MDSC, Treg and Th17 cells in peripheral blood of patients with HPV infection are associated with the pathological process, severity and clinical pathological features of cervical diseases as well as therapeutic effects. Therefore, they can be used as biomarkers to detect the occurrence and development of HPV-positive cervical diseases. Key words: Human papillomavirus; Cervical cancer; Myeloid-derived suppressor cell; Regulatory T cell; T helper 17 cell

ХАРАКТЕРИСТИКА IМУННОГО СТАТУСУ У ЖІНОК З ЛАТЕНТНОЮ ПАПІЛОМАВІРУСНОЮ ІНФЕКЦІЄЮ ШИЙКИ МАТКИ

Мета дослідження – аналіз змін показників, що характеризують стан імунітету, у жінок з генітальною латентною папіломавірусною інфекцією, часто поєднаною з урогенітальною інфекцією, на початку обстеження та через 6 місяців спостереження.Матеріали та методи. Обстежено жінок репродуктивного віку (від 18 до 45 років, 1200 осіб), що звернулись до гінекологічних відділень Перинатального центру та клінічної лікарні № 18 м. Києва за період з 2011 до 2016 рр. Контрольну групу склали 15 здорових жінок. Дослідження проведено за допомогою таких методів, як: цитологічний, кольпоскопічний, бактеріологічний, методу ПЛР, фенотипування лімфоцитів периферичної крові та статистичних методів.Результати дослідження та їх обговорення. При обстеженні 1200 жінок у 210 (16,0 %) виявлена ДНК вірусу папіломи людини (ВПЛ) за відсутності клінічних та морфологічних ознак інфекції, що свідчило про латентну папіломавірусну інфекцію (ПВІ). З них у 84 – діагностована моноінфекція, у 126 – поєднана папіломавірусна та урогенітальна інфекції (УГІ). Інфікування ВПЛ і вірогідність подальшого розвитку захворювання (елімінація або персистенція вірусу) значною мірою визначається клітинними та гуморальними факторами імунітету. Для з’ясування ролі імунної системи людини при латентній ПВІ проведено фенотипування лімфоцитів периферичної крові з використанням моноклональних антитіл та визначення рівня імуноглобулінів (Ig) А, М, G за методом радіальної імунодифузії на початку обстеження і через 6 місяців. У 140 жінок встановлена транзиторна ПВІ, у 70 – персистуюча.У жінок з латентною ПВІ шийки матки виявлені деякі ознаки вторинної імунної недостатності, що виражалось у зниженні відсотка Т-лімфоцитів та Т-хелперів з одночасним підвищенням кількості цитотоксичних лімфоцитів та природних кілерів (NK) на тлі активації гуморальної ланки імунітету. Супутня УГІ статевих органів підтримувала, а іноді і посилювала виявлені особливості імунореактивності при ПВІ. У жінок з транзиторною ПВІ спостерігалась нормалізація показників клітинного та гуморального імунітету, а подальша персистенція ВПЛ у шийці матки призводила до більш суттєвого пригнічення реакцій не тільки клітинної, а й гуморальної ланок імунітету (зниження кількості NK та імунорегуляторного індексу, рівня IgA).Висновок. Таким чином, у жінок з латентною ПВІ ШМ виявлялись деякі ознаки вторинної імунної недостатності, що виражалось у зниженні відсотку Т-лімфоцитів та Т-хелперів, з одночасним підвищенням кількості цитотоксичних лімфоцитів та природних кілерів на тлі активації гуморальної ланки імунітету.

Cytokine profile of cervical mucus at different forms of papillomavirus infection

Aim. To study the levels of pro- and anti-inflammatory cytokines in cervical secretion in females with cervical epithelial dysplasia and latent papillomavirus infection. Methods. The study included 120 females aged 20 to 40 years with cervical papillomavirus infection, who were assigned to two groups using «case-control» method. The first group included 60 females with latent disease, the second group - 60 females with mild and moderate cervical epithelial dysplasia (cervical intraepithelial neoplasia stages I and II). Cytokine levels in cervical secretion were measured by ELISA using «ProCon» test system. Results. ELISA test showed increased levels of interleukin-4 and interleukin-10 (43 [21; 74] and 48 [12; 88] pg/ml, respectively) and decreased levels of interleukin-2 (18.5 [5.5; 27.5] pg/ml), interleukin-6 (0.6 [0.06; 0.9] pg/ml), tumor necrosis factor alpha (88.5 [0; 123] pg/ml), interferon γ (2 [0; 4] pg/ml) in cervical secretion of females with cervical epithelial dysplasia compared to females with latent papillomavirus infection. Thus, females with cervical epithelial dysplasia showed increased levels of anti-inflammatory cytokines: interleukin-4 - by 2.7 times and interleukin-10 - by 2.4 times compared to females with latent disease, while levels of pro-inflammatory cytokines was decreased as following: interleukin-2 - by 1.4 times, interleukin-6 - by 4.5 times, tumor necrosis factor alpha - by 1.8 times, interferon γ - by 6.3 times (p 0.05). Conclusion. Imbalance of immune response cytokine regulation with anti-inflammatory cytokines prevailing might be an important factor facilitating persistence of papillomavirus in cervical epithelium and contributing to cervical epithelial dysplasia onset and progression.

SPR-HPV detection of human cervical papillomavirus infection in clinical research

Objective To study the status of surface plasmon resonance (SPR) detection of cervical human papillomavirus (HPV) infection in clinical practice.Methods 502 cases of cervical HPV in patients with cervical cell's genetic subtypes were diagnosed using SPR.Positive rates of HPV lesions of cervical levels detected by SPR and nucleic acid molecules rapid flow-through hybridization gene chip (HybriMax) technology were compared.Results Twenty-two kinds of subtypes were detected by SPR.106 women were found with single infection of HPV,including 47 women (44.34％) with abnormal cytological results,while 36 women were found with multiple infection of HPV,including 16 women (44.44％) with abnormal cytological results,and the difference was not significant (P＞0.05).Among 106 women with single infection of HPV,93 women were found with high risk HPV infection,including 45 women (48.39％) with abnormal cytological results,while 13 women were found with middle-low risk HPV infection,including 2 women (15.38％) with abnormal cytological results,and the difference was statistically significant (P＜0.005).Comparison of SPR and HybriMax technology showed that the two test results showed no significant difference (P＞0.05).Conclusions SPR for detection of HPV infection is more reliable,it can combine HybriMax as the primary means of clinical detection. Key words: Surface plasmon resonance technology; Human papillomavirus; Clinical research

Relationship between subclinical cervical human papillomavirus (HPV) infection and recurrence of condyloma acuminatum in patients

Objective To investigate the relationship between subclinical cervical HPV infection and recurrence of condyloma acuminatum (CA) in patients. Methods Cervical swabs were collected from 52 patients with frequently recurrent CA, 55 patients with infrequently recurrent CA, and 65 normal human controls. The Cenechip method was performed to detect the presence and type of HPV in cervical swabs followed by a statistical analysis. Results HPV was found in 67.3% (35/52) of swabs from patients with frequently recurrent CA, 5% (19/55) from patients with infrequently recurrent CA, and 4.6% (3/65) in the controls. There was a statistical difference among the three groups in the detection rate of HPV. Conclusion The subclinical cervical HPV infection may contribute to the recurrence of CA.

Prognostic Implication of High Risk Human Papillomavirus E6 and E7 mRNA in Patients with Intraepithelial Lesions of the Cervix in Relationship to Age

Since the introduction of the cytological screening programs, a significant reduction in the incidence of cervical cancer has been achieved. Almost all of these cancers are related to high-risk (HR) Human Papillomavirus (HPV) cervical infections. However, the natural history of HPV infection seems to be different in younger patients, resulting in a higher rate of regression. There is, therefore, the need to identify HPV-related biomarkers in order to enhance the effectiveness of screening of high-risk cytological lesions, in particular in women over 35 years of age. This study aims to evaluate the prognostic value of the HR HPV E6 and E7 mRNA expression in women with intraepithelial lesions of the cervix, older or younger than 35 years of age. One hundred and eighty-four HR HPV DNA positive patients with a low squamous intraepithelial lesion (LSIL) were tested for mRNA expressions, included in an observational study, and evaluated at follow-up with standard cytology up to 24 months from the mRNA test. The frequency of HSIL/LSIL cytology in the older cohort of mRNA positive patients was significantly higher compared to mRNA-negative patients, both at 1 and 2 years of follow-up (Chi-square: p 0.007 and p 0.009), but this difference was not found in the younger cohort. According to our results, the E6/E7 mRNA test could be a biomarker for viral activity, useful in identifying patients at higher risk of abnormal cytology, and in implementing the management of HR HPV DNA-positive women over 35 years of age.

Cervical human papillomavirus (HPV) infection and associated genotypes in female patients with vulvar condyloma acuminatum from Shanghai area.

：ObjectiveTo studycervical HPV infection in female patients with vulvar condyloma acuminatum(CA)fromShanghai area.MethodsExfoliated cells were obtained from cervices and vulva lesions of CAof 194 patients.respectively.HPV genotyping was carried out in cell samples usingcapture-hybridization method and gene chip techniques.Results HPV was detected in vulvalesions of all the 194 patients.Among them,74.2%(144/194)were positive for lowrisk(LR)-HPV,and 25.8%(50/194)for high risk(HR)-HPV.A single HPV genotype(6 or 11)wasdetected in 136(94.4%)patients with LR-HPV.and mixed genotypes of LR-HPV and HR-HPV in46(86%)patients with HR.HPV.Of the 194 patients.85.6%(166/194)were complicated by cervicalHPV infection.including 119(61.4%)cases of LR-HPV and 46(23.7%)cases of HR-HPV,In the caseof HPV genotype.the consistence between CA lesions and cervix was 95.8%(159/166).Theprevalence of LR-HPV declined sequentially from subtype 11 to 6 and 53,and that of HR-HPVfrom subtype 16 to 18 followed by 52,31,45 and 58.Conclusions There is a high rate ofinfection with HR-HPV in female patients with CA.and nearly one quarter of these patientsare complicated by cervical HR-HPV infection.

Prevalence of cervical human papillomavirus infection and types among women immigrated to Sicily, Italy

We determined the prevalence of human papillomavirus (HPV) cervical infection and HPV genotypes among 115 women immigrating to Sicily (Italy), with regard to abnormal cytology and socio-behavioral characteristics in a cross-sectional, observational study. Information was collected with the help of cultural mediators/translators. HPV-DNA was assayed by the INNOLiPA HPV assay and a nested PCR/sequencing method. Sixty (52.2%) women came from sub-Saharan Africa and 55 (47.8%) from Eastern Europe. HPV infection was found in 55 (47.8%) women. The most frequent types were the oncogenic types HPV-16 (7.8%), HPV-18 and 51 (6.0% each), HPV-52 (5.2%), 31, 53, and 68 (4.3% each). Twenty-seven (23.5%) women had cytological abnormalities associated with HPV infection (p=0.04). Being single (OR = 2.98; 95%CI: 1.30-6.84) and parity (OR = 0.29; 95%CI: 0.12-0.65) were consistent predictors of HPV infection. Only 21 (18.2%) women returned to collect the results of their Pap and HPV tests. The high prevalence of HPV infection and oncogenic types among immigrant women make them a priority group for cervical cancer screening. Linguistically and culturally appropriate prevention efforts are needed to sensitize immigrant women regarding HPV-related issues and to conduct vaccine strategies for cervical cancer prevention.

Production of interferons and change of the lymphocyte subpopulation phenotype in peripheral blood at cervical papillomavirus infection.

IFN-gamma and IFN-alpha production in vitro by peripheral blood cells activated by phytohemagglutinin or the Newcastle disease virus was impaired in patients with a benign process, cervical intraepithelial neoplasm and cancer in situ associated with human papillomavirus infection. In case of IFN-gamma and IFN-alpha production impairment following cervical papillomavirus infection, the increased severity of disease was accompanied by remarkable IFN system suppression. The lower synthesis of both IFN correlated with changes of some lymphocyte-subpopulation phenotype in peripheral blood. Lower CD4+ and CD3+ DR+ T cell concentrations were observed in papillomavirus-infected patients with impaired IFN production; impaired IFN-gamma production was accompanied by lower CD4/CD8 index.

Interrelation of lymphocyte subpopulations in peripheral blood under cervical papillomavirus infection.

T(CD3+)-, B(CD19+)-lymphocytes and their subsets (CD4+, CD8+, CD3+ DR+, CD3- DR+) in peripheral blood of patients with CIN I, CIN II, CIN III and cancer in situ associated with HPV infection were evaluated. In peripheral blood of women with CIN II, CIN III and cancer in situ the number of T-lymphocytes which expressed CD3+ DR+ antigen decreased. In patients with CIN I, CIN III and cancer in situ the level of the CD4+ cells decreased; the level of the CD8+ cells increased. These patients had a lower CD4/CD8 ratio, the number of B cells being standard. The results may have important implications in the prognosis and immunotherapy of HPV infection.

HPLC determination of the stability of retinoic acid in ovule formulations for the treatment of cervical dysplasia related to papillomavirus

We studied the efficacy of all-trans-retinoic acid-containing ovules in combination with an α-interferon-based gel and Decapeptyl° IM in the treatment of cervical papillomavirus infections and intraepithelial dysplasia. Stability tests showed that the retinoic acid in the ovules was stable for at least 4 months at 4°C. In a pilot study, we obtained complete remissions with the three-drug combination, whereas all-trans-retinoic acid and α-interferon used alone produced only partial remissions; Decapeptyl° also induced the disappearance of similar lesions, but was associated with recurrences due to persistence of the virus.

Human papilloma virus infection among women attending an STD clinic correlated to reason for attending, presence of clinical signs, concomitant infections and abnormal cytology.

The purpose of this study was to demonstrate the prevalence of cervical human papilloma virus (HPV) infection correlated to reason for attending an STD clinic, presence of clinical signs of HPV infection, concomitant infection and abnormal cytology. Samples from the cervical canals of 588 consecutive women attending the STD clinic, Department of Dermato-Venereology, Sahlgrenska Hospital, Gothenburg, were taken with a Cytobrush for detection of HPV DNA with the dot blot/Southern-blot technique. Visible condylomata, i.e. filiform or papular condylomata, were registered. Acetic acid test and colposcopy were not routinely performed. Cytological examination was performed as well as isolation of Chlamydia trachomatis on Mc Coy's cells and culture on Sabouraud agar for Candida albicans. The prevalence of HPV DNA was 8% (48/588). In the group of 233 women attending because of concern about HPV infection, 94 (40%) had visible signs of HPV infection and 30 (13%) were positive for HPV DNA in the cervix. In 355 women attending for other reasons, such as discharge, pruritus or STD check-up, 4 (1%) had visible signs of HPV infection and 18 (5%) were HPV DNA positive. Of 98 women with visible signs of vulvar/vaginal HPV infection, 33 (34%) were HPV-positive in the cervix with a commercial Southern-blot test. Of 490 patients without visible signs of HPV infection, 15 (3%) were HPV-positive in the cervix. In the group of HPV-positive women a positive culture for Candida was demonstrated in 26% (11/43), Compared to 16% (79/504) of the HPV-negative women.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraceptive and reproductive risks for cervical dysplasia in southwestern Hispanic and non-Hispanic white women.

Various contraceptive practices and reproductive factors have been associated with cervical neoplasia in case-control studies worldwide. To investigate contraceptive and reproductive risk factors associated with high-grade cervical dysplasia in southwestern Hispanic and non-Hispanic white women, we carried out a clinic-based case-control study among university-affiliated clinic attendees. Oral contraceptive use ever (odds ratio [OR] = 0.4, 95% confidence interval [CI]: 0.2-0.9) and past diaphragm use (OR = 0.3, 95% CI: 0.1-0.8) were protective for dysplasia in analyses adjusted for age, ethnicity, sexual behaviour, and for cervical papillomavirus (HPV) infection. After further adjustment for Pap smear screening interval, oral contraceptive use ever remained protective for dysplasia. Vaginal deliveries were strongly associated with dysplasia with > 2 vaginal deliveries associated with a 3.9-fold increase in risk after adjustment for age, ethnicity, sexual behaviour, and HPV infection. Using logistic regression models to simultaneously control for effects of multiple factors as potentially related to cervical dysplasia, we found low educational attainment, cervical HPV infection, cigarette smoking, history of any sexually transmitted disease, and having one or more vaginal deliveries to be associated with dysplasia; oral contraceptive use and past diaphragm use also remained protective for high-grade cervical dysplasia in these regression analyses. The data suggest that use of oral contraceptives (ever) and past diaphragm use are protective for high-grade cervical dysplasia among Hispanic and non-Hispanic white women in New Mexico. The clinic-based perspective of this research (versus population-based studies) may help explain some of these findings.

Anogenital warts in children.

Fourteen children presenting with anogenital (AG) warts and their close family members were studied; 28.6 and 8.3% of presenting children and other child household members, respectively, had non-genital cutaneous warts; 42.8% of children with AG warts had one or more adult household member with common hand warts. Fifty per cent of all mothers had subclinical cervical papilloma virus (PV) infection; only one male adult had subclinical PV infection of the penis without concurrent AG warts. Of the children with AG warts 42.8% had one or more adult household member with AG warts. Human papilloma virus (HPV) deoxyribonucleic acid (DNA), type 6/11 most frequently, was detected in 38.5% AG wart biopsies from children, and 67% AG wart biopsies from adults. HPV 31/33/35 was detected in 28.5% of cervical preneoplasias and type 6/11 in the one case of subclinical PV infection of the penile shaft. Detection of HPV types 6/11, 16/18, or 31/33/35 in AG warts in children was significantly associated with vertical (from an HPV-infected maternal birth canal during vaginal delivery) or sexual transmission of these warts (Fisher exact probability P = 0.031).

Cervical papillomavirus infection and cervical dysplasia in Hispanic, Native American, and non-Hispanic white women in New Mexico.

Human papillomavirus infections of the cervix are found with varying frequencies in different populations worldwide, and have been associated with cervical cytologic abnormalities. We studied 1,603 randomly selected Hispanic, Native American, and non-Hispanic White women in New Mexico to determine the prevalence of cervical HPV infection in these ethnic groups, and its association with Pap smear abnormalities, using a new commercial dot-blot hybridization assay. Nine percent of all women screened had evidence of cervical HPV infection (13.7% of non-Hispanic White women, 9.7% of Hispanics, and 6.6% of Native American women). Prevalence was higher in younger women ages 14-19 years than in older age groups. Over half of women with cervical HPV infection (n = 145) had normal Pap smears. The proportion of infected women increased among those with more advanced cytopathologic abnormalities; 5.6 percent with normal Pap smears had cervical HPV vs 66.7 percent with moderate-severe dysplasia. Cervical HPV infection is common among New Mexico clinic attendees, varies in prevalence among the three major ethnic groups, and is strongly associated with cervical cytopathologic abnormalities.

Cytologic Correlates of Cervical Papillomavirus Infection

A fundamental question in Papanicolaou smear screening is the specificity of cytologic criteria for the recognition of genital human papillomavirus (HPV) infection. To address this problem, we conducted a two-phase study of routinely screened women to determine the efficiency with which cytologic findings identified the presence of HPV DNA, focusing on the criteria for identifying smears as "atypical." In phase 1, 25 of 290 (8.6%) smears were designated atypical, but only 3 (12%) of the samples contained HPV nucleic acids. Four of five (80%) smears designated as diagnostic of HPV/cervical HPV infection were associated with HPV nucleic acids. By applying more stringent criteria for the diagnosis of atypical in phase 2, only 3 of 166 (1.8%) were identified as atypical. Of these, two (67%) contained HPV nucleic acids. The criteria that most efficiently correlated with HPV nucleic acids included prominent nuclear enlargement with either multiple nuclei or nuclear hyperchromatism. On review of the 19 HPV-positive and 20 control HPV-negative smears originally diagnosed as cytologically negative, the above criteria identified an additional 3 cytologically atypical/positive smears versus none (0 of 20) in the control group. This study supports the concept that cytologic abnormalities suggesting "subtle" HPV infection may be extremely difficult to distinguish from non-HPV-related changes, and that criteria used to imply "suggestive but not diagnostic for HPV infection" should be continually reevaluated. The potential role of HPV DNA analysis in Papanicolaou smear interpretation is discussed.

Management of Cervical Papillomavirus Infections: A Response

Management of Cervical Papillomavirus Infections: A Response