Human papillomavirus coinfections of the vulva and uterine cervix

Clearance of cervical human papillomavirus infection by treatment for cervical dysplasia

OBJECTIVES

The aim of this study was to investigate the prevalence of human papillomavirus (HPV) after treatment for cervical dysplasia.

STUDY DESIGN

The presence of HPV was investigated in cervical scrapes of 91 patients, before and after treatment, using consensus primers in the polymerase chain reaction.

RESULTS

Before treatment for cervical dysplasia, 89 of 91 patients (98%) were HPV-positive compared with 28 of 91 patients (31%) after treatment. The HPV type present before treatment was found in the scrapes of only 9 of 89 patients (10%). Detection of HPV after treatment was associated with human immunodeficiency virus infection and incomplete conization.

CONCLUSION

The HPV type present before treatment was frequently cleared by treatment for cervical dysplasia.

Human papillomavirus DNA after treatment of cervical dysplasia: low prevalence in normal cytologic smears

BACKGROUND

The presence of human papillomavirus (HPV) DNA in relation to cervical cytology was evaluated after treatment of cervical dysplasia.

METHODS

Forty patients, 22 with normal and 18 with abnormal cytology (mild or moderate dyskaryosis), with a history of cervical dysplasia were selected. Only patients with HPV DNA positive biopsies obtained before treatment were included. The presence of HPV was assessed in cervical smears at least 1 year after treatment of cervical dysplasia by using a polymerase chain reaction (PCR) with consensus primers (CPI/IIG). HPV typing was done by direct sequence analysis of the CPI/IIG PCR generated amplimers.

RESULTS

Smears from 3 of the 22 patients with normal cytology after treatment were positive for HPV DNA (14%). HPV DNA positive smears were found in 13 of the 18 patients with abnormal cytology after treatment (72%) (relative risk: 5.3; 95% confidence interval: 1.78-15.75). In 11 of the 16 HPV DNA positive smears (69%), the HPV type was different from that before treatment. In 35 of 40 patients, the HPV type before treatment could not be detected after treatment (88%).

CONCLUSIONS

A minority of the patients with normal cytology after treatment of cervical dysplasia had detectable HPV DNA. In contrast, a high prevalence of HPV DNA was found in cervical smears of patients with abnormal cytology after treatment of cervical dysplasia. After treatment, none of the patients with abnormal cytology but HPV DNA negative smears had recurrence of cervical intraepithelial neoplasia. This suggests the value of supplementary HPV DNA testing during follow-up of patients treated for cervical dysplasia.

Genital HPV infection not a local but a regional infection: experience from a female teenage group

OBJECTIVES

To investigate the prevalence of human papillomavirus (HPV) infections in a group of female teenagers, and to analyse to what extent HPV DNA was also detectable, in urethra and cervix samples among the patients with macroscopic genital warts compared with those without.

DESIGN

The patients were interviewed about their sexual habits and history of venereal diseases. They underwent a gynaecological health control examination, including macroscopic inspection for genital warts and collection of a cytological vaginal smear (Pap smear). Cell samples were also taken from endocervix and urethra and from vulva lesions, when found. These samples were tested for HPV DNA of the types 6, 11, 16, 18 and 33 using the polymerase chain reaction (PCR) technique.

SETTING

An adolescence out-patient clinic in Malmö, Sweden.

SUBJECTS

Forty-nine female teenagers consulting for gynaecological complaints, some of them for genital warts.

RESULTS

Twenty patients had present and four had a history of genital warts (group A). The other 25 patients had no visible lesions (group B). In the first group (A) 18 of the 24 patients were positive for HPV DNA in one or more of the three locations studied. More patients were positive in urethra (17) than in cervix (15). In group B four of the 25 patients were positive for HPV DNA in urethra, three of these also in cervix. In the two groups 11 and four patients, respectively, showed pathological Pap smears.

CONCLUSIONS

The finding of HPV DNA in urethra, both from women with and without visible genital warts, indicates that there is a high probability that the infection is also present in cervix, suggesting that the genital HPV infections are multifocal. Thus, patients with genital warts are most likely to have cervical HPV infections and will more often have pathological Pap smears than patients without warts.

Detection of papillomaviral-like DNA sequences in premalignant and malignant perineal lesions of sheep

Small hyperkeratotic and ulcerated lesions and clinical cancers were isolated from the perineal region of sheep and examined for evidence of papillomavirus infection by various criteria including gross morphology, histology, immunohistochemistry and DNA hybridisation. No specific diagnostic features of papillomaviral infection by immunohistochemistry were found, although some lesions showed gross morphological and histological features similar to papillomaviral effect in other species. DNA hybridisation analysis, using human papillomaviral type 11, 13, 16 and 18 DNA probes under conditions of reduced stringency (Tm-40 degrees C), detected homologous sequences in two thirds of the biopsies examined. These homologous sequences occurred in benign hyperkeratosis as well as invasive squamous cell carcinomas but were much more frequently isolated from carcinomas. This finding suggests that a papillomavirus is associated with the development of squamous cell carcinomas of the perineum of sheep.

Human papillomavirus detection from the female genital tract: combined vs. separate scrape methods

Because genital human papillomavirus (HPV) infections tend to be multifocal, it was studied how effective one combined specimen is in detecting HPV-DNA from the lower female genital tract. The study population consisted of 50 patients referred to a colposcopy clinic for a suspected condylomatous and/or dysplastic lesion. From half of the patients, a separate scrape from the cervix, vagina and vulva was taken first followed by a combined scrape representing all the genital sites, and from the other half, vice versa. HPV-DNA (types 6, 11, 16 and 18) was identified using the AffiProbe hybridisation test. Thirty-six specimens collected from 17 patients were positive for HPV-DNA. A multifocal infection was demonstrated in at least 11/17 (65%) HPV-DNA positive patients. The combined scrape was the most informative specimen, revealing 75% of all HPV-DNA-positive patients. It was concluded that HPV-DNA can reliably be detected from the female genital tract in a simple way from one combined specimen.

Human papillomavirus infection in women with multicentric squamous cell neoplasia

Tissues from 32 women with multicentric squamous cell neoplasia of the anogenital region (72 anatomically distinct lesions at the cervix, vagina, vulva, perineum, or anus) were tested for the presence of human papillomavirus with the polymerase chain reaction or in situ hybridization. All the women had invasive carcinomas or grade 3 intraepithelial neoplasia lesions at a minimum of one site and one or two squamous cell lesions at another site(s). Human papillomavirus was detected in all of the multicentric lesions in 87.5% (28/32) of the women and in at least one lesion in 12.5% (4/32). In the 28 women with detectable human papillomavirus at all sites, 61% (17/28) had the same virus type(s) at all sites (types 6, 16, 6 and 16, 33) and 25% (7/28) had 6 or 16 at one site and both viruses at the other site(s). Four women (15%) had different virus patterns in the separate lesions.

Human papillomavirus infection of the male diagnosed by Southern-blot hybridization and polymerase chain reaction: comparison between urethra samples and penile biopsy samples

A group of 108 healthy men aged 18 to 23 years underwent penoscopy after application of acetic acid. In 39 (37%) aceto-white lesions were found and a biopsy was taken. From 105 patients a urethra sample was collected with a brush. The prevalence of HPV-DNA by dot-blot and Southern-blot hybridizations (DBH/SBH) and polymerase chain reaction (PCR) as well as the correlation between results from urethra samples and penile aceto-white epithelium were examined. In urethra, HPV-DNA was detected in four of the 66 patients (6%) with normal epithelium and in three of the 39 (8%) with aceto-white epithelium by using DBH/SBH. By PCR the corresponding findings were eight (12%) and 10 (26%) HPV-DNA-positive patients, respectively. Out of the 39 biopsy samples HPV-DNA was detected in six (15%) by DBH/SBH and in 17 (44%) by PCR. Twenty-two (56%) of the patients with aceto-white lesions were by PCR positive in either the urethra sample or biopsy. All samples positive by DBH/SBH were also positive by PCR except for one biopsy with HPV 35, a type not tested for by PCR. HPV 11 was the most common finding in urethra and HPV 6 and 16 in aceto-white epithelium.

Cervical intra-epithelial neoplasia and koilocytotic lesions of the lower genitalia in an Icelandic population

This study is based on women who participated in cervical cancer screening and on 390 women referred from the screened group for colposcopy. The study analyzed the frequency of atypia, CIN and koilocytosis and evaluated the efficiency of cytologic vs. histologic diagnosis. The clinical expression of the koilocytotic lesions and the rate of infected partners were evaluated. In the screened population the prevalence of smears with atypia and CIN was 3.2% and that of koilocytosis 0.5%. In the colposcopic group the frequency of koilocytosis in the histologic sections was 98% compared to 18% of the smears. The koilocytotic lesions were mostly multicentric, subclinical and asymptomatic and often associated with normal cytology. The rate of infected partners of women with normal smears and non-symptomatic vulvar lesions was low (15%), increased if smears were abnormal (30%), and was highest when the partner had gross condylomata (89%). As to atypia and CIN, the rate of undegraded smears was 18%, false-negative smears 8%, undergraded colposcopic biopsies 33%, false-negative colposcopic biopsies 3%, and the false-negative rate of combined cytology and colposcopy was less that 1%. Colposcopy is recommended for unclassified CIN and CIN 2–3 repeat smear for atypia and CIN 1 and combined cytology and colposcopy for condylomata.

Time trends in the prevalence of human papillomavirus infections in archival Papanicolaou smears: analysis by cytology, DNA hybridization, and polymerase chain reaction

A retrospective study was undertaken to determine the prevalence of human papillomavirus (HPV) infections in routine Papanicolaou (Pap) smears collected by general practitioners from Western Australian women in each of the years 1972, 1982, and 1987. HPV infection was detected by cytology, dot-blot hybridization, or polymerase chain reaction (PCR). It was found that the prevalence of HPV infection remained unchanged over the 15 year study period, was independent of age, and was associated with normal cytology at a rate far greater than previously recognized. Indeed, the prevalence of cervical intraepithelial neoplasia (CIN) lesions, as detected by cytology, was 3.0% in 1972 and 3.8% in 1982 and 1987. The prevalence of HPV infection, detected as koilocytosis or parakeratosis, was 6.5%, 6.8%, and 5.3% in smears collected in 1972, 1982, and 1987, respectively, from 1,800 women. In 237 cytologically normal smears reprocessed for HPV-DNA studies, the prevalence of HPV 16 was determined to be 15.6%, 11.2%, and 17.8% in 1972, 1982, and 1987, respectively, as determined by dot-blot hybridization. However, the PCR detected HPV 16 in an additional 55.5%, 62.9%, and 57.0% of cytologically normal and dot-blot negative smears. The prevalence of HPV 16 infection in cytologically normal smears was estimated to be 71.0%, 74.1%, and 74.8% in 1972, 1982, and 1987, respectively, by combining the HPV 16 dot-blot and PCR-positive results. The high prevalence of HPV 16 in cytologically normal Pap smears suggests that infection with HPV 16, as detected by PCR amplification, does not place women in a high-risk category for cervical cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Automated polymerase chain reaction for papillomavirus screening of cervicovaginal lavages: comparison with dot-blot hybridization in a sexually transmitted diseases clinic population

The aim of the present study was to compare the recently developed polymerase chain reaction (PCR) technique with conventional dot-blot DNA hybridization for human papillomavirus (HPV) detection. Cells were collected by cervicovaginal lavage from a study group of 109 women attending a sexually transmitted diseases clinic. Using a machine that we developed for alternation of temperature cycles, HPV was detected in 51% of patients by PCR. By dot-blot hybridization, 44% of the patients were positive. Concordance of combined positive and negative results between PCR and dot blot was 69%. The greater sensitivity of PCR may have accounted for 19% of specimens that were PCR positive but dot-blot negative. Unexpectedly, however, 12% of specimens were dot-blot positive but negative by PCR, and several specimens were discordant for type of HPV. Both HPV DNA tests agreed with cytology in 41% of women, and in 33% cytology was negative in the face of positive PCR and dot blot. Concordance of cytology with just PCR was 59%, and only with dot blot was 56%. Cervicography agreed with both HPV DNA tests in 41% of patients, with PCR alone in 55%, and with dot blot alone in 58%. Biopsy results did not reveal a strong correlation between histopathological criteria of HPV infection and detection of HPV DNA by either PCR or dot-blot hybridization. Thus the present study has shown that PCR is a slightly more sensitive indicator of HPV infection than dot-blot hybridization. Agreement of HPV DNA results with conventional screening tests was not strong, an observation consistent with many comparative studies by others. In conclusion, PCR is slightly more sensitive than DNA hybridization for detection of HPV, it can be used in conjunction with specimen collection by gentle lavage of the cervicovaginal epithelium, and the possibility remains that it may prove suitable as a screening test.

Use of AffiProbe HPV test kit for detection of human papillomavirus DNA in genital scrapes

The presence of human papillomavirus (HPV) DNA in cervical and vaginal scrapes was analyzed by the AffiProbe HPV test kit (Orion Corp., Orion Pharmaceutica, Helsinki, Finland), which is a 1-day solution hybridization test for HPV type 6/11, 16, or 18. The AffiProbe test was compared with a commercially available dot blot test (ViraPap and ViraType tests; Life Technologies Inc., Gaithersburg, Md.). The study group consisted of 178 patients seen in a gynecological outpatient clinic. Altogether, 64 specimens (36 cervical and 28 vaginal scrapes) from 49 patients were positive by the AffiProbe test. Concurrently collected cervical scrapes from 174 patients were available for the reference test, which yielded 27 positive results for HPV type 6/11 or 16/18 and 25 positive results for HPV type 31/33/35. Agreement as to the presence of HPV type 6/11, 16, or 18 by the two tests was reached in 85% of the specimens. Eleven cervical specimens were positive by the AffiProbe test only, and nine cervical specimens were positive by the ViraType test only. Independent evidence obtained by the polymerase chain reaction, repeat examination, or the concurrent presence of HPV DNA in vaginal or vulval epithelium supported the AffiProbe and the ViraType test results for 6 of the 11 and 6 of the 9 specimens with discrepant results, respectively. Thus, the DNA tests had similar sensitivities for HPV type 6/11, 16, and 18 DNAs, but the results were obtained within 1 day by the AffiProbe test, whereas results for the ViraPap and ViraType analyses required from 4 days to 2 weeks.

Detection of human papillomavirus in reprocessed routine Papanicolaou smears by DNA hybridization

DNA dot blot hybridization was used for the detection of human papillomavirus (HPV) types 6, 11, 16, and 18 in reprocessed routinely collected Papanicolaou smears. DNA was extracted from the smears with alkaline lysis and applied onto a nitrocellulose filter. The specificity and sensitivity of the dot blot hybridization on reprocessed Papanicolaou smears were confirmed by Southern blot analysis of selected samples, using CaSki, SiHa cell lines as positive controls and HF 32 as negative controls. From 42 normal smears and 44 abnormal smears with koilocytosis present, 9 (21%) and 43 (98%), respectively, were positive for HPV 6/11/16 or 18. These results show that reprocessed Papanicolaou smears in combination with DNA hybridization have potential application in retrospective studies on the prevalence and distribution of HPV infection.

Detection of human papillomavirus type 16 DNA in cervical swabs and formalin-fixed, paraffin-embedded squamous cell carcinomas of non-genital tissues using a synthetic oligodeoxynucleotide probe

The potential of using a chemically synthesized oligodeoxynucleotide as a diagnostic probe to detect human papillomavirus type 16 (HPV-16) in genital infections was evaluated by comparing it with a cloned full-length HPV-16 probe in dot-blot DNA hybridizations. An oligonucleotide sequence, 20 bases in length from the E6 region of HPV-16 (E6 oligo) and different from the DNA sequences of HPV types 6, 11 and 18 by at least 2 base pairs, was chosen for chemical synthesis. The oligoprobe, which was 5'-end labelled with [32P]dATP, was found to be specific, but approximately ten times less sensitive than the full-length radiolabelled probe of HPV-16, in dot-blot hybridizations with the DNA of HPV-6, -11, -16 and -18, HPV positive and negative cell-lines. From 36 cervical or vulval scrapes two samples were found positive with both cloned HPV-16 and oligoprobe hybridization. Of 21 samples of formalin-fixed, paraffin-embedded squamous cell carcinomas originating from anus, oesophagus, penis, colon, breast and skin only 4 anal squamous cell carcinomas were positives when hybridized with cloned HPV-16 DNA or with the oligoprobe. This study confirms that HPV-16, which is frequently associated with squamous cell carcinoma of the cervix is also strongly associated with squamous cell carcinoma of the anus.