Risk factors in the development of cervical intraepithelial neoplasia in women with vulval warts

A colposcopic case-control study of cervical squamous intraepithelial lesions in women with anogenital warts

OBJECTIVE

To assess whether anogenital warts, present or past, are an indication for women to be referred for colposcopy.

DESIGN

A case control study comparing patients with and without a history of anogenital warts.

SETTING

A department of genitourinary medicine in West London.

PATIENTS

468 patients examined by colposcopy between January 1985 and December 1987 of whom 147 (31%) had abnormal cytology, 163 (35%) had anogenital warts and 158 (34%) had both.

MAIN OUTCOME MEASURES

Colposcopic findings and histology of cervical biopsies compared with behavioural and disease variables.

RESULTS

Human papillomavirus infection (HPVI) of the cervix showed no relationship with a life time history of vulval warts, or with the presence of anogenital warts on clinical examination, or with any parameter of sexual behaviour included in the study. Cervical intraepithelial neoplasia (CIN) was strongly associated with current IUCD usage (RR = 7.75) and coitarche under 16 years of age (RR = 3.72), but a history of vulval warts yielded a negative association (RR = 0.34), suggesting a protective effect. This relationship held true when cytological dyskaryosis was made the dependent variable (RR = 0.24).

CONCLUSIONS

Anogenital warts are not a risk for subclinical cervical HPVI or for CIN and therefore not an indication for colposcopy.

Increased incidence of cervical cytological abnormalities in women with genital warts or contact with genital warts: a need for increased vigilance?

OBJECTIVE

To determine whether women who have a history of genital warts or whose sexual partners have such a history were more likely to have borderline or dyskaryotic cervical smears than other women.

DESIGN

Prospective study conducted over a five month period.

SETTING

A genitourinary medicine clinic in Cambridge, UK.

PATIENTS

One hundred and eighty five women who attended the clinic during the study period, on whom cervical cytology was performed. Ninety-seven had a history of genital warts and twenty had partners with genital warts.

METHODS

Cervical cytology taken by standard methods. Demographic data and sexual history obtained by questionnaire. Colposcopy was performed on patients with a history of warts or wart contact.

OUTCOME MEASURED

Relative incidence of cytological abnormalities in the various groups of patients.

RESULTS

"Borderline" nuclear change was the most frequent abnormality reported in the wart contact group (six cases) whereas mild dyskaryosis was the most frequent abnormal finding in those women with a history of warts (21 cases).

CONCLUSIONS

Women with warts or contact with genital warts were more likely to have borderline or dyskaryotic cervical smears than women without such a history. Recommendations for follow-up of these patients are made.