Human Papilloma Virus Research

Zbroch T, Grzegorz Knapp P, Knapp PA. Department of Gynecology SPSK, Medical Academy, Bialystok, Poland.

Verrucous carcinoma of the cervix is of special interest because of its rare occurrence and frequently existing difficulties in the differential diagnosis, which in verrucous disease eventually leads to a final, more favorable diagnosis. We present a case report of cervical verrucous carcinoma as a rare variant of squamous cell carcinoma in a 65-year-old woman who underwent total hysterectomy based on initial histological diagnosis of cervical dysplasia. Special attention is focused on clinical assessment of the lesion with the depicted restriction of exfoliated cytology as well as misdiagnoses of inappropriately taken, even colposcopically directed biopsy, not covering a full thickness of biopsied tissue. The macro- and micromorphologic similarities of cervical verrucous carcinoma with condylomata acuminata on one hand and invasive squamous cell carcinoma on the other, inclined us to search for a common factor causing human papillomavirus infection.

J Infect Dis. 2005 Mar 1;191(5):731-8. Epub 2005 Jan 21.

Development and duration of human papillomavirus lesions, after initial infection.

Winer RL, Kiviat NB, Hughes JP, Adam DE, Lee SK, Kuypers JM, Koutsky LA. Department of Epidemiology, University of Washington, Seattle, Washington 98103, USA.

BACKGROUND: To determine the potential value of human papillomavirus (HPV) vaccines, information concerning the incidence and duration of clinically important lesions is needed. METHODS: A total of 603 female university students were followed for a mean duration of 38.8 months. Triannual gynecologic examinations included cervical and vulvovaginal specimen collection for Pap and HPV DNA testing. Women with cytologic evidence of a high-grade squamous intraepithelial lesion (SIL) were referred for colposcopically directed biopsy. RESULTS: Among women with incident HPV infection, the 36-month cumulative incidence of cervical SILs found by cytologic testing (47.2%; 95% confidence interval [CI], 38.9%-56.4%) was higher than that of vaginal SILs (28.8%; 95% CI, 21.3%-38.2%). The median time to clearance of cervical and vaginal SILs was 5.5 and 4.7 months, respectively. Among women with incident HPV-16 or HPV-18 infection, the 36-month cumulative incidence of cervical intraepithelial neoplasia (CIN) grade 2 was 20.0% (95% CI, 10.8%-35.1%), and that of CIN grade 3 was 6.7% (95% CI, 2.5%-17.0%). The 36-month cumulative incidence of clinically ascertained genital warts among women with incident HPV-6 or HPV-11 infection was 64.2% (95% CI, 50.7%-77.4%). CONCLUSIONS: Intraepithelial lesions are common early events among women with incident HPV infection, and the interval between incident HPV-16 or HPV-18 infection and biopsy-confirmed CIN grade 2-3 appears to be relatively short.

MMW Fortschr Med. 2004 Dec 16;146(51-52):28, 31-2.

Diagnosis of major sexually transmitted infections in the doctor's office: viral diseases.

Human Papilloma Virus Research - Article in German

Sexually transmitted infections caused by viruses include infections by the Herpes simplex virus (HSV), the human papillomavirus (HPV), and the human immunodeficiency virus (HIV). The diagnosis is established on the basis of clinical presentation and the direct demonstration of the antigen or antibodies.

Int J STD AIDS. 2004 Dec;15(12):836-8.

HPV 16/18-associated condyloma acuminatum of the urinary bladder: first international report and review of literature.

Chrisofos M, Skolarikos A, Lazaris A, Bogris S, Deliveliotis Ch. 2nd Department of Urology, University of Athens, 1 Sismanogleiou Str, 151 26 Marousi, Greece. mxchris@yahoo.com

Condyloma acuminatum is an anogenital lesion caused by human papillomavirus (HPV) infection, a common sexually transmitted disease. It usually affects the external genitalia while urethral and/or bladder involvement is rare. HPV types are classified into three categories depending on their oncogenic potential: low risk (type 6, 11, 42, 43, 44, 59, 66, 68, 70), intermediate risk (type 30, 31, 33, 34, 35, 39, 40, 49, 51, 52, 53, 57, 58, 63, 64) and high risk (type 16, 18, 45, 56). High-risk and intermediate-risk HPV-DNA types, together with other co-factors still to be defined, are responsible for over 90% of the cases of anogenital pre-malignant and malignant tumours. We report a unique case of a urinary bladder condyloma acuminatum positive for HPV 16/18 DNA, presented as the primary and only site of the disease in an immunocompetent patient. We review the treatment and follow-up strategies of this rare lesion.

Publication Types:
• Case Reports
• Review
• Review of Reported Cases

Med Wieku Rozwoj. 2003 Jul-Sep;7(3 Suppl 1):359-68.

Sexually transmitted infections in sexually abused children

Human Papilloma Virus Research - Article in Polish

The sexually transmitted infection (STI) in an infant can be an early consequence of child sexual abuse (CSA). The risk of acquisition of a STI depends, among others, on the prevalence of these infections in the abusing population and the type of sexual assault. As the detection of sexually transmissible organism can be an unique evidence of CSA, only the best standardized methods should be used for the diagnosis of STIs in children. STIs are seen in less than 10% of abused child and in a half of them are asymptomatic. The relevance of STIs for the diagnosis of CSA should be assessed taking into consideration the age of a child, a type of sexually transmissible organism and its localization. Generally, postnatally acquired gonorrhoea, syphilis and genital Chlamydia trachomatis infection in a child more than 2-year old are most clinically evident for CSA. Infections with HPV, HIV and HSV can also be important.

Publication Types:
• Review
• Review, Tutorial

Bull World Health Organ. 2004 Jul;82(7):483-92.

Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru.

Garcia PJ, Chavez S, Feringa B, Chiappe M, Li W, Jansen KU, Carcamo C, Holmes KK. Center for AIDS and STDs, University of Washington, Harborview Medical Center Box 359931, Seattle, WA 98104, USA.

OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy.

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