Human papilloma virus : association with vulvovaginitis and genital intra-epithelial neoplasia

Abstract: In many women with gynecological complaints such as itching, burning, discharge, and fissures causing dyspareunia, examination of the vulvovaginal mucosa reveals hyperkeratotic and papillomatous changes. Polymerase Chain Reaction (PCR) technique revealed 64% of such lesions to harbour Human Papilloma Virus (HPV)- DNA, whereas Southern blot (SB) technique showed 50% to be positive for HPV- DNA.Women with papillomatous lesions were more often HPV-DNA positive than those with/Zat hyperkeratotic lesions. The virus-induced vulvovaginitis described was sometimes the sole cause of atypical Pap-smears. However, papilloma virus infections in vulva and vagina were often accompanied by cervical as well as vaginal and vulval intra-epithelial neoplasia.In women with an atypical Pap-smear, signs of HPV were observed by colposcopy in 58% of cases, by cytology in 21%, by histopathology in 53% and by HPV- DNA hybridization techniques in 46%. Colposcopy, cytology and histopathology were more sensitive than SB and Filter In Situ Hybridization (FISH) in detecting HPV in benign epithelium and in mild to moderate dysplasia. The FISH technique, when applied to cell samples and the SB technique for biopsy material proved equally sensitive when benign tissue and mild to moderate dysplasia were analysed. However, in women with severe dysplastic lesions, use of the SB technique on biopsy material proved more sensitive than FISH.In lesions with severe dysplasia, HPV-DNA was very often present (67% of CIN III lesions). HPV 16, which is capable of oncogenic transformation, was found in 54% of such tissue.At follow-up after laser treatment of genital intra-epithelial neoplasia, HPV-DNA could be detected in 38% of cases. This indicates that HPV may affect the entire mucosa of the lower genital tract, even when not clinically detectable. Thus, to eradicate the virus, systemic therapy would appear to be required.Vulvovaginal HPV infection is an entity with characteristic symptoms, morphological changes and oncogenic potential. Certain HPV-types are associated with the development of genital intra-epithelial neoplasia. The diagnostic methods presently available are not, however, sensitive enough for detection of HPV-infection and there is no effective treatment currently available. It would therefore be premature to suggest the introduction of a screening program for certain oncogenic HPV- types. Further study of the natural history of the virus infection is needed before any step can be taken toward using HPV screening in the effort to prevent cervical cancer.7