Evaluation of frequency human papillomavirus infections during pregnancy

OBJECTIVES: The frequency of human papillomavirus (HPV) infection was estimated among pregnant women. MATERIALS AND METHODS: Cervical smears were obtained from 50 patients treated in the Chair and Department of Obstetrics and Perinatology, University Medical School of Lublin. They were investigated for the presence of HPV DNA. For the above purpose Digene Hybrid Capture method was used. RESULTS: HPV DNA was detected in the 4 (8%) of 50 patients. One of them had mixed infection low and high risk types of HPV, the other--high risk types of HPV infections. CONCLUSIONS: 1. HPV DNA was detected in 8% of the patients, in all cases high risk types of HPV was found. 2. The diabetic patients seem to be more vulnerable to HPV infection during pregnancy.     

妊娠期与非妊娠期人乳头瘤病毒的感染率比较

目的:探讨HPV在不同妊娠时期感染率及基因分型的差别。方法:利用DNA杂交导流技术检测180例妇女妊娠早、中、晚期宫颈分泌物中HPV的表达及基因分型,同时检测180例非妊娠期健康妇女的宫颈分泌物作为对照。结果:180例非妊娠期健康妇女的宫颈标本中,HPV感染率为13%(23/180)。检出高危基因型(HPV16/18/31/52/56型)16例;低危基因型(HPV6/11型)5例;常见亚型(HPV53)2例。在妊娠期妇女的标本中,早、中、晚孕期感染率分别为19%(34/180)、20%(36/180)及32%(58/180)。检出高危基因型(HPV16/18/31/33/52/58/68型)81例;低危基因型(HPV6/11/42型)43例;常见亚性(HPV53/66)4例。其中有多重型感染患者。结论:妊娠期HPV感染率明显高于非妊娠期健康妇女,且感染率随妊娠进展而逐渐上升,其中高危亚型尤为明显,需要引起临床重视。     

Triage of atypical squamous cells of undetermined significance with hybrid capture II: colposcopy and histologic human papillomavirus correlation

OBJECTIVE: To estimate the effectiveness of Hybrid Capture II to predict high-grade cervical intraepithelial neoplasia (CIN) from a cytological cervical sample. Evidence of high-risk human papillomavirus (HPV) was also determined from biopsy samples using the polymerase chain reaction (PCR) for women referred with atypical squamous cells of undetermined significance (ASCUS) Papanicolaou smears. METHODS: We screened 8170 women with Papanicolaou smears, of whom 278 (3.4%) returned ASCUS. All ASCUS cases underwent colposcopy and Hybrid Capture II testing. High-grade CIN biopsy specimens were tested for high-risk HPV by PCR. RESULTS: Nearly 30% of ASCUS cases had CIN biopsy results (11.9% showing CIN II or CIN III and 17.6% showing CIN I). Hybrid Capture II positive rates were 93.3% for cases with CIN III, 72.2% for CIN II, and 51.0% for CIN I (P <.001). ASCUS-Premalignant Process Favored cases showed a 28.1% high-grade biopsy rate and a 100% Hybrid Capture II positive rate. For ASCUS-Undefined and ASCUS-Reactive Process Favored cases, Hybrid Capture II returned positive in 90.9% of CIN III and 61.5% of CIN II cases (P <.001). Sixty-nine of 178 (38.8%) patients with no evidence of CIN tested positive for Hybrid Capture II. Human papillomavirus deoxyribonucleic acid (DNA) high-risk subtypes were detected by PCR in the tissue of all high-grade CIN cases with negative Hybrid Capture II results. CONCLUSION: Hybrid Capture II returned negative in 25% of cases with biopsy-proven high-grade CIN with associated high-risk HPV DNA by PCR (non-Premalignant ASCUS subset), and positive in 39.3% of cases with normal results; this limits its clinical utility.     

Dominant human papillomavirus 16 infection in cervical neoplasia in young Japanese women; study of 881 outpatients

OBJECTIVE: Human papillomavirus (HPV) infection is reported to be related to carcinogenesis in the uterine cervix. In Japan, screening for cervical cancer by cytology is performed in women over 30 years old. The purpose of this study was to determine whether there is an association between patient age and cervical neoplasia or HPV infection in Japanese women. METHODS: Specimens from 881 randomly selected patients who came to our clinic were tested for HPV DNA by using Hybrid Capture II, whereas specimens from a 204-patient randomly selected subset diagnosed with cervical neoplasia were tested for HPV DNA by using polymerase chain reaction (PCR). HPV typing was performed in all the PCR-positive cases. RESULTS: The HPV-positive rate in the 20- to 29-year-old patients (29.0% in the normal cytology/histology group and 85.5% in the abnormal group) was higher than in the 30- to 59-year-old patients, and the rate declined until age 60 when age increased. While HPV 18, HPV 52, other HPV types, and HPV types as a whole were frequently detected in 30- to 49-year-old patients, HPV 16 was detected more frequently in the younger group than the other HPV types (P = 0.03). Among the HPV 16-positive patients with cervical neoplasia, the proportion of cervical intraepithelial neoplasia (CIN) 3 cases was high (44%) in the 20- to 29-year-old group. CONCLUSIONS: Screening for cervical neoplasia by cytology should also be performed in women under 30 years old in Japan. The HPV typing could be a tool to strictly follow-up younger women who were diagnosed with CIN.     

Human papilloma virus infection in pregnant women with normal pap-smears, HPV oncogenity and risk factors

The process of carcinogenesis in both types of cervical carcinoma is dependent on the infection of oncogenic types of HPV. HPV infection could be diagnosed on the basis of whether or not the DNA virus in present. In pregnant women the latent-persistent infection easily changes into its active form. This process is related to changes in immunological response and concentration of the hormones. AIM: The main aim of the study was to evaluate the frequency of HPV infection in healthy pregnant women in second and third trimester of pregnancy and the presence of selected risk factors. MATERIAL AND METHODS: The study was conducted in 2005-2006 on hospitalized women in The Clinic of High Risk Pregnancy. The first group consisted of 180 pregnant women in 2nd trimester of pregnancy, the second comprised 220 pregnant women in the 3rd trimester. In all women the Pap-smears and diagnosis of DNA presence of high and low risk HPV from the border line of cervical epithelium were tested on the first day of the hospitalization. The PCR method using Human Papilloma Virus Typing Set was used. RESULTS: In 400 pregnant women the presence of HPV was found in 4.5%, type 16 was fund in 2.5%, type 18 in 1.7%. Combined infection 16 and 18 types was found in 0.2%. In 180 pregnant women in II trimester high risk HPV was found in 4.4%: 16 type was found in 2.8%, 18 type in 1.7%. In IlI trimester high risk HPV was found in 4.5%: 16 type was found in 2.3%, type 18 in 1.8%, combined 16 and 18 in 0.4%. Low risk HPV was found in 1.0%- type 6. In II trimester in 1.1%, In III trimester 0.9%. There were no differences between HPV infection rate in II and III trimester, pregnant women age, the gravity and HSV2 infection. The difference was found between high risk HPV infection and parity, cigarette smoking and oncological family history. CONCLUSION: Asymptomatic HPV infection has the same frequency in II and III trimester. High parity, cigarette smoking and oncological family history were connected with an increased rate of high risk HPV infection. All women in reproductive age should be checked for the HPV DNA.     

HPV and pregnancy: diagnostic methods,transmission and evolution

Pregnancy may foster the development of infections, in particular HPV infections. The aim of this study was to evaluate the entity of the relationship between HPV infection and pregnancy, with all the possible complications associated with this relationship. The pathology may be latent or manifest. Possible methods of diagnosis are clinical, namely gynecological examinations, PAP-tests, colposcopy or molecular, using viral DNA assay, Southern Blot, PCR, Hybrid Capture, etc. The prevalence of HPV infection in pregnancy varies between 5.4 and 68.8%. The population with the highest risk, also among pregnant women, are those under the age of 26. A number of different opinions emerge from the literature regarding the possibility of maternal-fetal virus transmission. None of the patients examined carried out treatment during pregnancy. The data reported in the literature on the relationship between HPV and pregnancy are highly discordant. This discrepancy depends on the diagnostic techniques used, the clinical history of the pregnant woman and the period of pregnancy when the sample is collected. Pregnancy enhances the development of the pathology which then often recedes in the postpartum. The possible maternal-fetal transmission of the virus is an important aspect: the letter is the main factor responsible for juvenile laryngeal papillomatosis. A number of Authors report an initial presence of HPV in newborns which often disappears within 6 months after birth.     

Detection of HPV infection by analyzing the changes in structure of peripheral blood lymphocytes specifically induced by HPV E7 antigen

PURPOSE: Detection of human papilloma virus (HPV) infection in clinical practice was examined based on the observation that peripheral blood lymphocytes exposed in vitro to antigenic or mitogenic stimulation change their intracellular structures as measured by polarization of fluorescent light emitted by labeled cells. MATERIALS AND METHODS: A total of 47 women were enrolled in this study. They were classified into four groups based on the results of HPV-DNA detection in cervical tissues by the Hybrid Capture II kit (Digene, Gaithersburg, MD, USA) and pathological examination. Ten women with no HPV-DNA detection were used as a normal control group. Fifteen women without pathological diagnosis in the cervical tissues had HPV-DNA detection. Ten women with CIN lesions had 80% HPV-DNA detection. Twelve women with invasive squamous cell carcinoma had 100% HPV detection. Peripheral blood lymphocytes derived from all women were collected and then exposed to HPV-E7 antigen and PHA mitogen. RESULTS: The positive response rate of HPV-E7 antigen was ten percent (1/10) in the normal control group, 73.3% (11/15) in the HPV infectious women, 50% (5/10) in the CIN women, and 91.7% (11/12) in the cervical cancer patients. The overall sensitivity rate of blood tests was 77.1% and the specificity rate was 57.8% when the Hybrid Capture II HPV Test kit was used as the standard detection method for cervical tissue. CONCLUSIONS: The results showed that peripheral blood lymphocytes derived from patients with cervical lesions might be another choice to be used as a screening method to detect HPV infection compared with conventional methods.     

HPV testing can reduce the number of follow-up visits in women treated for cervical intraepithelial neoplasia grade 3

OBJECTIVE: We evaluated high-risk human papillomavirus (HPV) testing by Hybrid Capture II (HC II) in addition to cytology to predict recurrent/residual cervical intraepithelial neoplasia (CIN) 2/3 and cervical cancer in women treated for CIN 3. METHODS: Follow-up study of 108 women with histologically confirmed CIN 3. RESULTS: Pretreatment, in 96% (104/108) of the smears high-risk HPV DNA was present. Posttreatment, 71% (77/108) of the women had normal cytology and negative HC II test and none developed recurrent/residual disease during a median follow-up of 28.8 months with a range of 2.4-64.8 months. One of the 12% (13/108) of women with normal cytology and positive HC II test was diagnosed with cervical adenocarcinoma. One of the 7% (8/108) of women with abnormal cytology (borderline dyskaryosis or worse) and negative HC II test was diagnosed with CIN 2. Three of the 9% (10/108) of women with abnormal cytology and a positive HC II test were diagnosed with CIN 2/3. These results show an increased risk for recurrent/residual CIN 2/3 and cervical carcinoma when at least one posttreatment test is positive. The highest relative risk (72.9, 95% CI 25-210) was present in women with both tests positive. CONCLUSIONS: HPV testing with Hybrid Capture II in conjunction with cytology can be used as a tool to select women with an increased risk for recurrent/residual CIN 2/3 and cervical cancer. The standard policy in The Netherlands is cytology at 6, 12, and 24 months posttreatment. However, for women with both normal cytology and negative HC II test at 6 months the chance to develop recurrent/residual CIN 2/3 and cervical carcinoma is so low that retesting at 12 months can be omitted.     

Managing atypical squamous cells of undetermined significance in Papanicolaou smears

OBJECTIVE: To assess strategies using repeated conventional Pap smear and human papillomavirus (HPV) DNA testing, alone or in combination, for identifying women with concomitant cervical intraepithelial neoplasia 2 and 3 (CIN 2/3) in women with atypical squamous cells of undetermined significance (ASCUS) in their Pap smears. STUDY DESIGN: A total of 360 women cytologically diagnosed with ASCUS were referred for colposcopy and underwent a repeat Pap smear, a biopsy when necessary and HPV testing using three different modes of detection of high-oncogenic-risk HPV types: 1, first-generation Hybrid Capture test (HC-1) (Digene Diagnostics, Gaithersburg, Maryland); 2, second-generation Hybrid Capture test (HC-2); and 3, polymerase chain reaction (PCR). RESULTS: Nineteen patients (5.3%) had histologic CIN 2/3. The sensitivity and specificity of the repeat Pap smear alone for the detection of CIN 2/3 were 73.7% and 62.9%, respectively, when referring all women with a repeat Pap smear using an ASCUS-positive threshold. The proportion of women referred for colposcopy was 39.0%. When HPV testing for high risk was used for identification of women with histologic CIN 2/3, sensitivity and specificity were, respectively, 68.4% and 85.9% for HC-1, 89.5% and 73.9% for HC-2 and 89.5% and 59.0% for PCR. The rate of referral for colposcopy of these three modes of HPV testing was 16.9%, 29.4% and 44.0%, respectively. The sensitivity and specificity for identification of women with concomitant CIN 2/3 using a combination of repeat cytology showing a low grade squamous intraepithelial lesion or high grade squamous intraepithelial lesion and/or a test positive for high-oncogenic-risk HPV group were, respectively, 94.7% and 73.2% when used in combination with HC-2. The referral rate of women for colposcopy of this combined strategy was 30.4%. CONCLUSION: As compared to the strategy using abnormal repeat Pap smear alone, those using high-risk HPV testing with Hybrid Capture showed statistically significantly higher specificities and lower proportions of women with ASCUS referred for colposcopy. In particular, a promising strategy would be to refer for colposcopy only women with repeat Pap smears showing squamous intraepithelial lesion and/or those positive for high-risk HPV detected by Hybrid Capture testing.     

The prevalence of human papilloma virus DNA in women with mucopurulent endocervicitis

OBJECTIVE: The aim of the study was to determine the prevalence of human papillomavirus (HPV) infection in a group of patients with mucopurulent endocervicitis. MATERIALS AND METHODS: One hundred and forty-eight patients who came for their routine medical screening and were diagnosed with mucopurulent endocervicitis were enrolled in the study. HPV DNA was sought in cervical swab specimens placed in digene transport medium by use of the Digene Hybrid Capture assay. RESULTS: HPV infection was detected in 5.4% (8/148) of the patients with mucopurulent endocervicitis. The mean age of the patients was 36.4+/-8.2 (18-54) years. Approximately 40% (59/148) of the patients used intrauterine devices currently or in the past, while 16.2% (24/148) used combined oral contraceptives as the contraceptive method. HPV DNA was detected in eight patients: five had infections with low-risk subtypes, one with high/intermediate risk subtypes and one with the combination of high- and low-risk subtypes. The mean age of the HPV infected patients was significantly lower than the HPV negative patients (28.2+/-6.3 versus 36.9+/-8.1 years, p = 0.003). Risk factors for HPV infection did not differ between the infected and uninfected groups. CONCLUSION: HPV infection should be sought in patients with clinical evidence of mucopurulent endocervicitis even without risk factors for cervical neoplasia.     

Amerindian women of the Brazilian Amazon and STD

Papanicolaou tests, PCR for HPV, C. trachomatis, HSV-1/2 and N. gonorrhoea, and Hybrid Capture II were performed for high- and low-risk HPV groups during screening for cervical cancer in 49 women of the Parakana tribe. Cytological diagnoses of HPV were suggested in three samples: PCR showed 12 (22.4%) cases of DNA positive HPV, 16 (1), 18 (2), 58 (3), 39 (1), 61 (1), 33 (1), 35 (1), unknown (2), and HCII analyzed 48 samples: 19 positive (39.58%) for the high-risk group and four (18.33%) for the low-risk group. The prevalence of HPV was 42.85% (p = 0.001) by molecular biology methods. The largest viral load was 1588.11 pg/ml for HPV 39 in a 16-year-old. PCR was positive for C. trachomatis and negative for HSV-1/2 and N. gonorrhoea. Parakana women present a high risk for the development of cervical cancer.     

Colposcopy vs Hybrid Capture II assay in detection of cervical human papilloma virus infection

PURPOSE OF INVESTIGATION: Considering the relationship between high-risk human papillomavirus types and the presence or subsequent development of cervical high-grade preinvasive lesions, the aim of the study was to determine if the Hybrid Capture II test can be used to triage women with atypical colposcopic findings. METHODS: The study was carried out on 100 patients with suspicious colposcopy findings (suggestive of human papillomavirus infection) who underwent a cervical smear for human papillomavirus testing DNA Hybrid Capture II and direct biopsies for histopathological analysis. RESULTS: Sixteen patients were negative for human papillomavirus. Of the eight patients positive for high-risk HPV type, seven presented an abnormal transformation zone grade 2 (high-grade squamous intraepithelial lesion of the cervix at histopathology). There was a significant positivity of medium-high risk virus types in the cases with more abnormal colposcopy (chi2 = 7.44; p < 0.005). Histopathological findings of high-grade squamous intraepithelial lesions were registered in the patients positive for medium-high risk human papillomavirus types (chi2 = 7.66; p < 0.025). CONCLUSIONS: Based on these results it can be concluded that if a diagnosis of a high-grade squamous intraepithelial lesion has been made on the basis of colposcopic and histopathological findings, there is a high probability that the infection was due to one or more types of human papillomavirus. There are necessary further studies to interpretate both the advantages and disadvantages of intermediate triage procedures, like Hybrid Capture II testing, compared with immediate colposcopy.     

Chlamydia trachomatis and human papillomavirus (HPV) infections in teenage sexually active girls

OBJECTIVE: The purpose of the study was to determine the frequency of C.trachomatis and HPV infections in teenage, sexually active girls. MATERIAL AND METHODS: 48 non-pregnant, sexually active young women (between 16-19 years of age), who submitted for periodical check-up during oral contraceptive use. Patients had periodical mild pain in the lower abdominal area and increased amount of mucigenous secretion. They had their first sexual intercourse before 16 years of age, multiple partners (>3), unprotected intercourse. The direct immunofluorescence (DIF) was used for C. trachomatis antigen detection (Chlamydia Direct IF (bioMérieux, France). DNA HPV presence and oncogenic potential was assessed using hybridization method (Hybrid Capture I HPV Assay, Digene Corp. Beltsville, MD U.S.A.). RESULTS: C. trachomatis antigen was detected in 13 aut of 48 swabs (27%), presence of HPV DNA was detected in 2 teenage girls with normal cytology (4.2%). In cytological evaluation LSIL (low grade squamous intraepithelial lesions) was described in 5 cases. In 4 of them along with LSIL coexisted C. trachomatis infection.     

Human papillomavirus DNA detection and histological findings in women referred for atypical glandular cells or adenocarcinoma in situ in their Pap smears

OBJECTIVE: To evaluate the association between high-risk human papillomavirus (HPV) DNA detection and histological diagnosis in women referred for atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) at Pap smear. METHODS: In this cross-sectional study, 146 women referred for AGC (124), AGC with high-grade squamous intraepithelial lesion (HSIL) (15), or AIS (7) were tested for HPV DNA using Hybrid Capture II (HC II). All women underwent colposcopic examination, and cervical biopsy was performed for 95 patients. Fifty-one women referred due to AGC with normal colposcopy and normal second Pap smear were scheduled for control visits every 4 months. RESULTS: The overall prevalence of HPV DNA was 38%. HPV DNA was detected in 93% of the women with HSIL associated with AGC and in 71% of women with AIS Pap smear, being significantly higher when compared with the prevalence (29%) in women with AGC alone. Forty-five women (30.8%) had clinically significant histological lesions (CIN 2 or worse). High-risk HPV DNA was detected in only 16% of the women without significant abnormalities in biopsy, in contrast to 96% of those who had CIN 2 or CIN 3 and 75% of women with AIS. Eighty-five percent of women with invasive cervical carcinoma (squamous or adenocarcinoma) tested positive for HPV DNA. HPV DNA detection was significantly associated with histological diagnosis of CIN 2 or worse, with an odds ratio (OR) = 51.8 (95% CI 14.3-199.9). CONCLUSION: HPV DNA detection was strongly associated with the severity of cervical lesion (CIN 2 or worse) in women referred for AGC or AIS in their Pap smear. These data implicate the use of HPV testing in triage of women with AGC Pap smears.     

Longitudinal Study of the Effects of Pregnancy and Other Factors on Detection of HPV

Objective: An epidemiologic study of 108 pregnant and 192 nonpregnant women was carried out to determine the effects of pregnancy and other factors on the detection of HPV infection, since both or larger numbers of pregnancies and HPV infection are known to be risk factors for cervical cancer. Patients and methods: Study participants were followed up at 3-months intervals for a period of 15 months (1–6 months after delivery). At each visit, two cervical specimens were taken, one for routine cytology and a second for HPV DNA hybridization using Virapap/Viratype, and a 5-ml blood sample was taken and a self-administered questionnaire was completed. Results: In cervical specimens of the initial examination, HPV DNA was detected among 5.0% of pregnant and 5.2% of nonpregnant women, whereas HPV 16/18 was found in 80% of the HPV-positive specimens. Using multiple cervical specimens taken over time, 13.9% of the pregnant and 15.1% of the nonpregnant women tested positive for HPV DNA at least once. Adjusted for study group, age, and the number of available cervical specimens, ever detection of HPV infection (any type) was associated with more sexual partners and larger numbers of cigarettes smoked daily. An autoregressive generalized linear model was used to analyze the time-dependent multiple observations per study subject. Adjusting for age and trimester of pregnancy, the determinants of detecting high-risk HPV types (16/18 and 31/33/35) in the cervical specimen were an abnormal Pap smear, a positive HPV result in a preceding specimen, more than six sexual partners in the lifetime, and currently smoking more than 20 cigarettes per day with odds ratios of 10.9, 5.6, 3.2, and 2.7, respectively. Conclusion: Our data provide no evidence for a higher detection rate of HPV during pregnancy.     

The prevalence and significance of high-risk human papillomavirus DNA test in southern Malaysia and Singapore

Aim of Study: To investigate the prevalence of high-risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore.
Method: Laboratory results of Hybrid Capture-II (Digene) HPV DNA and liquid-based cytology tests of consecutive women who had screening performed between January 2004 and December 2006 were studied retrospectively.
Results: Of 2364 women studied, the overall prevalence of high-risk HPV DNA detection rate was 25.6%. The prevalence peaked at 49.1% for women between 20 and 24 years old and declined to 23% among women between the age of 30 and 49 years. A small second peak of prevalence rate of 30% was observed among women above the age of 50 years old. 76.1% of the high-risk HPV infection regressed within the study period. An incidence infection rate of 16% was noted among a small group of women who had a second HPV DNA test. A total of 1153 women had both the HPV DNA and the cytology tests. Cytological abnormality (ASCUS or more) was detected in 8.9% in HPV DNA-positive group and in 3.1% in HPV DNA-negative group ( P  < 0.001). The risk ratio for HSIL was 9.8 for HPV-positive women compared to HPV-negative women. The prevalence of cytological abnormalities increased with increasing age of the women.
Conclusion: The epidemiology and clinical impact of high-risk HPV infection for women in Southern Malaysia and Singapore were indistinguishable from experience elsewhere. The apparent moderately high incidence of cervical cancer was explainable by suboptimal screening program.     

Cervical human papillomavirus deoxyribonucleic acid persists throughout pregnancy and decreases in the postpartum period.

OBJECTIVE: Our goal was to determine the persistence of human papillomavirus infection of the cervix in a prospectively evaluated cohort of pregnant women observed from the first trimester until after delivery. STUDY DESIGN: A group of 232 women were enrolled in the first trimester of pregnancy and had cervico-vaginal lavage specimens collected for detection of the deoxyribonucleic acid of human papillomavirus. They underwent sampling again in the third trimester (146 patients available) and at 4 to 12 weeks after delivery (83 patients available). Human papillomavirus deoxyribonucleic acid was detected by means of the Hybrid Capture assay. RESULTS: In the first trimester of pregnancy, 31% of the patients had positive test results for human papillomavirus deoxyribonucleic acid, whereas 35.6% had positive results in the third trimester (P = 1.0). A comparison of first-trimester test results with postpartum results (paired data available from 83 patients) showed a decline from 39.8% positivity to 26.5% (P =.04). Comparing third-trimester results with postpartum results (paired data available from 74 patients) showed a decline from 35.1% to 25. 7% positivity (P =.12). When specimens positive for human papillomavirus were divided between those containing "high cancer risk" types (9 virus types often associated with dysplasia or malignancy) and "low cancer risk" types (5 types usually found in benign lesions), similar trends were seen, although not all comparisons were statistically significant. CONCLUSION: The increased prevalence, during pregnancy, of detectable human papillomavirus deoxyribonucleic acid, which was previously reported (Fife et al, Am J Obstet Gynecol 1996;174:1487-93), persists at a similar level throughout pregnancy but declines in the postpartum period. This observation is most consistent with activation of the virus by the physiologic changes of pregnancy.     

The triage of squamous cell abnormalities of cervical cytology by human papilloma virus screening

OBJECTIVE: The aim of the study was to determine the presence of human papilloma virus (HPV) infection in cervical swabs by the use of the Digene Hybrid Capture assay in a cohort of patients with squamous cell abnormalities found in cervical cytologic screening. MATERIALS AND METHODS: Thirty-four (0.3%) of 1,100 patients who came for their routine cervical cytologic screening and diagnosed as having squamous cell abnormalities were enrolled in the study. Colposcopy-directed biopsy was obtained from all study patients. HPV DNA was sought in cervical swab specimens placed in Digene transport medium by the use of the Digene Hybrid Capture assay. The findings of cervical cytology, colposcopy-directed biopsy and HPV screening were compared. RESULTS: In a total of 34 women who were diagnosed as having squamous cell abnormalities in their routine cervical cytologic screening, 15 women had atypical squamous cell lesions of undetermined significancy (ASCUS), 16 women had low-grade cervical intraepithelial lesions (LGSIL), and three women had high-grade cervical intraepithelial lesions (HGSIL). Five (15%) of these women tested positive for HPV screening in cervical swabs where four women had infection with high-risk and one woman had infection with low-risk subtypes. None of the patients with koilocytotic changes of the squamous cells in the class of LGSIL histopathologically tested positive for HPV screening. In addition, one patient diagnosed as having invasive cervical carcinoma histopathologically tested negative for HPV screening. Atypical vascularization was seen colposcopically in this 37-year-old woman who had ASCUS cytologically. CONCLUSION: HPV screening seems to have value in the triage of patients with ASCUS with no clear advantage to colposcopy-directed biopsy. The routine performance of HPV screening for the triage of patients with squamous cell abnormalities has no advantage over colposcopy-directed biopsy.     

The latent infection of human papilloma virus in pregnat woman and colonization of placenta--preliminary report

Human papilloma virus infection may have a latent form without characteristic changes in Pap-smears. Some data suggests there exists a possibility of materno-foetal transmission of the HPV infection. HPV infection may be one of the possible reasons for IUGR. AIM: The main aim of the study was to find DNA HPV in the Pap-smear and placentas in pregnancy complicated by the intrauterine growth restriction. MATERIAL AND METHODS: In two groups of women with normal Pap-smears, the material for DNA presence was taken from the uterine cervix and from the central part of placenta after the delivery. The study group consisted of pregnant women with the pregnancy complicated by fetal growth restriction. The control group consisted of women with normal fetal weight pregnancy. In cervical smears and placental fragments the presence of HPV DNA and typing of HPV using the PCR method has been done. RESULTS: In the control group the presence of low risk types of HPV was found but DNA HPV wasn't present in the placental fragments. In the study group, in 4 cases high risk HPV DNA was found in cervical smears and in 3 of those cases HPV DNA was also present in the placental fragments. In two cases it was type 16, in one--type 18. CONCLUSIONS: The latent form of high risk HPV infection might be the reason for materno-foetal transmission of HPV. The high rate of high oncogenic risk types of HPV in the group of pregnancies complicated by IUGR might suggest the correlation between HPV infection and IUGR etiology.     

Significance of HPV tests on women with cervical smears showing ASCUS

BACKGROUND: The relationship between the human papillomavirus (HPV) tests and the cytological findings was evaluated. METHODS: Totally, 161 women participating in the organized cytological screening in the County of Uppsala and showing atypical squamous cells of uncertain significance (ASCUS) in their cervical smears were identified during 2002 and 2003. Those women were invited for a repeated examination about 3 months later. At that occasion, a smear sample was collected and used for cytological examination and a concomitant HPV test. Oncogenic HPV was identified by polymerase chain reaction and HPV deoxyribonucleoside acid (DNA) sequence analysis in 50 cases and by Hybrid Capture II in 111 cases. RESULTS: Women with an ASCUS diagnosis showed a normal cytology and a negative HPV test in 30% of the cases, abnormal cytology and a positive HPV test in 32% of the cases; in 26% of the women, the HPV test was positive, whereas cytology was normal; and in 11% of the women, the HPV test was negative, whereas cytology was abnormal (ASCUS or more). CONCLUSION: The results show that HPV tests identify a larger group of women at risk to develop cervical cancer in comparison with cytological examination. As the HPV tests have a higher sensitivity than the cytological screening, it is suggested that an HPV test in conjunction with a diagnosis of ASCUS can be employed to more efficiently select women, to whom further follow up is recommended.