Human Papilloma Virus Infection and Associated Intraepithelial Neoplasia of the Cervix, Vagina and Vulva

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Abstract
EDITORIAL COMMENT: This issue contains reports of 3 studies indicating that a cervical smear indicative of wart virus disease or of cellular abnormalities short of dysplasia may be associated with intraepithelial neoplasia of any degree (CINICIN3). The following statement on cervical smear reporting procedures endorsed by the Royal Australian College of Obstetricians and Gynaecologists could be regarded as unduly conservative in the light of this recent information.CERVICAL SMEAR REPORTING PROCEDUREThe problem of doctors repeating smear tests month after month on patients who have abnormal tests because of no firm recommendation by the pathologist involved, prompted the endorsement of the following recommendations by the Victorian Cytology Service:i That when a cytological prediction is made of established dysplasia, of any degree, with or without papilloma or wart virus infection, and whether or not the patient is pregnant, the recommendation should read ‘Colposcopic evaluation is recommended’.ii When a cytological prediction of papilloma or wart virus infection is made, without evidence of established dysplasia, in the first instance the recommendation should be ‘Please repeat smear in 6 months’.iii If evidence of papilloma or wart virus infection persists, a second 6‐monthly smear may be recommended. If the changes are present in the third smear, indicating persistence of a lesion for 12 months, the recommendation should be ‘In view of the persistence of the changes, colposcopic evaluation should be considered’.Summary: A prospective colposcopic and histological study was performed on 333 patients with cytologically detected human papilloma virus infection (HPV) without cytological evidence of associated intraepithelial neoplasia. The colposcopic changes seen in the cervix, vagina and vulva were documented and target biopsies were taken from abnormal areas in these 3 sites. Colposcopic and histological evidence of HPV infection was found in the cervix of 314 patients (94%), vagina in 274 patients (82%) and vulva in 146 patients (44%). Histologically proven cervical intraepithelial neoplasia was found in 94 of 333 patients biopsied (28%), vaginal intraepithelial neoplasia in 3 of 333 patients biopsied (0.9%) and vulval intraepithelial neoplasia in 9 of 146 patients biopsied (6.2%). This study identified the colposcopic changes of HPV infection to be widespread throughout the lower female genital tract. The diagnosis of intraepithelial neopiasia undetected by cytology in 28% of patients with HPV infection indicates that such patients require colposcopy and target biopsy according to the colposcopic findings.