Low risk of type‐specific carcinogenic HPV re‐appearance with subsequent cervical intraepithelial neoplasia grade 2/3

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Abstract
Carcinogenic human papillomavirus (HPV) infections are very common after sexual debut and nearly all become undetectable (“clear”) within a few years. Following clearance, the long‐term risks of type‐specific HPV re‐appearance and subsequent risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) are not well defined. In the 7‐year, population‐based cohort study in Guanacaste, Costa Rica, we studied how often type‐specific carcinogenic HPV infections re‐appeared after clearance and how often re‐appearance led to CIN2+. We considered 1,740 carcinogenic HPV infections detected by MY09/11 PCR among 2,805 women (18–91 years old, median 34) who were actively followed at 6‐ or 12‐month intervals. We identified women with one or more type‐specific HPV infections that cleared and re‐appeared and further defined a subgroup of “definite clearance and re‐appearance” (≥2 intervening negative results over a period of ≥1 year). We determined the absolute risk of CIN2+ among the different groups. p values are two‐sided. Only 7.7% (81/1,052) of HPV‐infected women had intervening negative results. Very few (3.7%, 39/1,052) had “definite clearance and re‐appearance”, of which 5.1% (2/39) subsequently persisted to a diagnosis of CIN2. There were zero CIN3+ lesions. Extremely few women (2/2,805 of women in our cohort) had a type‐specific carcinogenic HPV infection clear, re‐appear and lead to CIN2+. If confirmed, this argues against vaccination to avoid re‐appearance that leads to precursor lesions and against the need of frequent HPV screening after initial negative results.

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