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HPV Testing in sexually active womenWeill Medical College of Cornell University, New York, NY, USA.Human Papilloma Virus (HPV) testing was done in two separate groups of women. In the first, there were 83 patients with an initial abnormal Pap smear of LSIL or HSIL. They were observed serially, with HPV testing and Pap smears. Any biopsy intervention was based upon Pap smear findings. They were observed for 1-53 months with a mean of 19 months. There were 261 HPV tests obtained, a mean of 3.14 and 422 Pap smears, a mean of 5.1 per patient. Fifty-one of the 83 patients (61.4%) had colposcopy, conization, or both. There was a correlation between a positive HPV test and abnormal Pap smears in this population. Fourteen of 20 patients (70%) whose last HPV test was positive had either ASCUS (6) or LSIL (8). Although most patients, 51 of 63 (81%) whose last HPV test was negative had a normal Pap smear, 19% had abnormal smears. Five had ASCUS and seven had LSIL. The second study population consisted of 20 women with vulvar vestibulitis whose vulvar smear tested positive for HPV. They were treated with intralesional interferon alpha 2-beta by injection, 12,000,000 units in 12 divided doses over a four-week period. Post treatment testing was negative for HPV in 19 (95%). There is an important future role for HPV testing in clinical practice. Most of the current criticism of HPV testing narrowly focuses upon its shortcomings as an adjunct to the Pap smear. In fact, in this study, 19% of women with a negative HPV test had an abnormal Pap smear, either ASCUS (6) or LSIL (8). However, HPV testing will be necessary to hasten the elimination of HPV by such agents as interferon or Imiquimod before women develop abnormal Pap smears. In addition, it will be used to identify HPV negative women who will be candidates to receive an HPV vaccine. For more information, contact blrevell@mail.med.cornell.edu Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis. |
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