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Persistence of human papillomavirus infection (HPV) of the cervix after treatment for cervical intraepithelial neoplasia predisposes to lesion recurrence. Given the weakness of natural immunity against HPV it has been suggested that certain anatomical sites could act as viral reservoirs though which the infection could be retransmitted to the cervix even if the initial HPV tests after treatment are negative. This review examined the possible role of various reservoirs such as the oral cavity, the anus, the fingers and the partner's penis. The available data are insufficient to confirm a significant risk of cervical re-infection from any site other than the penis. It seems that the risk of transmission by the male partner can be reduced by consistent condom use; therefore this should be included in the patient's counselling. Further studies are required to elucidate the role of the other sites especially the anus where some reports imply a possibility for transmission to the cervix. In this context expanding the indications for HPV vaccination to include women who have been treated for CIN should be considered.

This is a prospective study of the epidemiological, clinical, and virological characteristics of cases of genital warts in a Greek University Hospital. The women completed a questionnaire regarding their medical and sexual history and underwent cervical cytology, HPV DNA typing, mRNA testing, colposcopy, Chlamydia testing, and proctoscopy. Univariate and multivariate analyses were performed. The most commonly detected types were type 6 (36.1%) and 16 (24.3%). E6/E7 mRNA testing was positive in 21.5%. Concurrent cervical intraepithelial neoplasia grade 2 or worse was found in 11.1% and intra-anal warts in 10.4%. For chlamydial infection the number of sexual partners was a significant predictor. Women with warts infected with types 6 and 11 constituted only 37.5% of the total. This could have a negative effect on the efficacy of vaccination in reducing the incidence of the disease. Based on the present findings the authors recommend cytology and colposcopy for all women with genital warts.

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