Genital warts and cervical neoplasia: An epidemiological study

Abstract

Summary Cervical carcinoma and cervical intra-epithelial neoplasia (CIN) are likely to be associated with all sexually transmitted diseases (STDs). To help discover which (if any) of the recognised STDs might actually cause these conditions, a key question is whether one particular such association is much stronger than the others. The present study is therefore only of women newly attending an STD clinic, and compares the prevalences of cytological abnormalities of the cervix among 415 women attending with genital warts, 135 with genital herpes, and 458 with trichomoniasis or gonorrhoea. Significantly more genital wart patients (8.1%) than trichomoniasis or gonorrhoea patients (1.9%) showed dyskaryotic changes (adjusted relative risk (RR)=5.8 with 95% limits 2.5-13.5) at, or a few months before, first attendance, while no excess whatever was seen in women with genital herpes. Moreover, half the women had a subsequent smear (at an average of 3-4 years after first attendance) and, although the diagnosis at first attendance was not related to the onset rate of dyskaryotic changes observed in these subsequent smears, it was related to the onset rate of grade III cervical intra-epithelial neoplasia (CIN III), which was found in 7 previous genital wart patients, in 2 previous trichomonas patients, but in 0 previous genital herpes patients. Thus, our findings suggest that herpes is not directly relevant to dyskaryotic change, but that one or more of the human papilloma viruses that cause genital warts may be.

Natural History of Genital Papillomavirus Infections

“…In vivo long-term use of oral contraceptives increases the risk for condylomata acuminata [163,164], HPV was detected with increasing frequency the longer oral contra ceptives were taken [127], This association was indepen dent of lifetime number of male sexual partners, age, and race. It is not clear if oral contraceptive use is mainly responsible for acquisition of genital HPV infection or transformation of HPV-infected epithelium: an increased risk for cervical cancer with oral contraceptive use was only seen in HPV-positive women [128], whereas in another case-control study, adjustment for HPV neutral ized relative risks seen for oral contraceptive use [129].…”

A case-control study of cervix cancer in Singapore

“…The effect of smoking (Harris et al, 1980;Buckley et al, 1981;Winkelstein et al, 1984;La Vecchia et al, 1986), oral contraceptive use (Harris et al, 1980;Vessey et al, 1983;WHO, 1985;Brinton et al, 1986), venereal infections other than HPV (Franceschi et al, 1983;Rawls et al, 1986;La Vecchia et al, 1986), diet (Marshall et al, 1983; (Wangsuphachart et al, 1987 Sexual, reproductive and contraceptive history Table III presents information collected on sexual and reproductive history. There is no material difference in age at menarche, but a significant difference is seen with respect to age at first intercourse.…”

Low Grade Cervical Intraepithelial Neoplasia Associated with Human Papillomavirus Infection

“…32 HPV was targeted recently as the most likely infectious agent in the etiology of cervical cancer. 1,3,4,[6][7][8][9][10]24,36 Certain types of HPV have been implicated in the development of CIN and invasive cancer of the lower genital tract. HPV 6 and 11 appear to have a low oncogenic association, and HPV 16 and 18 have a high association.…”

“…Human papillomavirus (HPV) has been shown to be associated with cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma of the uterine cervix. 1,3,4,[6][7][8][9][10]24,36 Certain types of HPV have been implicated in the development of intraepithelial neoplasms and invasive cancer. 19 Low grade CIN (LCIN) creates controversy among gynecologists because of the difficulty of managing the lesions: a major question is whether the lesion should be treated or only followed.…”