Symptoms and HPV infection of the vulva: clinical manifestations or mere coincidence?*

Abstract

Two hundred women with abnormal Pap smears and/or vulvar symptoms and 30 with normal Pap smears were investigated to determine the association between symptoms and (i) human papilloma virus infection of the vulva, and (ii) a spongiotic tissue reaction or a spongiotic dermatitis of the vulva. All had vulvar colposcopy and biopsy Human papilloma virus infection was diagnosed by histopathology and in situ hybridisation technique. HPV infection was present in biopsies of 48% of asymptomatic women and 33% with symptoms (p = 0.13) and HPV DNA in 37% of asymptomatic women and 31% with symptoms (p = 0.72). Spongiotic tissue reaction was diagnosed in 53.5% of asymptomatic women compared to 74% of symptomatic women (p = 0.007). This study suggests that vulvar symptoms are not clinical manifestations of HPV infection, but may be caused by dermatitis rather than HPV infection per se.

‘HPV vulvitis’ revisited: frequent and persistent detection of novel epidermodysplasia verruciformis‐associated HPV genotypes

“…26,45,47 These assumptions are in part derived from the colposcopic observation of aceto-whitening of vulva and microscopic findings of koilocytes in the biopsy specimens, incriminating HPV infection as those occurring in the cervical epithelium. Clinicopathologic correlations in these patients were further supported by the demonstration of HPV antigens and/or HPV DNA using immunohistochemical 23,25,26,45 and molecular-based techniques, [19][20][21]23,24,27,29,[32][33][34][36][37][38][39][40][41][42][43][44][45] respectively.…”

“…‘HPV vulvitis’ describes a putative clinical disorder characterized by local symptoms of burning, pruritus, pain and/or dyspareunia, evidence of HPV infection by clinical, colposcopic and/or histologic examination and no other explainable causes 18–47 . The spectrum of clinical findings in HPV vulvitis includes vestibular or vulvar squamous papillomatosis (VSP), vulvar erythema (VE) and/or acetowhite regions of vulva.…”

“…The low prevalence of detectable HPV DNA in the previous vulvitis/VSP studies 19,29–41,46,47 may be in part because of the sensitivity and specificity of the methods employed. The detection of HPV DNA by in situ hybridization or polymerase chain reaction (PCR) using probes and primers specific only for GM genotype may underestimate the prevalence of HPV DNA, particularly the CU and EV genotypes 48,49 .…”

“…The spectrum of clinical findings in HPV vulvitis includes vestibular or vulvar squamous papillomatosis (VSP), vulvar erythema (VE) and/or acetowhite regions of vulva. The validity of this proposed clinical entity has not been readily accepted by most authorities because of the predominately negative or insignificant positive results for HPV in the later studies, 19,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]46 high prevalence of VSP, VE and vulvar acetowhite lesions among healthy, sexually active women without vulvar complaints, 29 and the frequent histologic over-diagnosis of HPV by the finding of koilocytes in biopsy specimen. 19 Moreover, many of the vulvar symptoms in this population may be caused by an unrecognized dermatitis rather than HPV infection per se.…”

“…19 Moreover, many of the vulvar symptoms in this population may be caused by an unrecognized dermatitis rather than HPV infection per se. 41 The low prevalence of detectable HPV DNA in the previous vulvitis/VSP studies 19,[29][30][31][32][33][34][35][36][37][38][39][40][41]46,47 may be in part because of the sensitivity and specificity of the methods employed. The detection of HPV DNA by in situ hybridization or polymerase chain reaction (PCR) using probes and primers specific only for GM genotype may underestimate the prevalence of HPV DNA, particularly the CU and EV genotypes.…”