Gynecology
A population-based five-year follow-up study of cervical human papillomavirus infection,☆☆

https://doi.org/10.1067/mob.2000.106749Get rights and content

Abstract

Objective: The purpose of this study was to determine the long-term tendency for cervical human papillomavirus infections to persist in the general population. Study Design: From 500 women who participated in a 1991 population-based survey, 90 healthy women with normal results of cytologic examination (women with human papillomavirus deoxyribonucleic acid detected and age-matched control women without human papillomavirus deoxyribonucleic acid detected) were interviewed and examined 5 years later colposcopically, cytologically, and with human papillomavirus serologic testing and human papillomavirus deoxyribonucleic acid testing by polymerase chain reaction with 2 different consensus primer pairs (MY09 and MY11 and GP5+ and GP6+), type-specific polymerase chain reaction, and deoxyribonucleic acid sequencing. Results: The 5-year human papillomavirus clearance rate was 92%. Only human papillomavirus type 16 infections persisted. Colposcopic impression of grade 2 cervical intraepithelial neoplasia was associated with persistent human papillomavirus 16 infection (P <.03). Human papillomavirus detection was associated with sexual history. Human papillomavirus type was the only determinant of human papillomavirus persistence. Conclusion: The high clearance rates in a population-based setting with a 5-year follow-up period imply that inclusion of human papillomavirus deoxyribonucleic acid testing in population-based cervical screening programs should target persistent infection. (Am J Obstet Gynecol 2000;183:561-7.)

Section snippets

Study group

Five hundred women who were residents of Stockholm, Sweden, were enrolled when attending the population-based invitational cervical screening program in 1991.17 This screening program invites all resident women aged 25 to 60 years to undergo examination, at first yearly and at >26 years of age at 3-year intervals. The attendance rate is about 65%. Fifty-six women with normal results of cervical cytologic examination had detection of cervical HPV DNA by polymerase chain reaction (PCR) with the

Reanalysis of 1991 cervical samples

Because only MY09 and MY11 primers had been used in 1991, the earlier samples were thawed and analyzed with GP5+ and GP6+ primers in 1997. Five of 46 samples from the cohort originally without HPV detection by MY09- and MY11-based PCR in 1991 had positive detection with the GP5+ and GP6+ primers. Conversely, 10 of 44 samples that had HPV detected by MY09- and MY11-based PCR in 1991 yielded negative results with the GP5+ and GP6+ primers (Table I).

For all 5 samples that had HPV detected with GP5+

Comment

Our estimate of a population-based 5-year clearance rate of 92% is well in line with results of previous follow-up studies, which have reported HPV clearance rates of >90% through 2 years of follow-up,7, 9, 10 and also well in line with estimates of the clearance rate derived from comparisons between HPV serologic results and HPV DNA detection.25 The tendency for the high-risk HPV type 16 to have a slower clearance rate has also been noted in several previous studies.7, 8, 10, 13 Thus our

Acknowledgements

We acknowledge Professor Britt-Marie Landgren and the staff at the Kvinnohälsan outpatient clinic for providing facilities and skilled assistance.

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    Supported by the Swedish Cancer Society. Joakim Dillner, MD, PhD, is supported by the Swedish Medical Research Council and by the Nordic Academy for Advanced Studies.

    ☆☆

    Reprint requests: Kristina Elfgren, MD, Department of Obstetrics and Gynecology, K57, Huddinge University Hospital, S-141 86 Huddinge, Sweden.

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