ACETOWHITENING OF THE CERVIX AND VULVA AS A PREDICTOR OF SUBCLINICAL HUMAN-PAPILLOMAVIRUS INFECTION - SENSITIVITY AND SPECIFICITY IN A POPULATION-BASED STUDY

Objective: To evaluate acetowhite changes of the cervix and vulva as a predictor of human papillomavirus (HPV) infection. Methods: In this p opulation-based study all women aged 19, 21, 23, and 25 years and regi stered as living in a primary health care area within the city of Umea , Sweden were eligible for inclusion. Each participant underwent a gyn ecologic examination with sampling of epithelial cells for HPV-DNA det ection and Papanicolaou smear. Colposcopy was performed 5 minutes afte r application of 5% acetic acid. A two-step, polymerase chain reaction (PCR) technique was employed for HPV-DNA detection. Results: Colposco py and sampling of epithelial cells could be performed in 535 women. T he sensitivity of detection of HPV infection by the acetowhitening of the cervix was 22% (95% confidence interval [CI] 18%, 26%). The specif icity of detection of HPV infection by the acetowhitening of the cervi x was 90% (95% CI 87%, 93%). The sensitivity of detection of HPV infec tion by cytology was 13% (95% CI 10%, 16%), and the specificity was 99 % (95% CI 98%, 100%). The combination of acetowhitening and cytology d id not improve the diagnostic value. Conclusion: Acetowhitening of the cervix and vulva has low sensitivity as a predictor of HPV infections as determined by PCR. (C) 1997 by The American College of Obstetricia ns and Gynecologists.