EPIDEMIOLOGIC EVIDENCE OF CERVICAL INTRAEPITHELIAL NEOPLASIA WITHOUT THE PRESENCE OF HUMAN PAPILLOMAVIRUS

The aim of this paper was to provide epidemiological evidence to suppo rt the notion that cervical intraepithelial neoplasia (GIN) without hu man papillomavirus (HPV) is a true entity. If a diagnosis of HPV-negat ive cervical neoplasia is erroneous, one would not expect there to be any differences in risk factors between HPV-positive and HPV-negative patients. Patients at a gynaecological outpatient clinic of a universi ty hospital [a total of 265 consecutive women with dyskaryotic cervica l smears who were subsequently diagnosed with CIN I (n=37), CIN II (n= 43) or CIN III (n=180)] completed a structured questionnaire regarding smoking habits and sexual history. Analysis of an endocervical swab f or Chlamydia trachomatis, analysis of a cervical scrape for HPV, and m orphological examination of cervical biopsy specimens were also perfor med. HPV was found in 205 (77.4%) out of the 265 women. Univariate ana lysis showed that current age (P= 0.02), current smoking behaviour (P= 0.002) and the number of sexual partners (P=0.02) were significantly a ssociated with the presence of HPV. Age at first sexual intercourse, a past history of venereal disease or genital warts, and current infect ion with Chlamydia trachomatis were not associated with the presence o f HPV. Using multivariate logistic regression analysis, the number of sexual partners and current smoking behaviour showed an independent si gnificant association with HPV. HPV-negative and HPV-positive CIN pati ents differ with respect to the risk factors for HPV. These findings s uggest that HPV-negative CIN is a separate true entity.