HUMAN PAPILLOMAVIRUS INFECTION AND CERVICAL PRECANCER - IMPLICATIONS FOR MANAGEMENT AND CONTROL

Over the last decade a large number of clinical, epidemiolo,oical and experimental studies have elucidated the role of human papillomavirus (HPV) in the pathogenesis of genital tumors including carcinoma of the uterine cervix. Moreover, the sexual mode of transmission of genital HPVs and detection of viral DNA in cervical premalignant and malignant lesions suggest a causative role for HPV in cervical oncogenesis. Dif ferences in the type of HPV found in different grades of cervical lesi ons have led to the theory that there exists two categories of HPVs, t he low-risk (6 and 11) and the high-risk (16, 18, 31, 33, 35 and 39) g roups, being associated with low and high grade lesions respectively. Taking into account the unpredictable biological behaviour of precance rous cervical lesions, a modification of the CIN classification has be en proposed. This classification, known as the Bethesda System, identi fies low grade and high grade squamous intraepithelial lesions and bet ter corresponds to currently held views on the behaviour of premaligna nt lesions, Based on the observed biological dichotomy of HPV infectio n in cervical lesions, further elaboration of the Bethesda system is p ossible, This paper studies the role of HPV in cervical carcinogenesis as well as the clinical relevance of HPV typing in the management of cervical neoplasmas.