HISTOLOGIC CORRELATES OF VULVAR HUMAN PAPILLOMAVIRUS INFECTION IN CHILDREN AND YOUNG-ADULTS

Two clinically important issues in the treatment of vulvar wartlike le sions are the histologic criteria for the recognition of human papillo ma virus (HPV)-related lesions and the exclusion of lesions derived fr om cutaneous rather than genital HPV types. We analyzed a series of 70 biopsies from the vulva or distal vagina of 57 children and 13 young adults for HPV nucleic acids by polymerase chain reaction (PCR) amplif ication and typed the isolates following isotope labeling and restrict ion digestion (restriction fragment length polymorphism [RFLP] analysi s). Lesions were classified as condyloma, suggestive of condyloma (pap illary/verrucous architecture without koilocytotic atypia), or nonspec ific epithelial alterations. Three observers independently agreed on t he presence of papillary/verrucous architecture and koilocytotic atypi a with a high degree of concordance (kappa = 0.74 and 0.71, respective ly). By RFLP analysis, 77% of the lesions diagnosed as condyloma and 6 8% of those diagnosed as suggestive of condyloma contained HPV nucleic acids versus 9% of the nonspecific group. The HPV types identified we re HPV 6 (67%), HPV 11 (17%), HPV 16 (3%), and unknown types (14%). No cutaneous HPV types were identified. Three patients with unknown HPV types had a history of sexual abuse, implying a genital source. These findings indicate that verrucopapillary external genital lesions, as d efined in this report, are likely to be associated with HPV and that t he vast majority contain genital HPV types irrespective of histologic presentation.