Papillomavirus detection: Demographic and behavioral characteristics influencing the identification of cervical disease

OBJECTIVE: This study was undertaken to assess the association between dete ction of high-risk types of human papillomavirus and various demographic an d behavioral characteristics and to further relate this association to cerv ical histopathologic findings. STUDY DESIGN: A total of 1007 patients with a Papanicolaou test result repo rted as high-grade squamous intraepithelial lesion or with 2 results report ed as atypical squamous cells of undetermined significance or low-grade squ amous intraepithelial lesion were referred from city and county clinics to a colposcopic clinic. All women had a cervical smear obtained, underwent co lposcopically directed biopsy and endocervical curettage, and had a specime n taken for human papillomavirus deoxyribonucleic acid detection by polymer ase chain reaction. Demographic information was obtained from each patient. RESULTS: Human papillomavirus deoxyribonucleic acid was identified in 655 ( 66%) of the specimens. High-risk human papillomavirus types (16, 18, 31, 33 , and 35) were detected in 463 (70.7%) of these specimens. The prevalence o f evidence of human papillomavirus (koilocytosis) and grade 1 cervical intr aepithelial neoplasia in the biopsy specimen decreased significantly with a ge, whereas the prevalence of grade 2 or 3 cervical intraepithelial neoplas ia in the biopsy specimen increased with age. There was a significant age-d ependent decreasing trend in detection of high-risk human papillomavirus de oxyribonucleic acid among women who had human papillomavirus-associated cha nges,grade 1 cervical intraepithelial neoplasia, and grade 2 or 3 cervical intraepithelial neoplasia in the biopsy specimen. The prevalences of high-r isk human papillomavirus among patients with grade 1 cervical intraepitheli al neoplasia and grade 2 or 3 cervical intraepithelial neoplasia were simil ar, and both were significantly higher than among women with no evidence of cervical intraepithelial neoplasia or koilocytosis in the biopsy specimen. Risk factors associated with grade 2 or 3 cervical intraepithelial neoplas ia were different from those associated with human papillomavirus-associate d changes and with grade 1 cervical intraepithelial neoplasia. CONCLUSION: The detection of high-risk human papillomavirus was age-depende nt for all histologic categories. Patients with grade 2 or 3 cervical intra epithelial neoplasia had a prevalence of high-risk human papillomavirus tha t was similar to that among women with grade 1 cervical intraepithelial neo plasia but significantly higher than that among women whose biopsy specimen s appeared normal or demonstrated only the presence of human papillomavirus -induced changes (koilocytosis). This suggests that separation of human pap illomavirus-associated changes only from grade 1 cervical intraepithelial n eoplasia may be of significance in tissue diagnosis.