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High prevalence of abnormal cervical cytology in young women with genital warts
Chenchit Chayachinda, Manopchai Thammakhantho, Chanon Nuengton, Amphan Chalermchockcharoenkit, Isarin Thanabunyawat
Gynecolologic Infectious Disease and Female STD Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700
Genital warts and cervical intra-epithelial neoplasia
(CIN) are both associated with human
papillomavirus (HPV) infection. Although the
etiologic HPV types are different, the occurrence of
genital warts may be a marker of a relative
deficiency in immune response that can be a factor
for cervical intra-epithelial lesion. From literature
review, only few studies have been conducted to
explore this issue but all of them showed a
significant association.
Year
19921
Country
N.
Ireland
n
Design
Pap smear Colposcopic
(LSIL+)
Bx (CIN+)
100 Initial
Pap
smear
10 years
later
20032
20053
Canada 496 Cohort
(10years)
Israel
74
Crosssectional
20114 Croatia 221 Cohort
(7years)
15(15%)
Methods
This retrospective cohort study included 600 women
with either genital warts or syphilis who attended
Siriraj Female STD Clinic from 2007-2011. Exclusion
criteria were pregnancy, HIV infection, known case
of cervical cancer or genital warts, rape case and
being a commercial sex worker. Eligible subjects
were 104 women with late latent syphilis and 293
women with genital warts. The diagnosis of cervical
intraepithelial neoplasia was based on liquid-based
Pap smear, colposcopy and/or biopsy. Loop
electrical excisional procedure (LEEP) was
performed when
Results
12(12%)
99(20%)
37(37%)
149(30%)
ASCUS+ 13.5% =>
CIN 10.8%
111(50%)
78(35.3%)
Cancer 6(2.7%)
LSIL; low grade squamous intraepithelial lesions, CIN; cervical
intraepithelial neoplasia, ASCUS; atypical squamous cells of
undetermined significance
Age (year)
Body mass index
(kg/m2)
Age at first
intercourse (year)
Genital warts
(n= 293)
Syphilis
(n=104)
P
26.8 ± 8.8
49.7±
15.5
<0.01
20.6 ± 3.0
23.5 ±
4.0
<0.01
20.3 ± 4.8
20.8 ±
4.0
0.35
Number of sex
partner
2.1 (1-10)
1.5 (1-2)
<0.01
Parity
0.4 (0-4)
2.6 (0-8)
<0.01
Abortion
0.3 (0-4)
0.4 (0-4)
0.08
Table 1: Literature review on prevalences of abnormal cervicalcytology in women with genital warts
Data was shown in mean ± S.D. or mean with range as
appropriate.
Table 2: Characteristics of the participants
Objectives
Women with genital warts had 9 times higher
prevalence of LSIL+ than ones with late latent syphilis
had (18.1% vs 1.9%, p < 0.05). Age, body mass
index (BMI) and number of sex partners revealed
significant difference.
To compare the prevalence of low grade squamous
intra-epithelial lesions and more (LSIL+), as well as its
associated factors, between women with genital warts
and ones with syphilis.
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Genital warts
(n= 53)
Syphilis
(n= 2)
LSIL
44
0
ASC-H
3
1
HSIL
6
0
AGC
0
1a
Negative
1
1
Chronic
inflammation
1
0
HPV infection
2
0
CIN I
4
0
CIN II-III
7
1a
No biopsy
38b
0
Pap smear (LSIL+)
Colposcopic Bx
LSIL; low grade squamous intra-epithelial lesion, ASC-H;
atypical squamous cell cannot exclude HSIL, HSIL; high
grade squamous epithelial lesion, AGC; atypical glandular
cells, Bx; biopsy, CIN; Cervical intra-epithelial neoplasia
aSame patient
bColposcopic finding appeared negative.
Table 3: Abnormal cervical cytology
Genital warts
(n= 7)
Syphilis
(n= 1)
Negative
1
0
CIN I
1
0
CIN II-III
5
1
CIN; Cervical intra-epithelial neoplasia
Table 4: Loop electrical escisional procedure (LEEP) results
Discussion
Sexually transmitted infection is one of the risk factors
of cervical cancer development because other social
habits such as smoking, multiple sex partners and
condom usage refusal usually come along.
These factors increase oncogenic human
papillomavirus (HPV) exposure. The malignant
transformation of cervix takes 10-15 years resulting in
the higher prevalence in the older women.
The present study demonstrated that such
transformation was strikingly faster among young
women who had genital warts. Comparison to older
women with syphilis was aimed to illustrate how huge
the interaction of different HPV-related diseases was.
This can be explained by the individual’s probable
relative immunodeficiency toward HPV and
the co-infection of the non-oncogenic and oncogenic
HPV infection5.
Conclusion
The high prevalence of LSIL+ among young women
with genital warts supports the relation among
diseases causing by different HPV types.
References
1. Handley J, Lawther H, Homer T, Maw R, Dinsmore W. Ten year
follow-up study of women presenting to a genitourinary medicine clinic
with anogenital warts. Int J STD AIDS. 1992; 3(1): 28-32
2. Li J, Rousseau MC, Franco EL, Ferenczy A. Is colposcopy
warranted in women with external anogenital warts?. Journal of lower
genital tract disease. 2003; 7(1): 22-28
3. Sadan O et al. Occurrence of cervical intraepithelial neoplasia in
generally healthy women with exophytic valvar condyloma acuminata.
Infectious diseases in Obstetrics and Gynecology. 2005; 13(3): 141-3
4. Milojkovic M, Milojkovic D, Russo M, Vakan BV. High squamoua
intra-epithelail lesion and cancer of lower genital tract in women with
anogenital warts. Arch Gyenol Obster. 2011:284: 453-7
5.Ball SLR et al. Analyses of Human papillomavirus genotypes and viral
loads in anogenital warts. J Med Virol. 2011; 83: 1345-50