Development and Duration of Human Papillomavirus Lesions, after Initial Infection

TLDR

Incidence and duration of clinically important HPV lesions are needed to assess the potential value of HPV vaccines. The study followed 603 university women for 38.8 months, performing triannual gynecologic examinations with Pap and HPV DNA testing. Among women with incident HPV infection, 47.2% developed cervical SILs and 28.8% vaginal SILs within 36 months, with median clearance times of 5.5 and 4.7 months; HPV‑16/18 infection led to 20% CIN2 and 6.7% CIN3 incidence, while HPV‑6/11 infection caused 64.2% genital warts.

Abstract

BackgroundTo determine the potential value of human papillomavirus (HPV) vaccines, information concerning the incidence and duration of clinically important lesions is needed MethodsA total of 603 female university students were followed for a mean duration of 38.8 months. Triannual gynecologic examinations included cervical and vulvovaginal specimen collection for Pap and HPV DNA testing. Women with cytologic evidence of a high-grade squamous intraepithelial lesion (SIL) were referred for colposcopically directed biopsy ResultsAmong women with incident HPV infection, the 36-month cumulative incidence of cervical SILs found by cytologic testing (47.2%; 95% confidence interval [CI], 38.9%–56.4%) was higher than that of vaginal SILs (28.8%; 95% CI, 21.3%–38.2%). The median time to clearance of cervical and vaginal SILs was 5.5 and 4.7 months, respectively. Among women with incident HPV-16 or HPV-18 infection, the 36-month cumulative incidence of cervical intraepithelial neoplasia (CIN) grade 2 was 20.0% (95% CI, 10.8%–35.1%), and that of CIN grade 3 was 6.7% (95% CI, 2.5%–17.0%). The 36-month cumulative incidence of clinically ascertained genital warts among women with incident HPV-6 or HPV-11 infection was 64.2% (95% CI, 50.7%–77.4%) ConclusionsIntraepithelial lesions are common early events among women with incident HPV infection, and the interval between incident HPV-16 or HPV-18 infection and biopsy-confirmed CIN grade 2–3 appears to be relatively short