Papillomavirus Infection of the Female Genital Tract Before and After Treatment: A Cytological, Colposcopic and Histological Study*

EDITORIAL COMMENT: All practitioners and many members of the public are becoming increasingly concerned about papillomavirus infection of the genital tract, in men and women, because of its apparent escalating prevalence, and its relationship to the development of invasive cancer. It is difficult to suppress fear that the HIV‐1 virus that causes AIDS will ultimately spread through the community in a similar manner. The authors have studied 135 patients with an abnormal Papanicolaou smear and reported the colposcopic and histological findings after a follow‐up for 12 months. The takeaway message is that HPV infection persists in spite of treatment; at the initial investigation 114 of the 135 women had colposcopic evidence of HPV ± CIN and 99 showed histological evidence of these lesions (tables 4 and 5); at follow‐up colposcopy 108 women still had evidence of HPV ± CIN (table 6). The enormous difference in the proportion of patients with HPV7CIN rather than HPV alone in 1986 compared with the 2 previous years (table 8) indicates either a rapid change in the disease, or in its interpretation by colposcopists and pathologists. The absence of invasive cancer on follow‐up is not reassuring after only 12 months' surveillance. In the authors' series the most recent follow‐up experience is that colposcopy showed persistence of HPV infection in 87% of patients who originally presented because of an abnormal Papanicolaou smear (table 7). Summary: Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear‐cut in all situations. Despite various treatment modalities, close follow‐up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.