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Obstet Gynecol. 2018 Aug;132(2):261-270. doi: 10.1097/AOG.0000000000002736.

Human Papillomavirus Genotypes From Vaginal and Vulvar Intraepithelial Neoplasia in Females 15-26 Years of Age.

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Department of Microbiology Infectious Diseases, the Royal Women's Hospital, Department of Microbiology, the Royal Children's Hospital, Infection and Immunity, Murdoch Children's Research Institute, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; the Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; the Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas; Institut Catala d'Oncologia, IDIBELL, CIBER-ESP, RTICC, L'Hospitalet de Llobregat, Barcelona, Spain; the Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; the Department of Pathology, SMBD Jewish General Hospital and McGill University, Montréal, Québec, Canada; the Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia; the Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida; the National Institute of Public Health, Cuernavaca, Morelos, Mexico; the Division of Gynecologic Oncology, University of Alabama, Birmingham, Alabama; the Department of Clinical Science, University of Bergen/Haukeland University Hospital, Bergen, Norway; the Danish Cancer Society Research Center, Copenhagen, Denmark and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Johns Hopkins University School of Medicine, Baltimore, Maryland; the Department of Obstetrics and Gynecology, Clinica Colsanitas, Fundacion Universitaria Sanitas, Bogota, Colombia; Institut du col, Paris, France; the National Institute of Cancer, Bogotá, Colombia; the Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland; the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Montréal, Québec, Canada; Robert E. Fechner Laboratory of Surgical Pathology, University of Virginia Health System, Charlottesville, Virginia; the Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; UCLA School of Nursing, Los Angeles, California; Merck & Co, Inc., Kenilworth, New Jersey; Universidad del Rosario, Bogota, Colombia; and Analytica LASÉR, Montréal, Québec, Canada.



To estimate the proportion of vulvar and vaginal low-grade and high-grade squamous intraepithelial lesions (LSILs and HSILs) in females 15-26 years of age attributable to 14 human papillomavirus (HPV) genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59).


A post hoc analysis of prospectively diagnosed vulvar and vaginal LSILs and HSILs among females 15-26 years of age enrolled in the placebo arms of two phase 3, randomized HPV vaccine trials assessed 14 prespecified HPV genotypes associated with cervical cancers or anogenital warts using a type-specific multiplex polymerase chain reaction assay. The frequency of lesions associated with specific HPV genotypes was estimated by proportional and other attribution methods.


During approximately 4 years of follow-up in 8,798 females, 40 vulvar LSILs and 46 vulvar HSILs were diagnosed in 68 females, and 118 vaginal LSILs and 33 vaginal HSILs were diagnosed in 107 females. Females developing vulvar (41.2%) or vaginal (49.5%) lesions also had cervical lesions, whereas 6.5% of females with cervical lesions had vaginal or vulvar lesions. At least 1 of the 14 HPV genotypes was detected in females with vulvar LSIL (72.5%), vulvar HSIL (91.3%), vaginal LSIL (61.9%), and vaginal HSIL (72.7%). Considering only HPV-positive lesions, the nine most common genotypes causing cervical cancer and anogenital warts (6, 11, 16, 18, 31, 33, 45, 52, and 58) were found in 89.4% of vulvar LSILs, 100% of vulvar HSILs, 56.0% of vaginal LSILs, and 78.3% of vaginal HSILs.


Most vulvar and vaginal lesions were attributable to at least 1 of the 14 HPV genotypes analyzed. Effective immunization programs could potentially prevent substantial numbers of HPV-related vulvar and vaginal LSILs and HSILs.


CLINICALTRIALS.GOV,: NCT00092521 and NCT00092534.

[Indexed for MEDLINE]

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