Risk factors for high-risk human papilloma virus persistence after loop excision procedure as treatment of cervical dysplasia

R. Ursu, A. Anton, D. Nemescu, L. Iancu

Abstract: Persistence of high-risk human papilloma virus types (HR-HPV) after surgical treatment of cervical intraepithelial neoplasia (CIN) is an important factor which influences the management and the recurrence risk. In this study, we assessed the efficiency of the loop electrosurgical excision procedure (LEEP) in HR-HPV removal. Cervical samples from 31 women, diagnosed with CIN and HR-HPV, were genotyped at six months after LEEP. We assessed the influence of various risk factors on HR-HPV persistence, using univariate and multivariate analysis: age, menopausal status, parity, abortions, oral contraception, smoking, sexual partners, initial cervical smear test and histopathological results. We detected persistent infections in 7 (22.6%) patients with 16, 18, 31, 39, 51 and 66 HPV types. Univariate analysis found that age over 30 years, multiparity, use of contraception and CIN2-3 were significant factors for persistence of HR-HPV after LEEP. Multivariate analysis showed that CIN2-3 was the only significant risk factor for HPV persistence (OR=10.7). Furthermore, although not significant, parity was also retained into final equation. HR-HPV persistence is a frequent phenomenon after LEEP. We highlight the importance of glandular involvement, residual tissue and difficulties of the resection procedure in multipara. HPV genotyping is a sensitive method to follow up this group of patients, as it can identify a type specific HPV infection. In our country with the known highest mortality rate in EU countries of cervical cancer, we need an organized cervical neoplasia screening with a validated HPV genotyping test.
DOI:10.18643/gieu.2015.176

Keywords: human papillomavirus, genotyping, cervical intraepithelial neoplasia, persistence, cervical cancer.