Skip to main content
SpringerLink
Log in

Risk factors of persistent HPV infection after treatment for high-grade squamous intraepithelial lesion

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the risk factors associated with persistent high-risk human papillomavirus (HR HPV) infections in patients undergoing cervical excision for treatment of high-grade squamous intraepithelial lesion (HSIL).

Methods

A retrospective cohort study included 160 patients who underwent cervical excision for treatment of HSIL between January 2014 and December 2014. The clinical characteristics, cervical cytology, and HPV test results were reviewed. Persistent HR HPV infections were identified within 6 months after treatment. The effects of various factors such as patient age, menopausal status, parity, HPV type, and histopathological results on persistent HR HPV infections were assessed using univariate and multivariate analyses.

Results

The mean age of patients was 38.1 ± 11.5 years (range 18‒86 years). Among them 148 (92.5%) had HR HPV infections, and persistent infections after surgical treatment were detected in 48 (32.4%) patients. Univariate logistic regression analysis showed that older age (> 50 years), short follow-up duration (< 3 months), and menopause were associated with persistent HR HPV infections. Multivariate analysis showed that menopausal status was the only significant independent predictor for HR HPV persistence after treatment (odds ratio, 5.08; 95% confidence interval, 1.93–13.36; P = 0.001).

Conclusions

Persistent HR HPV infections were detected in approximately 30% of patients within 6 months after cervical excision for HSIL. Elderly patients with menopause are at increased risk of HR HPV persistence after treatment for HSIL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ding DC, Hsu HC, Huang RL, Lai HC, Lin CY, Yu MH et al (2008) Type-specific distribution of HPV along the full spectrum of cervical carcinogenesis in Taiwan: an indication of viral oncogenic potential. Eur J Obstet Gynecol Reprod Biol 140:245–251

    Article  CAS  PubMed  Google Scholar 

  2. Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Désy M et al (1999) Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis 180:1415–1423

    Article  CAS  PubMed  Google Scholar 

  3. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189:12–19

    Article  CAS  Google Scholar 

  4. Choi YJ, Park JS (2016) Clinical significance of human papillomavirus genotyping. J Gynecol Oncol 27:e21

    Article  CAS  PubMed  Google Scholar 

  5. Koshiol J, Lindsay L, Pimenta JM, Poole C, Jenkins D, Smith JS (2008) Persistent human papillomavirus infection and cervical neoplasia: a systematic review and meta-analysis. Am J Epidemiol 168:123–137

    Article  PubMed  PubMed Central  Google Scholar 

  6. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R et al (2007) Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer 121:621–632

    Article  CAS  Google Scholar 

  7. Chatzistamatiou K, Moysiadis T, Angelis E, Kaufmann A, Skenderi A, Jansen-Duerr P et al (2017) Diagnostic accuracy of high-risk HPV DNA genotyping for primary cervical cancer screening and triage of HPV-positive women, compared to cytology: preliminary results of the PIPAVIR study. Arch Gynecol Obstet 295:1247–1257

    Article  CAS  PubMed  Google Scholar 

  8. Montz FJ (2000) Management of high-grade cervical intraepithelial neoplasia and lowgrade squamous intraepithelial lesion and potential complications. Clin Obstet Gynecol 43:394–409

    Article  CAS  PubMed  Google Scholar 

  9. Kucera E, Sliutz G, Czerwenka K, Breitenecker G, Leodolter S, Reinthaller A (2001) Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone? Eur J Obstet Gynecol Reprod Biol 100:72–76

    Article  CAS  PubMed  Google Scholar 

  10. Nagai Y, Maehama T, Asato T, Kanazawa K (2000) Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is it an alarm for disease recurrence? Gynecol Oncol 79:294–299

    Article  CAS  PubMed  Google Scholar 

  11. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M et al (2002) The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA 287:2114–2119

    Article  PubMed  Google Scholar 

  12. Kim YT, Lee JM, Hur SY, Cho CH, Kim YT, Kim SC et al (2010) Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia. Int J Cancer 126:1903–1909

    Article  CAS  PubMed  Google Scholar 

  13. Duesing N, Schwarz J, Choschzick M, Jaenicke F, Gieseking F, Issa R et al (2012) Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet 286:1549–1554

    Article  PubMed  Google Scholar 

  14. Park JY, Lee KH, Dong SM, Kang S, Park SY, Seo SS (2008) The association of pre-conization high-risk HPV load and the persistence of HPV infection and persistence/recurrence of cervical intraepithelial neoplasia after conization. Gynecol Oncol 108:549–554

    Article  PubMed  Google Scholar 

  15. Song SH, Lee JK, Oh MJ, Hur JY, Na JY, Park YK et al (2006) Persistent HPV infection after conization in patients with negative margins. Gynecol Oncol 101:418–422

    Article  PubMed  Google Scholar 

  16. Pirtea L, Grigoraş D, Matusz P, Pirtea M, Moleriu L, Tudor A et al (2016) Human papilloma virus persistence after cone excision in women with cervical high grade squamous intraepithelial lesion: a prospective study. Can J Infect Dis Med Microbiol 2016:3076380

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fallani MG, Penna C, MarchionniM Bussani C, Pieralli A, Andersson KL et al (2008) Prognostic significance of high-risk HPV persistence after laser CO2 conization for high-grade CIN: a prospective clinical study. Eur J Gynaecol Oncol 29:378–382

    CAS  PubMed  Google Scholar 

  18. Costa S, De Simone P, Venturoli S, Cricca M, Zerbini ML, Musiani M et al (2003) Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization. Gynecol Oncol 90:358–365

    Article  PubMed  Google Scholar 

  19. Alonso I, Torné A, Puig-Tintoré LM, Esteve R, Quinto L, Campo E et al (2006) Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2–3. Gynecol Oncol 103:631–636

    Article  PubMed  Google Scholar 

  20. Nam K, Chung S, Kim J, Jeon S, Bae D (2009) Factors associated with HPV persistence after conization in patients with negative margins. J Gynecol Oncol 20:91–95

    Article  PubMed  PubMed Central  Google Scholar 

  21. Baser E, Ozgu E, Erkilinc S, Togrul C, Caglar M, Gungor T (2014) Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia. Int J Gynaecol Obstet 125:275–278

    Article  PubMed  Google Scholar 

  22. García-Piñeres AJ, Hildesheim A, Herrero R, Trivett M, Williams M, Atmetlla I et al (2006) Persistent human papillomavirus infection is associated with a generalized decrease in immune responsiveness in older women. Cancer Res 66:11070–11076

    Article  CAS  PubMed  Google Scholar 

  23. Kang WD, Kim SM (2016) Human papillomavirus genotyping as a reliable prognostic marker of recurrence after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia (CIN2–3) especially in postmenopausal women. Menopause 23:81–86

    Article  PubMed  Google Scholar 

Download references

Funding

The study was not funded.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Cheil General Hospital & Women’s Healthcare Center, College of Medicine, Dankook University, 17, Seoae-ro 1-gil, Jung-gu, Seoul, 04619, Republic of Korea

    Kyeong A So, In Ho Lee, Tae Jin Kim & Ki Heon Lee

Authors
  1. Kyeong A So
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. In Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ki Heon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KAS manuscript writing. IHL data analysis. TJK manuscript editing. KHL project development/manuscript review.

Corresponding author

Correspondence to Ki Heon Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Institutional Review Board approved the study. All procedures performed in this study were in accordance with the ethical standards of the institution and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

So, K.A., Lee, I.H., Kim, T.J. et al. Risk factors of persistent HPV infection after treatment for high-grade squamous intraepithelial lesion. Arch Gynecol Obstet 299, 223–227 (2019). https://doi.org/10.1007/s00404-018-4936-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4936-9

Keywords

Search

Navigation