Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 453–457 | Cite as

High squamous intraepithelial lesion and cancer of lower genital tract in women with anogenital warts

  • Miodrag MilojkovicEmail author
  • Dimitrije Milojkovic
  • Mico Rosso
  • Bojana Vujic Vakanjac
Gynecologic Oncology



The aim of this paper was to determine the incidence of high-grade squamous intraepithelial lesion (HSIL) and cancer of lower genital tract in patients with anogenital warts and their treatment.


Between 1 September 1988 and 30 June 1994, 221 consecutive women with anogenital warts were prospectively examined in the colposcopy outpatient clinic. In 2004, the same group of patients was re-examined.


There were abnormal cytological findings in 111 (50.2%) patients; 31 patients (14.0%) had HSIL, and 6 of them (2.7%) had cancer. There were abnormal colposcopic findings in 152 (68.8%) women; 78 women (35.3%) had abnormal histological findings. In the histological findings, HSIL was found in 41 (18.5%) women and cancer in 6 (2.7%).


In spite of the fact that anogenital warts are caused by HPV types of low oncogenic risk (6/11), there is an increased incidence of HSIL and cancer in these women. Therefore, women with anogenital warts belong to an increased risk group regarding the cancer of lower genital tract, especially if they are associated with HPV types of a high oncogenic risk.


Anogenital warts High squamous intraepithelial lesion Genital cancer 


Conflict of interest



  1. 1.
    Parkin DM, Louie KS, Clifford G (2008) Burden and trends of type-specific human papillomavirus infections and related diseases in the Asia Pacific region. Vaccine 19(26 Suppl 12):M1–M16CrossRefGoogle Scholar
  2. 2.
    Syrjanen KJ (1996) Spontaneus evolution of intraepithelial lesions according to the grade and type of the implicated human papillomavirus (HPV). Eur J Obstet Gynaecol Reprod Biol 65:45–53CrossRefGoogle Scholar
  3. 3.
    Bleeker MC, Hogewoning CJ, Berkhof J, Voorhorst FJ, Hesselink AT, van Diemen PM, van den Brule AJ, Snijders PJ, Meijer CJ (2005) Concordance of specific human papillomavirus types in sex partners is more prevalent than would be expected by chance and is associated with increased viral loads. Clin Infect Dis 41:621–622CrossRefGoogle Scholar
  4. 4.
    Bleeker MC, Hogewoning CJ, Voorhorst FJ, van den Brule AJ, Berkhof J, Hesselink AT, Lettink M, Starink TM, Stoof TJ, Snijders PJ, Meijer CJ (2005) HPV-associated flat penile lesions in men of a non-STD hospital population: less frequent and smaller in size than in male sexual partners of women with CIN. Int J Cancer 113:36–41PubMedCrossRefGoogle Scholar
  5. 5.
    Weaver BA (2006) Epidemiology and natural history of genital human papillomavirus infection. J Am Osteopath Assoc 106(3 Suppl 1):S2–S8PubMedGoogle Scholar
  6. 6.
    Perez LA (2001) Genital HPV: links to cervical cancer, treatment, and prevention. Clin Lab Sci 14:183–186PubMedGoogle Scholar
  7. 7.
    Tao XH, Shen JG, Pan WL, Dong YE, Meng Q, Honn KV, Jin R (2008) Significance of SHP-1 and SHP-2 expression in human papillomavirus infected Condyloma acuminatum and cervical cancer. Pathol Oncol Res 14:365–371PubMedCrossRefGoogle Scholar
  8. 8.
    Ault KA (2006) Epidemiology and natural history of human papillomavirus infections in the female genital tract. Infect Dis Obstet Gynecol 2006(40470):1–5Google Scholar
  9. 9.
    Fife KH, Cramer HM, Schroeder JM, Brown DR (2001) Detection of multiple human papillomavirus types in the lower genital tract correlates with cervical dysplasia. J Med Virol 64:550–559PubMedCrossRefGoogle Scholar
  10. 10.
    Wentzensen N, Schiffman M, Dunn ST, Zuna RE, Walker J, Allen RA, Zhang R, Sherman ME, Wacholder S, Jeronimo J, Gold MA, Wang SS (2009) Grading the severity of cervical neoplasia based on combined histopathology, cytopathology, and HPV genotype distribution among 1,700 women referred to colposcopy in Oklahoma. Int J Cancer 124:964–969PubMedCrossRefGoogle Scholar
  11. 11.
    An HJ, Cho NH, Lee SY, Kim IH, Lee C, Kim SJ, Mun MS, Kim SH, Jeong JK (2003) Correlation of cervical carcinoma and precancerous lesions with human papillomavirus (HPV) genotypes detected with the HPV DNA chip microarray method. Cancer 97:1672–1680PubMedCrossRefGoogle Scholar
  12. 12.
    Berlin Grace VM, Niranjali Devaraj S, Radhakrishnan Pillai M, Devaraj H (2006) HPV-induced carcinogenesis of the uterine cervix is associated with reduced serum ATRA level. Gynecol Oncol 103:113–119PubMedCrossRefGoogle Scholar
  13. 13.
    Petersen EE, Clad A (1992) Klinische Bedeutung der Papillomaviren in der Gynäkologie. Gynäkologe 25:20–25PubMedGoogle Scholar
  14. 14.
    Munk C, Svare EI, Poll P, Bock JE, Kjaer SK (1997) History of genital warts in 10838 women 20 to 20 years of age from the general population. Risk factors and association with Papanicolaou smear history. Sex Transm Dis 24:567–572PubMedCrossRefGoogle Scholar
  15. 15.
    Kjaer SK, Breugelmans G, Munk C, Junge J, Watson M, Iftner T (2008) Links Population-based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark. Int J Cancer 123:1864–1870PubMedCrossRefGoogle Scholar
  16. 16.
    Wellings K, Nanchahal K, Macdowall W, McManus S, Erens B, Mercer CH, Johnson AM, Copas AJ, Korovessis C, Fenton KA, Field J (2001) Sexual behavior in Britain: early heterosexual experience. Lancet 358:1843–1850PubMedCrossRefGoogle Scholar
  17. 17.
    Matsumoto K (2007) Human papillomavirus and cervical cancer. Nippon Rinsho 65:2113–2124PubMedGoogle Scholar
  18. 18.
    Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (2009) Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 27:141–150PubMedCrossRefGoogle Scholar
  19. 19.
    Campion MJ, Singer A, Clarkson PK, McCance DJ (1985) Increased risk of cervical neoplasia in consorts of men with penile condylomata accuminata. Lancet 1:943–946PubMedCrossRefGoogle Scholar
  20. 20.
    Banura C, Franceschi S, van Doorn LJ, Arslan A, Kleter B, Wabwire-Mangen F, Mbidde EK, Quint W, Weiderpass E (2008) Prevalence, incidence and clearance of human papillomavirus infection among young primiparous pregnant women in Kampala, Uganda. Int J Cancer 123:2180–2187PubMedCrossRefGoogle Scholar
  21. 21.
    Sadan O, Bilevsky E, Shejter E, Levy T, Bachar R, Yarden H, Glezerman M, Lurie S (2005) Occurrence of cervical intraepithelial neoplasia in generally healthy women with exophytic vulvar condyloma acuminata. Infect Dis Obstet Gynecol 13:141–143PubMedCrossRefGoogle Scholar
  22. 22.
    Paavonen J (2007) Human papillomavirus infection and the development of cervical cancer and related genital neoplasias. Int J Infect Dis 11(Suppl 2):S3–S9PubMedCrossRefGoogle Scholar
  23. 23.
    Milutin Gasperov N, Sabol I, Matovina M, Spaventi S, Grce M (2008) Detection and typing of human papillomaviruses combining different methods: polymerase chain reaction, restriction fragment length polymorphism, line probe assay and sequencing. Pathol Oncol Res 14:355–363PubMedCrossRefGoogle Scholar
  24. 24.
    Selva L, Gonzalez-Bosquet E, Rodriguez-Plata MT, Esteva C, Suñol M, Muñoz-Almagro C (2009) Detection of human papillomavirus infection in women attending a colposcopy clinic. Diagn Microbiol Infect Dis [Epub ahead of print]Google Scholar
  25. 25.
    Pate Capps N, Stewart A, Burns C (2009) The interplay between secondhand cigarette smoke, genetics, and cervical cancer: a review of the literature. Biol Res Nurs 10:392–399PubMedCrossRefGoogle Scholar
  26. 26.
    International Collaboration of Epidemiological Studies of Cervical Cancer (2009) Cervical carcinoma and sexual behavior: collaborative reanalysis of individual data on 15,461 women with cervical carcinoma and 29,164 women without cervical carcinoma from 21 epidemiological studies. Cancer Epidemiol Biomarkers Prev 18:1060–1069Google Scholar
  27. 27.
    Sasieni P (2007) Cervical cancer prevention and hormonal contraception. Lancet 370:1609–1621CrossRefGoogle Scholar
  28. 28.
    Kobayashi A, Weinberg V, Darragh T, Smith-McCune K (2008) Evolving immunosuppressive microenvironment during human cervical carcinogenesis. Mucosal Immunol 1:412–420PubMedCrossRefGoogle Scholar
  29. 29.
    Akdeniz S, Yaldiz M, Akdeniz N (2002) Cervical biopsy specimens and human papilloma virus positivity in patients with external genital warts. Eur J Gynaecol Oncol 23:460–462PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Miodrag Milojkovic
    • 1
    Email author
  • Dimitrije Milojkovic
    • 1
  • Mico Rosso
    • 1
  • Bojana Vujic Vakanjac
    • 1
  1. 1.Department of Gynecology and ObstetricsClinical Hospital OsijekOsijekCroatia

Personalised recommendations