What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history.
OBJECTIVE
To clarify the prevalence, aetiology, symptoms and natural history of vestibular papillomatosis.


METHODS
Study in two parts: 1. prevalence assessed by colposcopic examination of the vulva of unselected patients by one doctor (J.M.W.); 2. patients selected by clinical appearance as having vestibular papillomatosis (by J.M.W. and other doctors) assessed in a research clinic.


METHODS
Outpatient genitourinary medicine clinic in South London.


METHODS
Part 1 study: 295 female clinic attenders; part 2 study: 18 women with clinical vestibular papillomatosis.


METHODS
Part 1 study: number of unselected patients found to have vestibular papillomatosis. Part 2 study: associated symptoms, histology, DNA hybridisation and polymerase chain reaction on vulval biopsies. Clinical regression of lesions. Cervical cytology and colposcopy.


RESULTS
Part 1 study: Vestibular papillomatosis was identified by colposcopic examination of the vulva in 3/295 (1%) of women. Part 2 study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic; the other nine had intermittent mild symptoms. Thirteen (72%) had a history of genital warts. Vulval biopsies had features suggestive of wart virus infection on histology in 17/18 (94%) and HPV16 was found by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%). On follow up (mean duration 9 months) the vulval lesions had regressed in 9/12 patients. Ten patients had cervical wart virus infection or intraepithelial neoplasia (CIN), or both, and five needed laser treatment for this.


CONCLUSIONS
In this study vestibular papillomatosis was associated with human papillomavirus (HPV) infection. This study suggests that vestibular papillomatosis need not be treated, but patients with it may be at increased risk for CIN.
Welch
J M
JM
Department of Genitourinary Medicine, St. Thomas' Hospital, London, UK.
Nayagam
M
M
Parry
G
G
Das
R
R
Campbell
M
M
Whatley
J
J
Bradbeer
C
C
D000293:Adolescent; D000328:Adult; D003127:Colposcopy; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D010212:Papilloma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D027383:Papillomaviridae / Q000302:isolation & purification; D015995:Prevalence; D014844:Vulva / Q000382:microbiology / Q000473:pathology; D014846:Vulvar Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology