title: Acetowhitening of the cervix and vulva as a predictor of subclinical human papillomavirus infection: sensitivity and specificity in a population-based study.
abstract: OBJECTIVE
  To evaluate acetowhite changes of the cervix and vulva as a predictor of human papillomavirus (HPV) infection.
  
  
  METHODS
  In this population-based study all women aged 19, 21, 23, and 25 years and registered as living in a primary health care area within the city of Umeå, Sweden were eligible for inclusion. Each participant underwent a gynecologic examination with sampling of epithelial cells for HPV-DNA detection and Papanicolaou smear. Colposcopy was performed 5 minutes after application of 5% acetic acid. A two-step polymerase chain reaction (PCR) technique was employed for HPV-DNA detection.
  
  
  RESULTS
  Colposcopy and sampling of epithelial cells could be performed in 535 women. The sensitivity of detection of HPV infection by the acetowhitening of the cervix was 22% (95% confidence interval [CI] 18%, 26%). The specificity of detection of HPV infection by the acetowhitening of the cervix was 90% (95% CI 87%, 93%). The sensitivity of detection of HPV infection by cytology was 13% (95% CI 10%, 16%), and the specificity was 99% (95% CI 98%, 100%). The combination of acetowhitening and cytology did not improve the diagnostic value.
  
  
  CONCLUSIONS
  Acetowhitening of the cervix and vulva has low sensitivity as a predictor of HPV infections as determined by PCR.
authors.affiliation: Department of Family Medicine, University of Umeå, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Jonsson
authors.forename: R
authors.initials: R
authors.lastname: Karlsson
authors.forename: M
authors.initials: M
authors.lastname: Evander
authors.forename: A
authors.initials: A
authors.lastname: Gustavsson
authors.forename: E
authors.initials: E
authors.lastname: Rylander
authors.forename: G
authors.initials: G
authors.lastname: Wadell
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000453:epidemiology* / Q000473:pathology; D014626:Vaginal Smears; D014844:Vulva / Q000473:pathology / Q000821:virology*
chemical_list: D004279:DNA, Viral; D007202:Indicators and Reagents; D019342:Acetic Acid