title: Molecular epidemiology and pathogenic potential of underdiagnosed human papillomavirus types.
abstract: BACKGROUND
  Human papillomavirus (HPV) tests are crucial diagnostic tools for the prevention of neoplastic lesions of the uterine cervix. However most commercial methods are designed to detect high-risk (HR) HPV types and a limited selection of low-risk ones, thus missing a fair number of intermediate/low-risk types. As a result, many HPV infections remain undiagnosed, generating distrust in virological diagnosis among gynaecologists, who continue to rely preferentially on cytological and colposcopic findings.
  
  
  RESULTS
  In this study, we tested 6,335 consecutive clinical samples, most of them from Italian patients with cytological abnormalities. The samples, collected in 2000-2007, were analyzed using PCR amplification of a 173-206 bp (depending on HPV type) conserved region in the L1 open reading frame, restriction endonuclease analysis and, where required, sequence analysis for type determination. Analysis of a smaller male sample and long term follow-up of a few female subjects was also performed. A total of 2,161 samples tested positive for HPV DNA (32.1%); 21.3% of them were mixed infections. Overall, 59 known and 2 unknown HPV types were detected. Their relative prevalence was calculated; notably, types not clearly identifiable using the most common commercial method accounted for 36% of infections. Clinical findings associated with the underdiagnosed types ranged from H-SIL to low-grade abnormalities, although none of these infections resulted in invasive cancer.
  
  
  CONCLUSIONS
  Given the high prevalence of some underdiagnosed HPV types in the population (principally HPV53, HPV66, HPV84, and HPV87) and their frequent association with cytological abnormalities, techniques capable of detecting and typing them would prove extremely useful.
authors.affiliation: Institute of Microbiology, Università Politecnica delle Marche, Ancona, Italy. menzo@univpm.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Menzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciavattini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bagnarelli
authors.forename: Katia
authors.initials: K
authors.lastname: Marinelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Sisti
authors.forename: Massimo
authors.initials: M
authors.lastname: Clementi
mesh_terms: D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D017720:Molecular Epidemiology; D027383:Papillomaviridae / Q000235:genetics* / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D017422:Sequence Analysis, DNA
chemical_list: D004279:DNA, Viral