title: High-risk human papillomavirus infection involving multiple anatomic sites of the female lower genital tract: a multiplex real-time polymerase chain reaction-based study.
abstract: High-risk human papillomavirus infection usually is seen at one anatomic site in an individual. Rarely, infection at multiple anatomic sites of the female lower genital tract in the same individual is encountered either simultaneously and/or at a later date. The current study identifies the various subtypes of high-risk human papillomavirus infection in these scenarios and analyzes the potential significance of these findings. High-risk human papillomavirus infection involving 22 anatomic sites from 7 individuals was identified after institutional review board approval. Residual paraffin-embedded tissue samples were retrieved, and all 15 high-risk human papillomavirus were identified and viral load quantified using multiplex real-time polymerase chain reaction-based method. Multiple high-risk human papillomavirus subtypes were identified in 32% of the samples and as many as 5 different subtypes of high-risk human papillomavirus infection in a single anatomic site. In general, each anatomic site has unique combination of viral subtypes, although one individual showed overlapping subtypes in the vagina, cervix, and vulvar samples. Higher viral load and rare subtypes are more frequent in younger patients and in dysplasia compared with carcinoma. Follow-up ranging from 3 to 84 months revealed persistent high-risk human papillomavirus infection in 60% of cases.
authors.affiliation: Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI 02905.
authors.forename: Yiang
authors.initials: Y
authors.lastname: Hui
authors.affiliation: Physicians Reference Laboratory, Overland Park, KS 66210.
authors.forename: Pradip
authors.initials: P
authors.lastname: Manna
authors.affiliation: Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI 02905.
authors.forename: Joyce J
authors.initials: JJ
authors.lastname: Ou
authors.affiliation: Physicians Reference Laboratory, Overland Park, KS 66210.
authors.forename: Spencer
authors.initials: S
authors.lastname: Kerley
authors.affiliation: Kent Hospital, Warwick, RI 02886.
authors.forename: Cunxian
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI 02905.
authors.forename: C James
authors.initials: CJ
authors.lastname: Sung
authors.affiliation: Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI 02905.
authors.forename: W Dwayne
authors.initials: WD
authors.lastname: Lawrence
authors.affiliation: Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI 02905. Electronic address: mquddus@wihri.org.
authors.forename: M Ruhul
authors.initials: MR
authors.lastname: Quddus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004279:DNA, Viral / Q000235:genetics*; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: CIN; Multifocal infection; Multisubtype infection; VAIN; VIN; hrHPV