title: Multiple Papillomavirus Infection and Size of Colposcopic Lesions Among Women With Cervical Intraepithelial Neoplasia.
abstract: OBJECTIVE
  The aim of the study was to evaluate the association between the size of cervical lesions as detected by colposcopy and multiple human papillomavirus (HPV) infection in subjects with cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  A case series of 898 subjects with CIN diagnosed by histopathology and infected by high-risk HPV. Human papillomavirus genotypes were identified using the INNO-LIPA genotyping system.
  
  
  RESULTS
  The rates of CIN 1, CIN 2, and CIN 3+ lesions were 53.1% (477/898), 14.1% (127/898), and 32.7% (294/898), respectively. Among CIN lesions diagnosed by loop electrosurgical excision procedure or by cold-knife conization, the rates of multiple as compared with single HPV infections increased from 31.7% (59/186) in lesions covering 0% to 25% of the cervix to 39.2% (40/102), 41.9% (13/31), and 48.9% (45/92) in those covering 26% to 50%, 51% to 75%, and more than 75% of the cervix, respectively (χ for trend = 7.9; p = .005). In ordered logistic regression, after correction for confounders, odds ratios (ORs) of larger cervical lesions were higher in multiple as compared with single infections (OR = 1.82; 95% CI = 1.24-2.66; p = .002). This association was confirmed among subjects infected by HPV 16 (OR = 2.45; 95% CI = 1.14-5.26; p = .02) and in CIN 3+ lesions (OR = 2.43; 95% CI = 1.23-4.80; p = .01).
  
  
  CONCLUSIONS
  Multiple high-risk HPV infection is associated with larger cervical lesions as detected by colposcopy. This association was confirmed among subjects infected by HPV 16 and in CIN 3+ lesions.
authors.affiliation: Departments of 1Obstetrics and Gynecology and 2Pathology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia and 3Department of Biomedical, Biotechnological and Translational Sciences, Unit of Surgical Pathology and Center for Molecular and Translational Oncology, University of Parma, Parma, Italy.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.forename: Barbara
authors.initials: B
authors.lastname: Gardella
authors.forename: Anna Daniela
authors.initials: AD
authors.lastname: Iacobone
authors.forename: Stefania
authors.initials: S
authors.lastname: Cesari
authors.forename: Paola
authors.initials: P
authors.lastname: Alberizzi
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Silini
mesh_terms: D000328:Adult; D000368:Aged; D060085:Coinfection / Q000150:complications* / Q000473:pathology* / Q000821:virology; D003127:Colposcopy; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications* / Q000473:pathology* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*