A clinical, histologic, and DNA study of vulvodynia and its association with human papillomavirus.

ABSTRACT

OBJECTIVE: To compare the clinical and histologic characteristics of vulvodynia with or without associated human papillomavirus (HPV) DNA, as determined by polymerase chain reaction (PCR). METHODS: We conducted a standardized chart review of patients referred for vulvodynia lasting for more than 3 months and systematically reviewed all vulvar biopsy specimens histologically. In addition, specimens were amplified by PCR followed by Southern blot hybridization to detect HPV DNA, and positive cases were typed using the Hybrid Capture system. RESULTS: Of 55 cases, 48 were evaluable by PCR. Human papillomavirus DNA was detected in 35% (17 of 48), including 44% (four of nine) of normal cases, 25% (eight of 32) with reactive squamous atypia, 67% (four of six) with condyloma/mild dysplasia, and 100% (one of one) with moderate/severe dysplasia. Patients who were positive for HPV DNA (n = 17) were not significantly different from HPV-negative patients (n = 31) for any of 82 clinical or epidemiologic variables. When patients with normal biopsies (n = 9) were compared to those with reactive squamous atypia (n = 39), there were significant differences in only two of 82 variables (duration of symptoms and current sexual activity). Of the 17 HPV-positive cases, 13 were typeable by the Hybrid Capture system. Five (38%) were positive for low-risk HPV types, three (23%) were positive for high-risk HPV types, and five (38%) were positive for both low- and high-risk types. CONCLUSIONS: Vulvodynia associated with HPV DNA is clinically identical to vulvodynia without HPV DNA, and vulvodynia associated with normal biopsy findings is very similar to that with reactive squamous atypia. These data suggest that HPV does not cause vulvodynia.