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HPV puts adolescent girls at high cervical cancer risk. (Adolescent Cervix Vulnerable to HPV).

ROCHESTER, N.Y. -- The new Bethesda criteria for managing Pap smears are much more aggressive, and much depends on whether the Pap smear shows evidence of human papillomavirus, Dr. Richard Kreipe said at a conference on pediatric infectious diseases sponsored by the University of Rochester.

"A woman's cervical cancer is very likely to have been caused by the human papillomavirus (HPV) infection," he said, likening cervical cancer to an infectious disease. "That's not universal, but there's a very high association, especially if she had HPV type 16, 18, 31, 33, or 35. Those are the cancer-prone types.

Dr. Kreipe, director of adolescent medicine at the university, said pediatricians with adolescent females in their practice should take interest because the adolescent cervix is more vulnerable to HPV than the adult one, ultimately putting the sexually active teenager at risk for cervical cancer.

Under the revised Bethesda criteria, if a patient has an abnormal specimen from a good sample at the time of her Pap smear, then the specimen should be checked for HPV If HPV type 16, 18, 31, 33, or 35 is found, then the patient should be sent directly to colposcopy.

If the specimen tests negative for those high-risk HPV types, then the Pap smear should be repeated every 4-6 months for 2 years, until three consecutive negatives are found. If a second abnormal smear is found within 2 years, regardless of the HPV type, the patient should go directly to colposcopy.

With the more aggressive criteria for managing Pap smears and the quicker route to colposcopy, ultimately rates of cervical cancer should come down, said Dr. Kreipe, a specialist in treating sexually transmitted diseases.

According to the Centers for Disease Control and Prevention, 50%-75% of sexually active men and women acquire genital HPV infection at some point in their lives. Approximately 20 million people are currently infected with HPV The infection is usually without symptoms, but all types of HPV can cause mild Pap smear abnormalities. Only in rare cases does it lead to cervical cancer.

One of the advantages of a quicker route to colposcopy is that biopsy has become more than simply a diagnostic tool, Dr. Kreipe said. Many of the biopsy methods actually treat the cervical intraepithelial neoplasia. "So if you get a sample, and you can see that you get all of the edges, it's an excisional biopsy that actually cures the illness."

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Title Annotation:human papillomavirus
Author:Babinski, Bob
Publication:Pediatric News
Geographic Code:1USA
Date:Jun 1, 2002
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