What's new in diagnosis and treatment of HPV-associated cervical lesions

The human papilloma virus (HPV) has been subject to intense discussion during the last decade, as evidence has accumulated to strongly suggest that viruses play an essential part in the genesis of cervical neoplasms. The contamination rate of the female population is reported to range between 5 and 80%, depending on the modality of detection. Many indications almost reliably suggest the oncogenicity of certain HPV-types. The highest progression rate was found in HPV 16 lesions, followed by HPV 18 lesions. In our material the incidence of HPV 16/18 and 31/33 infections compared to 6/11 was elevated in patients with cervical intraepithelial neoplasia (CIN) compared to women with non-CIN lesions. The exact histologic diagnosis of CIN lesions is essential for a differentiated therapy. Our data indicate that mild and moderate CIN lesions are detected more frequently by Pap smear and colposcopically directed punch biopsy than by cervical smears alone. Histological diagnosis and HPV-typing by in-situ hybridisation offers the possibility to establish a differentiated therapy, e.g. by way of close follow-up, local destruction or cone biopsy. Main attention should be directed at early detection of dysplasia, at timely institution of follow-up programs and a possibly conservative therapeutic management.