[Ano-genital papillomavirus infections in women]

Ano-genital papillomavirus infections in women are caused by high-risk human papillomaviruses (HPV) involved in cervical carcinogenesis (but also, to a lesser extent, in vaginal, vulvar and anal carcinogenesis) or by low-risk HPV responsible for condylomata acuminata, which may be peri-anal, perineal, vulvar or vaginal (less often cervical). Some low-grade cervical intra-epithelial lesions are also due to low-risk HPV. Cervical cancer is thus virus-induced and there is a relationship between precancerous lesions (CIN) and invasive cancer, characterized by a slow progression of the lesion. These features make it possible to screen for cytological abnormalities suggestive of intra-epithelial lesions before the invasion, using Pap smear, or to screen for a virus infection risk when high-risk HPV carriage is detected. Even though screening has proven to be effective in reducing the incidence of invasive cancer, it can still be significantly improved. Finally, a virus being necessarily required in cervical carcinogenesis, a very efficient and extremely immunogenic vaccine was developed; it will contribute to decrease the risk of cancer in vaccinated young women before the first sexual intercourse by at least 70 percent. However, this decrease in risk should not lead to suppress screening, which will remain essential in vaccinated women, even if its modalities will have to take viral tests into consideration.