Sexually transmitted infections and cervical atypia

Epidemiologic studies have long associated cervical cancer and dysplasia with sexual activity. In the past two decades an abundance of biological and epidemiologic data have indicated a relationship between herpes simplex virus type 2 (HSV-2) and these conditions. Unfortunately, the strength of the evidence (albeit circumstantial) has led many researchers to focus exclusively on the putative role of HSV-2 as the carcinogen. At the same time, many studies have shown that cervical atypia, if it is induced by HSV-2, must be a very rare outcome resulting from a very common exposure. On the basis of the assumption that all forms of dysplasia need not have a common cause and the likelihood that other sexually transmitted cervical pathogens (e.g., Chlamydia trachomatis, trichomonas vaginalis, papillomavirus, and perhaps cytomegalovirus) may be able to induce atypia and perhaps interact with HSV-2 to produce that outcome, the plea is made for inclusion of other sexually transmitted agents in prospective studies on cervical atypia.