Diagnosis of human papillomavirus genital tract infection

Although visible anogenital lesions are present in some persons infected with human papillomavirus (HPV), the majority of individuals with HPV genital tract infection do not have clinically apparent disease. Conventional viral detection assays, including serologic assays and growth in cell culture, are not available for the diagnosis and tracking of HPV infection. Papanicolaou tests are a valuable screening tool, but they miss a large proportion of HPV-infected persons. Accordingly, HPV DNA detection assays have become a key research tool in the detection of HPV infection, particularly in asymptomatic individuals. Several types of HPV DNA tests are now available, including Southern blots, dot blots, in situ hybridization, polymerase chain reaction, and solution hybridization (Hybrid Capture assay). Of these, the polymerase chain reaction assay is the most sensitive, whereas dot blots and solution hybridization are the least labor intensive. HPV DNA detection assays are not routinely used in screening patients, in part because the clinical relevance of asymptomatic infection is unclear. Nevertheless, these tests may be beneficial in confirming differential diagnoses and in providing prognostic information, particularly with respect to the HPV type involved.