OBJECTIVE: To determine whether HPV vaccination status impacts overall colposcopic description (i.e. acteowhitening & vascular changes) seen on colposcopy in women with high-risk HPV infections.
BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection and the leading cause of cervical cancer (CC) in women. Currently, abnormal CC screening is followed up with colposcopy, a procedure that utilizes a magnified image of the female cervix to aid a clinician towards a target area of the cervix for biopsy. It has been shown that HPV types 16 and 18 result in more prominent colposcopic findings (i.e. a greater amount of cervical whitening and more vascular abnormalities) compared to other high-risk HPV (hrHPV) types. Because both FDA-approved HPV vaccines (Gardasil approved in 2007 and Gardasil 9 approved in 2014) protect against HPV types 16/18, this data suggests that colposcopy may be less sensitive for identifying non-16/18 hrHPV-associated lesions, particularly for HPV vaccinated women.
METHODS: Subjects were part of the UCSF HPV natural history study, which enrolled and followed women from 1999 to 2011. Healthy women enrolled between the ages of 13-21 were examined every 4-6 months, and at each visit had colposcopy with colpophotography performed after the application of diluted acetic acid. 60 vaccinated and 59 unvaccinated women were identified for comparison; women in each group were matched for age and time in study. Of these, we were able to locate stored photographs of 59 vaccinated and 45 unvaccinated women. Colposcopic photographs were reviewed by author GF for every visit, blinded to HPV status and vaccination status. Outcomes included 1) colposcopic impression (normal, squamous atypia, low grade, and high grade) and 2) colposcopy severity score (defined as a scale from 0 – 7 for each cervical lesion based on vascular changes, size, acetowhitening, and lesion demarcation). Lesions with colposcopy severity scores between 0 and 3 were defined as “mild”, between 4 and 5 “moderate”, and between 6 and 7 “severe”.
RESULTS: A total of 1435 visits were analyzed for 104 subjects, ranging from 3–30 visits per subject. Fifty-two percent of visits were given a colposcopic impression of “normal”, 29% “squamous atypia”, 19% “low grade”, and <1% “high grade”. Fifty-seven percent of cervical lesions were determined to have a colposcopy severity score considered “mild”, 24% “moderate”, and 19% “severe”. Data will be presented comparing these findings, as well as previously defined outcomes, between vaccinated and unvaccinated subjects.