Prevalence and genotyping of human papillomavirus infection in women with vulvodynia

Background. Evidence of vulvar human papillomavirus infection varies and the frequency of the different genotypes has not been adequately assessed. Methods. Fifty consecutive sexually active healthy patients with vulvodynia and suspected of human papillomavirus infection underwent a vulvoscopy and biopsy. Ten normal vulvar samples were also enrolled as control. Histological and vulvoscopic findings were compared in relation to human papillomavirus-DNA presence and genotyping by a broad-spectrum polymerase chain reaction and reverse hybridization line probe assay. Results. Although the clinical and histological diagnoses did not always coincide, a good association was found (p < 0.0001). Human papillomavirus-DNA was detected in 42% of all biopsies and in none of the controls, and less frequently in acetowhite-positive patients ( 33.3%, p < 0.03). Squamous papillomatosis ( 74%) was the most frequent histological diagnosis, followed by condyloma ( 20%). Condyloma ( 90%) but not squamous papillomatosis ( 29.7%) was significantly associated with human papillomavirus-DNA presence. Out of the vulvoscopically normal patients, one ( 33%) was human papillomavirus-DNA positive. Out of the recorded microscopic features, only koilocytosis was associated with human papillomavirus-DNA presence. Eight different human papillomavirus genotypes were detected: high-risk 16 ( 43%), 31 ( 19%), 52 ( 14.3%), 68, and 59 ( 4.8% each), and low-risk types 6 ( 71.4%), 11, and 40 ( 4.8% each); 33.3% of infections were multiple, ranging from 2 to 4 genotypes. Out of the human papillomavirus-DNA positive squamous papillomatosis, 72.7% showed a high-risk type but the infection remained episomal. Conclusions. Our data confirm human papillomavirus as a frequent cause of vulvodynia and its frequent association with squamous papillomatosis or condyloma. The high-risk human papillomavirus in squamous papillomatosis suggests screening for possible undiagnosed cervical infection.