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THE PREVALENCE OF WART VIRUS INFECTION AND ITS ASSOCIATION WITH PRE-MALIGNANT LESIONS OF THE CERVIX
GEETA SINHA
SUMMARY The genital wart vit·us can pt·oduce flat lesions on the cervix which are diflicult to distinguish colposcopically or cytologically ft·om dysplasia. The peri-nuclear vaculation seen in the epithelial cells, called Koilocytes is a cytopathic effect of the wart virus. This is evident on cet·vical sc.-ape smear stained by Papanicolaou method. Cytological and histological evidence of cervical H.P.V. (Human Papilloma Vims) infection is being reported with inct·easing frequency. There is a great deal of cit·cumstantial evidence incriminating H.P.V. in genital tract carcinogenesis. This study was done to tind out the prevalence of wart virus infection (W. V.I.) in cenical smear of women attending ~ the out-patients clinic of Patna Medical College and Hospital. Out of a total of 500 cases, 34 (6.8%) had evidence of wart virus infection cytologically, whereas out of the dyskaryotic smeat·s 20.8% had evidence of ·W. V.I.
INTRODUCTION can produce flat lesions on the cervix Human warts arc caused by the human (apart from the typical condylomata papilloma virus (H.P.V.), a small acuminata), which are difficult to distin encogenic D.N.A. virus of the PAPOVA guish colposcopically or cytologically from viridae family. They can not be as yet dysplasia. It produces the characteristic propagated to vitro. The genital wart virus histological changes of Koilocytosis, multi nucleation and dyskeratosis (Kirk Dept. of Obst. &: Gyn. Patna Medical College & Hospital, Patna. up ct a!, 1982). The peri-nuclear vacu Accepted for Publication 011 11.7.9·1 olation seen in koilocytes is a cytopathic
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• 932 JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF INDIA effect of H.P. V. infection and those cclls the uterine cervix. are shed from the epithelium as they degenerate. The actual virus is demon MATERIALS AND METHODS strable by electron microscopy. Since the Cervical scrape smear of 500 patients cytological and colposcopic appearance attending the out-patients clinic of the of cervical human papilloma virus (HPV) ·neptt. of Obstetrics and Gynaecology of infection were documented by Meiscls et Patmt Medical College and Hospital and al (1977), cytological and histological in our private clinic between 1986-1990, evidence of cervical H.P. V. infection is was taken. The patients with positive being reported with increas-ing frequency. smear were subjected to colposcopy and This in part may reflect an increased directed biopsy. History of warty awareness of the condition. infection on the genitalia of their partners Moreover, it has been found that W.V.l. was elicited. (Wart virus infection) and C.l.N. (Cervical Cusco's speculum and modified Ayre's intra-epithelial neoplasia), frequently co spatula was used to obtain the smear from exist, one merging imperceptibly into the the squamo-columnar junction. The smears other. This has led many observers to were fixed with cytofix, dried and sent speculate whether the association is causal to the laboratory. They were stained by or causal. A theory linking the genital the Papanicolau's method and examined wart virus with cervical cancer has been for the evidence of inflammatory changes, described recently (Zur Hausen, 1982). pre-malignant changes, wart viral changes This study has been taken up to detect and frankly malignant changes. An in the incidence of W.V.I. in our population. ference was drawn as to the incidence of It may go a long way in the earlier wart viral changes and the association of detection or the high risk group, due to wart viral changes with various degrees the presence of this potential oncogen for or dyskaryosis.
Tnhlc I Distdhution of 500 cases ncconling to ngc g1·oup
Age groups in years No. of cases Percentage No. showing W.V.I.
Upto 20 15 3.0 Above 20-30 185 37.0 7 Above 30-40 175 35.6 24 Above 40-50 77 15.4 2 Above 50 45 9.0 1
Total 500 100 34 (6.8%)
• THE PREVALENCE OF WART VIRUS INFECTION 933
Table II Showing cytological pattern
Cytological diagnosis No. of cases Percentage
Normal smears 155 31.0 Inflammatory smears 212 42.0 Dyskaryotic smears 106 21.2 Mild 36 7.2 Moderate 24 4.8 Severe 46 9.2 Invasive carcinoma 27 5.4 Suqmous carcinoma 26 5.2 Adeno-carcinoma 1 0.2
Total 500
Table III , Showing association of wat·t vin•s infection (W.V.I.) with abnormal smears
Cytological diagnosis No. of cases Percentage
Inflammatory smear + W.V.I. 12 35.3 Dyskaryotic smear + W.V.I. Mild dyskaryosis + WVI 8 23.5} Moderate dyskaryosis + WVI 8 23.5 67.7 Severe dyskaryosis + WVI 6 17. .7 • Invasive carcinoma + WVI
Total WVI 34
OBSERVATIONS AND DISCUSSION years (Table I). Out of the total 500 cases, Wart viral changes were not demon 34 (6.8%) demonstrated evidence of wart strated in patients of less than 20 years virus infection cytologically. It was more of age. The peak age incidence was found common in people of low income group between 30-34 years, followed by 35-39 (82.4%). The most common presenting
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symptom was vagina discharge (76.4%). 11.8% of the patients were asymptomatic, 5.9% were pregnant and 5% had inter menstrual bleeding. 20.8% of the dyskar yotic smears had evidence of W. V.I., whereas only 5.6% of the inflammatory smears showed WVI. Out of the smears showing evidence of WVI, 64.7% were associated with various degrees of ] .. N ·;, ,....; dyskaryosis. Q It is quite probable that HPV induce -Q -c transformation of the cervical epithelium
t THE PREVALENCE OF WART VIRUS INFECTION 935
REFERENCES 3. McCanee DJ., Walker P.G., Dyson J.L., - 1. Dust M., Gissmann L., lkenberg H. & Zur Coleman D. V. & Singer A. : Brit. Med. J.: Hausen H. : Proceedings of the National 287;784;1983. Academy of Sciences : 8;3812;1983. 4. Meisels a., Fortin R. & Roy M. : Acta. 2. Krikup W., Evans A.S., Brough A.K., Davis Cytologica : 21;379;1977. J .A., 0 'Laughlin T., Wilkinson G. &Konaglzan 5. Zur Hausen H. :Lancet 2: 8312;1370;1982. J.M.: Brit.J. ofObstet. & Gyenc. :89;571; 1882 .
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