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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 16 (2005), Issue 2, Pages 83-91
http://dx.doi.org/10.1155/2005/798710
Canadian STI Best Practice Laboratory Guidelines

The Laboratory Diagnosis of Genital Human Papillomavirus Infections

François Coutlee,1,2,3 Danielle Rouleau,1,2 Alex Ferenczy,3 and Eduardo Franco4

1Département de Microbiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
2Département de Microbiologie-Infectiologie et Centre de Recherche, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
3Department of Pathology and Obstetrics and Gynecology, and the Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
4Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada

Copyright © 2005 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Human papillomaviruses (HPVs) are the etiological agents of several genital cancers, including cancer of the uterine cervix. The detection of HPV infection in genital samples may increase the sensitivity of primary and secondary screenings of cervical cancer. HPV testing may also improve the specificity of screening programs, resulting in the avoidance of overtreatment and cost savings for confirmatory procedures. The major determinants of clinical progression of HPV infection include persistence of HPV infection, involvement of high-risk HPV types, high HPV viral load, integration of viral DNA and presence of several potential cofactors. Signal amplification HPV-DNA detection techniques (Hybrid Capture II, Digene Corporation, USA) are standardized, commercially available, and capable of detecting several high-risk HPV types. They also increase the sensitivity of screening for high-grade lesions in combination with cytology. The sensitivity of these techniques to detect high-grade lesions is higher than that of cytology, but the referral rate for colposcopy is greater. These techniques are approved for the triage to colposcopy of women with cervical smears interpreted as atypical squamous cells of undetermined significance. Triage and screening for cervical cancer using HPV will probably be restricted to women aged 30 years or older because of the high prevalence of infection in younger women. Amplification techniques are ideal for epidemiological studies because they minimize the misclassification of HPV infection status. These techniques can detect low HPV burden infections. Consensus primers amplify most genital types in one reaction, and the reverse hybridization of amplicons with type-specific probes allows for the typing of HPV-positive samples. Consensus PCR assays are currently under evaluation for diagnostic purposes. HPV testing is currently implemented for the clinical management of women.