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Evidence Against Diathermy as a Beneficial Treatment for Human Papillomavirus Infection of the Cervix
Author(s) -
Mitchell Heather,
Medley Gabriele
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01785.x
Subject(s) - cervix , colposcopy , hpv infection , vulva , medicine , vagina , diathermy , imiquimod , cervical intraepithelial neoplasia , gynecology , cancer , pathology , cervical cancer , immunology , surgery
EDITORIAL COMMENT: In recent years there have been numerous reports regarding human papillomavirus infection of the female genital tract and its possible association with preinvasive and invasive carcinoma of these sites (cervix, vagina, vulva). The most alarming information comes from studies of DNA hybridization techniques which indicate that a very high proportion of patients with apparently normal cervices on colposcopy and cytology harbour this virus. Many studies indicate that only a small proportion of patients who show clinical evidence of the papillomavirus have evidence of continuing infection or go on to develop intraepithelial or invasive carcinoma. The proportion of patients who spontaneously eradicate signs of the disease is not established, neither do we know why some patients cure themselves of the disease and why others do not. There is also confusion in the literature as to whether local treatment can eradicate this disease. This paper gives a very good account of the current state of knowledge about papillomavirus infection. It seems difficult to understand how diathermy to the cervix can eradicate this viral infection when many studies have shown that papillomavirus infection is usually present in the vagina and vulva when it involves the cervix, unless the cellular damage induced by the cautery enhances the patient's immune response. There is evidence in numerous reports that biopsy of papillomavirus lesions and early dysplasias of the cervix modifies the natural history of these lesions, possibly by alteration of local immune function. The present study also indicates that treatment of the cervix for papillomavirus infection alone does not affect the incidence of subsequent development of intraepithelial neoplasia. These authors have stressed the fact that further long‐term follow‐up is required of patients with evidence of papillomavirus infection. Summary: An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77–2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.