Levine_Handbook for Principles and Practice of Gynecologic O

Chapter 4 Preinvasive Lesions of the Genital Tract 83

10 20 30 40 50 60

Low-risk HPV High-risk HPV

Prevalence (%) 0

40–49 50–59

14–19

20–24 25–29 30–39 Age (years)

infections within 1 to 2 years, but up to one-third will develop cytologic abnormalities while infected. Studies have estimated that 40% to 70% of young women will clear HPV infections within 1 year and less than 20% of women remain HPV DNA positive after 24 months of follow-up (Table 4.3). Older women are much less likely to spontaneously clear HPV infections. It is possible that women who appear to have cleared their HPV infection and become HPV DNA negative continue to have a latent, undetectable infection. Reactivation of latent infections could explain the increase in the FIGURE 4.1 U.S. prevalence of HPV infections in women. Source: Reprinted with permission from Harir S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus in the United States, the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis . 2011;204:566–573.

TABLE 4.3 HPV Persistence

Study

Year Average Age

Type of Infection

HPV Persistence at 1 Year

HPV Persistence at ~2 Years

Richardson et al.

2003

23

Incident, high risk

61%

X

Ho et al.

1998

20

Incident, high and low risk

30%

9%

Dalstein et al. 41% Sources : Richardson H, et al.The natural history of type-specific human papillomavirus infections in female university students. Cancer Epidemiol Biomarkers Prev . 2003;12:485–490; Ho GY, et al. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med . 1998;338:423–428; Dalstein V, et al. Persistence and load of high-risk HPV are predictors for development of high-grade cervical lesions: A longitudinal French cohort study. Int J Cancer . 2003;106:396–403; Bae J, et al. Natural history of persis tent high-risk human papillomavirus infections in Korean women. Gynecol Oncol . 2009;115:75–80. Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2003 32 Prevalent, high risk 60% 50% Bae et al. 2009 48 Prevalent, high risk X