Subclinical Genital HPV Infection (Without Exophytic Warts)
Subclinical genital HPV infection is a term often used to refer to manifestations of infection in the absence of genital warts, including situations where infection is detected on the cervix by Pap test, colposcopy, or biopsy; on the penis, vulva, or other genital skin by the appearance of white areas after application of acetic acid; or on any genital skin by a positive test for HPV.
Subclinical genital HPV infection occurs more frequently than visible genital warts among both men and women. Subclinical infection of the cervix is most commonly diagnosed by Pap screening with the detection of squamous intraepithelial lesions. The application of 3%--5% acetic acid usually turns HPV-infected genital mucosal tissue a whitish color.
However, acetic acid application is not a specific test for HPV infection, and the specificity and sensitivity of this procedure for screening have not been defined. Thus, the routine use of this procedure for screening to detect subclinical infection is not recommended. However, some experienced clinicians find this test useful for identification of flat genital warts.
A definitive diagnosis of HPV infection is based on detection of viral nucleic acid (DNA or RNA) or capsid protein. Pap-test diagnosis of HPV does not always correlate with detection of HPV DNA in cervical cells. Cell changes attributed to HPV in the cervix are similar to those of SIL and often regress spontaneously without treatment.
Tests that detect several types of HPV DNA in cells scraped from the cervix are available and may be useful in the triage of women with atypical squamous cells of undetermined significance (ASCUS) but not other types of cytologic abnormalities. Screening for subclinical genital HPV infection using DNA or RNA tests is not recommended.
Treatment
In the absence of coexistent SIL, treatment is not recommended for subclinical genital HPV infection diagnosed by colposcopy, biopsy, acetic acid application, or the detection of HPV by laboratory tests.
The diagnosis of subclinical genital HPV infection is often not definitive, and no therapy has been identified that eradicates infection. In the presence of coexistent SIL, management should be based on histopathologic findings.
Management of Sex Partners
Examination of sex partners is unnecessary. Most sex partners of infected patients probably are already infected subclinically with HPV.
No screening tests for subclinical infection are available. Likewise, whether patients who have subclinical HPV infection are as infectious as patients who have exophytic warts is unknown.
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