Vulvar vestibulitis syndrome and HPV

There is good evidence that vulvar vestibulitis syndrome (VVS) can be caused by HPV. Vulvar vestibulitis, a type of vulvodynia, affects many women. Patients typically present with a history of intermittent or continuous, localized, vulvar pain and frequently cannot tolerate sexual intercourse. Keep in mind that although only half of these cases appeared to have an HPV association, there are many types of HPV that are not routinely tested, so there are types that could have been missed. Therefore, the HPV factor in VVS could be even more significant than suggested in this study. In all cases of VVS, it would be worthwhile to do what you can to strengthen your immune system.

Am J Obstet Gynecol 1996 Jul;175(1):139-44:

Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome.

Bornstein J, Shapiro S, Rahat M, Goldshmid N, Goldik Z, Abramovici H, Lahat N Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.

"Objective: Our purpose was to assess the prevalence of infections by human papillomavirus, herpes simplex virus, and cytomegalovirus among women with severe vulvar vestibulitis.

Study design: Eighty-six women referred for dyspareunia and diagnosed as having severe vestibulitis underwent perineoplasty, including surgical removal of the sensitive vestibule. Controls included 25 age-matched patients without dyspareunia undergoing vaginal operations for various benign causes or undergoing repair of an episiotomy. Polymerase chain reaction analysis was carried out to determine the presence of viral genes.

Results: The prevalence of herpes simplex virus and cytomegalovirus among the subjects tested was nil, whereas human papillomavirus was detected in 46 cases (54%). The human papillomavirus present was not of types 6, 11, 16, 18, or 33. Only one woman of the 25 asymptomatic controls (4%) had human papillomavirus deoxyribonucleic acid in the vestibule (p < 0.001).

Conclusion: Our data provide support for the idea that vulvar vestibulitis is associated with human papillomavirus deoxyribonucleic acid in more than half of cases."

Minerva Ginecol. 1994 Mar;46(3):109-14.

[Vulvar vestibulitis] [Article in Italian]

Broso P, Buffetti G, Sacco A. Divisione di Ostetricia e Ginecologia, USSL 40, Ospedale di Ivrea, Torino.

"In 1987 Friedrich defined the vulvar vestibulitis syndrome as "severe pain on vestibular touch or vaginal entry; tenderness to pressure localized within the vulvar vestibule; and physical findings confined to vestibular erythema of varying degrees". The vulvar vestibule extends laterally from the hymenal ring to a line of more keratinized skin on the labia minora (Hart's line). Anteriorly the vestibule reaches upwards to the frenulum of the clitoris and posteriorly downward to the fourchette.

Characteristics of vestibulitis are the patient's complaint of entry dyspareunia, discomfort at the opening of the vagina and erythema and point tenderness discovered on palpation of the gland orifice with a cotton-tipped applicator (cotton swab is pressed gently in a circle around the base of the hymenal ring or at the posterior fourchette of the vagina). Women report severe pain at the vaginal introitus during intercourse, localized pain from tampon use.

Pain developed in all patients during periods when they were sexually active, although there are a few reports of vulvar vestibulitis in celibate women. Vulvar vestibulitis may be acute or chronic. The cause of vulvar vestibulitis are most likely multifactorial. Vestibulitis may result from any infectious process that causes vulvovaginitis, irritants agents (soaps, sprays), antiseptics, creams, destructive treatments (cryosurgery, podophyllin, laser treatment), HPV, recurrent bacterial vaginosis, chronic candidiasis, altered vaginal acid-base balance. The candidal organism appears to play some role in this syndrome. Human papillomavirus appears to be an associated variable. An allergy-based etiology for vestibulitis has not been defined."

Eur J Obstet Gynecol Reprod Biol. 2000 Apr;89(2):173-6.

A repetitive DNA sequence that characterizes human papillomavirus integration site into the human genome is present in vulvar vestibulitis.

Bornstein J, Zarfati D, Fruchter O, Goldshmid N, Abramovici H. The Gynecologic Research Laboratory, Colposcopy Unit, Department of Obstetrics and Gynecology, Carmel Medical Center and Rappaport Faculty of Medicine, Hatechnion, Haifa, Israel.

"Objective: To determine the DNA sequence of polymerase chain reaction (PCR) products obtained from surgical specimens of patients with severe vulvar vestibulitis, in order to identify and type the human papillomavirus (HPV)-DNA associated with vulvar vestibulitis.

Study Design: Fifty-three women, referred for dyspareunia and diagnosed as having severe vestibulitis, underwent perineoplasty operation consisting of surgical removal of the sensitive vestibule. PCR analysis using L1 HPV primer was performed, and DNA sequencing of the samples that were found to contain HPV-DNA was undertaken, using the dideoxy chain termination method.

Results: Using PCR, HPV-DNA was detected in 31 of 53 tissue specimens (58%). DNA sequencing of 12 HPV-positive PCR products revealed extensive homology to human Alu consensus sequence, albeit not to any known HPV sequence.

Conclusions: The presence of interspersed, repetitive-DNA sequence Alu, which is known to be the preferred site for HPV integration into human genome, in the PCR product reinforces previous observations, suggesting that HPV may have a role in the pathogenesis of vulvar vestibulitis. It further implies a possible integration of the HPV into human DNA in these cases."

Research Topics

Click a topic button