Comparison of human papillomavirus testing and cervical cytology with colposcopic examination and biopsy in cervical cancer screening in a cohort of patients with Sjogren's syndrome

Objective: The purpose of this study was to evaluate women with Sjögren Syndrome by using cervical cytology, colposcopic examination and HPV-DNA testing and to compare these findings with those obtained from the control group.

Method: A total of 100 women, who were referred to Ege University, School of Medicine, Department of Obstetrics and Gynecology for cervical cytological screening between September 2004 and March 2005 and 33 of whom had Sjögren syndrome were included in this study. The patients were informed and subjected to cervical cytology, colposcopic examination and HPV-DNA testing. Colposcopic biopsy and endocervical canal curettage were carried out in cases of suspicious colposcopic examination and cytological findings. The findings obtained from 33 women with Sjögren syndrome and 67 subjects in the control group were compared.

Results: Normal cervical cytology was detected in five women (5.7%), while suspicious cervical cytology was reported in 62 women (92.5%) in the control group. The prevalence of normal cytology in patients with Sjögren syndrome was 93.9% (n = 31), where 6.1% (n = 2) of the women had suspicious cervical cytology findings. HPV-DNA findings were negative in 66 women (98.5%) in the control group, where the test result of one women (1.5%) was positive. HPV-DNA findings of patients with Sjögren syndrome were positive in one women (3%) and negative in 32 (97%). Colposcopic findings were normal in 63 women (94%) in the control group, where abnormal colposcopic findings were observed in four women (6%). Normal colposcopic findings were observed in 32 women (97%) with Sjögren syndrome, while pathological findings were recorded in one woman (3%). Suspicious cervical cytology, positive findings at colposcopic examination and biopsy and positive HPV-DNA tests were observed together in only one 40-year-old woman who was diagnosed with Sjögren syndrome for a period of four years. Prevalence of dyspareunia and vaginal dryness (atrophic vaginitis) symptoms were observed in Sjögren syndrome and control groups as 36.3% and 22.3%, respectively.

Conclusion: No significant differences were observed between Sjögren syndrome and the control group who were evaluated by using cervical cytology, colposcopic examination and HPV-DNA tests. A higher prevalence of dyspareunia and vaginal dryness were observed in patients with Sjögren syndrome, yet this difference was not considered as significant with respect to either colposcopic or histopathological findings.

HPV; Cervical cytology; Colposcopy; Sjogren's syndrome

[1] Fleming Cole N., Toy E.C., Baker B.: "Sjogren's syndrome" Prim. Care Update Ob.lGyns., 2001, 8, 48.

[2] Sartore et al.: "The treatment of Sjogren's syndrome with tibolone: A case report". Am. J. Obstet. Gynecol., 2003, 189, 894.

[3] Mulherin et al.: "Sjogren's syndrome in women presenting with chronic dysparenia". Br. J. Obstet. Gynecol., 1997, 104, 1019.

[4] Hatch K.D.: "Handbook of Colposcopy. Diagnosis and Treatment of Lower Genital Tract Neoplasia and HPV Infections". Boston, Little, Brown and Co, 1989, 7.

[5] Munger K., P helps W.C., Bubb V., Howley P.M., Schlegal R.: "The E6 and E7 genes of the human papillomavirus type 16 together are necessary and sufficient for transformation of primary human keratinocytes". J. Viral., 1989, 63, 4417.

[6] Koutsky L.A., Holmes K.K., Critchlow C.W., Stevens C.E., Paavonen J., Becicman A.M.: "A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection". N. Engl. J. Med., 1992, 327, 1271.

[7] Beckmann AM., Myerson D., Daling J.R., Kiviat N.B., Fenoglia C.M., McDougall J.K.: "Detection and localization of human papillomavirus DNA in human genital condylomas by in situ hybridization with biotimylated probes". J. Med. Viral., 1985, 16, 265.

[8] Lorincz A.T., Reid R., Jenson A.B., Kurman R.T.: "Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types". Obstet. Gynecol., 1992, 79, 328.

[9] Bauer H.M., Ting Y., Greer C.E., Chambers J.C.. Tashiro C.J., Chimera J. et al.: "Genital human papillomavirus infection in female university students as determined by a PCR-based method". JAMA, 1991, 265, 472.

[10] Ley C., Bauer H.M., Reingold A., Schiffmann M.H., Chambers J.C., Tashiro C.J. et al.: "Determinants of genital papillomavirus infection in young women". J. Natl. Cancer Inst., 1991, 83, 997.

[11] Ozsaran A.A., Ate􀄆 T.. Dikmen Y., Zeytinoglu A., Terek C., Erhan Y., OzacarT., Bilgic;A.: "E valuation of the risk of cervical intraepithelial neoplasia and human papillomavirus infection in renal transplant patients receiving immunosuppressive therapy". Eur. J Gynaecol. Oneal., 1999, 20, 127.

[12] Rebello G., Hallam N., Smart G., Farquharson D.. McCafferty J. "Human papillomavirus testing and the management of women with mildly abnormal cervical smears: an observational study". Br. Med. J., 2001, 322, 893.

[13] Cuzick J., Sasieni P., Davies P., Adams J., Normand C., Frater A.: "A systematic review of the role of human papillomavirus testing within a cervical screening programme". Health Technol. Assess., 1999, 3, 14.

[14] Woodman C.B.J.. Collins S., Winter H., Bailey A., Ellis J., P rior P. et al.: "Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study". Lancet, 2001, 357, 1831.

[15] Levert M., Clavel C., Graesslin 0., Masure M.: "Human papillomavirus typing in routine cervical smears. Results from a series of 3778 patients". Gynecol. Obstet. Fertil., 2000, 10, 722.

[16] Nasiell K., Roger V., Nasiell M.: "Behavior of mild cervical dysplasia during long term follow-up". Obstet. Gynecol., 1986, 67, 665.

[17] Skoupoli et al.: "Obstetric and gynecological profile in patients with primary Sjogren's syndrome". Ann. Rheum. Dis., 1994, 53, 569.

[181 Capriello P., Barale E., Cappeli N., Lupo S., Teti G.: "Sjogren's syndrome: Clinical, cytological, histological and colposcopic aspests in women''. Clin. Exp. Obset. Gynecol., 1988, 15, 9.

[19] Marchesoni D., Mozzanega B., De Sandre P., Romagnolo C., Gambari P.F., Maggino T.: "Gynecological aspects of primary Sjiigren's syndrome". Eur. J. Obstet. Gynecol. Reprod. Biol., 1995, 63, 49.