Geburtshilfe Frauenheilkd 2006; 66 - PO_O_02_12
DOI: 10.1055/s-2006-952511

In view of the upcoming prophylactic HPV vaccine: Can we also vaccinate against vulvar (pre-)neoplastic disease?

M Hampl 1, H Sarajuuri 1, A Schönherr 1, HG Bender 1
  • 1Universitäts-Frauenklinik, Düsseldorf

Aims: The incidence of vulvar intraepithelial neoplasia (VIN) and vulvar cancer is increasing over the past two decades. The role of high risk HPV in the pathogenesis of undifferentiated, nonkeratinizing VIN and vulvar cancer in young women has been demonstrated, with HPV16 as the predominant virus type. In view of the upcoming prophylactic HPV vaccine aimed to prevent HPV 16, 18 (and 6, 11) infections we analysed the prevalence of HPV DNA and distribution of types in 133 patients with VIN/AIN 2–3 and vulvar carcinoma to predict the additional effect of the vaccine in prevention of vulvar disease.

Methods: 136 specimen were used for DNA extraction. PCR was performed with general primers GP5/6 for presence of HPV DNA. HPV typing was performed by sequencing and BLAST analysis.

Results: Specimen of 136 patients with VIN/AIN 2 or 3 and 28 cases with invasive vulvar carcinoma have been HPV-typed so far. The overall HPV DNA positivity was 79%, 87% of the VIN cases were HPV positive, but only 46% of the vulvar carcinoma. HPV DNA of the high risk type 16 was the most common type in VIN and vulvar carcinoma (77%) followed by HPV 33 in 15%. HPV 18 was only found in two specimen. Rare HPV types, HPV with unknown risk, multiple infections and low risk types were diagnosed in 17%. According to age at diagnosis, patients with vulvar carcinoma were divided in a group younger than 50 years (group1; n=10) and older than 50 (group2; n=18). In the group1, HPV DNA was detected in 70%, whereas in patients older than 50 years in 33%.

Conclusions: Theses results indicate that multiple HPV types are responsible for the induction of VIN and vulvar cancer in young women. The oncogenic HPV type 16 are predominantly found in those lesions with a prevalence of 83% in HPV positive VIN 3 and 69% in HPV positive vulvar carcinoma, suggesting that the prophylactic HPV 16 containing vaccine may help to reduce the incidence of these lesions in young patients significantly.