Genital warts and cervical cancer. I. Evidence of an association between subclinical papillomavirus infection and cervical malignancy

A blind comparative survey was undertaken to study the prevalence of subclinical papillomavirus infection (SPI) in a representative sample of women treated surgically for invasive or preinvasive cervical neoplasia. According to a semiobjective rating system, 73 of 80 women (91%) with cervical neoplasia and ten of 80 matched controls (12.5%) showed histologic evidence of human papillomavirus (HPV) infection. Sixty of the controls (75%), but none of the study group, had normal cervicovaginal epithelium. A highly significant statistical relationship exists between subclinical papillomavirus infection of the lower genital tract and the occurrence of cervical neoplasia (F = 378; P < 0.001; x2 = 109, P < 0.001). The prevalence of SPI was seven times greater in the study group than in comparable controls of equivalent disease status. Because both are covariables of promiscuity, statistical associations exist between cervical neoplasia and all sexually transmitted diseases. However, the strength, specificity and consistency of this relationship suggest that SPI may be a precursor of cervical malignancy. This contention is given biologic plausibility by a broad fabric of supporting epidemiologic, virologic and clinicopathologic evidence.