Human papillomaviral infection. The key to rational triage of cervical neoplasia.

The most common manifestation of sexually transmitted human papillomaviral (HPV) infection is a nonpapilliferous hyperplasia in the transformation zone. Such subclinical papillomaviral infections (SPI) closely resemble cervical intraepithelial neoplasia (CIN) and were previously misdiagnosed as such. In essence, the triage of the abnormal Papanicolaou smear amounts to the differentiation between benign warty proliferation, minor-grade dysplasia, and full-thickness intraepithelial neoplasia. Hence, a clear understanding of the morphologic expression and natural history of different types of HPV infection is now essential to the rational management of patients with lower genital tract neoplasia.