Histologic and biomolecular aspects of papillomatosis of the vulvar vestibule in relation to human papillomavirus.

OBJECTIVE

To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule.

METHODS

We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant.

RESULTS

Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection.

CONCLUSION

Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.