Genital viral infections. Studies on human papillomavirus and Epstein-Barr virus.

The concept 'sexually transmitted diseases' (STD) was introduced in the nineteen sixties and comprises many diseases of varying importance from scabies to HIV infection. The STD family has grown wider and new members will probably join. The starting point of these studies was that patients with HPV infection, attending the STD clinic, appeared to increase in number in the late eighties. HPV was analysed with the Southern blot technique from portio cervix in a female population attending the STD clinic. In this population 8% were HPV-positive. If vulvar/vaginal HPV manifestations were present the figure increased to 34%. Abnormal cytology was found in 13% and if the woman harboured high-risk types of HPV there was also a greater risk of abnormal cytology (Paper I). Different clinical manifestations of HPV infection were examined in men with respect to different types of HPV. Macular lesions seemed mainly to be related to high-risk types to accuminate lesions. Histological dysplasia was correlated to high-risk HPV types (Paper II). The resemblance of acetowhite lesions of the vulva to oral hairy leukoplakia suggested the possibility of EBV as an etiological factor. EBV was demonstrated with PCR in 48% and HPV in 17%. In the group with no acetowhite reactions the correspondings figures were 11% and 42% (Paper III). As these results were unexpected, another group of women with the same clinical manifestations, as well as a control group, were examined. The tendency to find more EBV in the acetowhite lesions was confirmed. HPV was detected equally in both groups (Paper IV). The inclusion criterion was presence of acetowhite, koilocytotic lesions in routine histological examination. When all biopsies were reevaluated, only 8 of 20 demonstrated an evident koilocytosis (Paper IV). A male group with acetowhite penile lesions and a group with no acetowhite reactions were investigated with respect to EBV and HPV. HPV positivity was strongly correlated to acetowhite lesions but not EBV. All lesions demonstrated an evident koilocytosis (Paper IV). The oral mucosa of men with acetowhite, penile lesions more often harboured both EBV and HPV compared to the controls (Paper IV). The portio cervix was examined to detect EBV and HPV, irrespective of clinical manifestations. EBV and HPV was found in 38% and 33%, respectively (Paper V). In patients with acetowhite, koilocytotic and/or dysplastic lesions on the portio cervix EBV was found in 30% and HPV in 51%. EBV was not associated with either acetowhiteness or dysplasia (Paper VI). A group of HPV infected men was investigated concerning psychological complications in connection with their viral, genital infection. Half of the group were anxious about the risk of giving their partner an oncogenic virus, and a fifth of the group had feelings of "dirtiness" and reported a decrease in their sexual desire (paper VII). In view of this, it is concluded that acetowhite, koilocytotic lesions of the penis and the cervix are HPV related. On the vulva, however, HPV seems to have a minor role, whereas EBV might be associated with acetowhite lesions. These and other recent findings suggest EBV to be a possible STD related virus. The oncogenic potential of EBV underlines the importance of further studies. Koilocytosis as a pathognomonic sign of HPV infection has to be reconsidered. Finally, psychological aspects have to be kept in mind in the treatment of patients with HPV infection.