NATURAL HISTORY OF GENITAL HUMAN PAPILLOMAVIRUS IN RENAL TRANSPLANTS

生殖器人乳头瘤病毒（HPV）感染是非常常见的。 这 性传播疾病可能会影响多达70%的所有性行为 活跃的女性。 疾病表现各异 这取决于HPV类型、感染部位和宿主因素。 HPV 6型和11型引起生殖器疣和低度上皮内 肿瘤 有令人信服的证据表明，16，18和31型 有助于高级别上皮内瘤形成的发展， 浸润性肛门生殖器癌作为多步骤过程的一部分， 致癌作用 对HPV的主要宿主防御似乎是细胞 介导的免疫。 以细胞损伤为特征的病症 例如器官移植的医源性免疫抑制 和人类免疫缺陷病毒感染与 生殖器疣和肛门生殖器疣的发生率和严重程度 恶性肿瘤。 在这项研究中，我们将建立生殖器的患病率， 一组60名女性在接受肾移植时的HPV感染 在术前即刻进行同种异体移植;三组，每组30例 每例接受同种异体移植不到一年的女性， 五年以上，五年以下。 这些队列 每隔四个月进行一次为期一年的随访， 发病率数据。 患者将接受常规盆腔检查 包括检查外部肛门生殖器区域和窥器 考试 由HPV感染引起的外部异常将在 活检 子宫颈抹片检查;宫颈衣原体和HSV培养， 将获得用于HPV检测的宫颈冲洗液。 聚合酶链 反应（PCR）将用于HPV检测并分型 通过标准技术进行。 此外，患者将被要求 在每次访问时填写性史。 免疫抑制数据将 从病人的病历中获取。 外部病变患者 将接受标准治疗 pap异常患者 涂片将被转介到妇产科， 进一步的评估和治疗。 临床，细胞学，当 指出，HPV感染的组织学表现将被描述。 这项研究的数据将提供重要的见解， 选择性免疫功能低下患者生殖器HPV感染史 人口

Genital human papillomavirus (HPV) infection is exceedingly common. This sexually transmitted disease may affect as many as 70% of all sexually active women at some time in their lives. Disease manifestations vary depending on the HPV type, the site of infection and host factors. HPV types 6 and 11 cause genital warts and low grade intraepithelial neoplasias. There is compelling evidence that types 16, 18 and 31 contribute to the development of high grade intraepithelial neoplasias and invasive anogenital cancers as part of the multistep process of carcinogenesis. The primary host defense against HPV appears to be cell mediated immunity. Conditions characterized by impairment of cellular immunity such as the iatrogenic immunosuppression of organ transplantation and human immunodeficiency virus infection are associated with an increase in the frequency and severity of genital warts and anogenital malignancies. In this study we will establish the prevalence of genital HPV infection in a group of 60 women at the time they receive their renal allografts in the immediate preoperative period; and three groups of 30 women each who have had established allografts for less than one year, one to five years, and greater than five years respectively. These cohorts will be followed at fourth month intervals for a year to determine incidence data. Patients will undergo routine pelvic examination including inspection of the external anogenital areas and speculum examination. External abnormalities attributed to HPV infection will be biopsied. A pap smear; cervical cultures for chlamydia and HSV and cervical washings for HPV testing will be obtained. The polymerase chain reaction (PCR) will be used for detection of HPV and typing will be performed by standard techniques. In addition, patients will be asked to complete a sexual history at each visit. Immunosuppression data will be obtained from the patient's medical chart. Patients with external lesions will be treated with standard therapies. Patients with abnormal pap smears will be referred to the Department of Obstetrics and Gynecology for further evaluation and treatment. Clinical, cytologic and, when indicated, histologic manifestations of HPV infetion will be described. Data from this study will provide important insights into the natural history of genital HPV infection in a select immunocompromised population.