Symptomatic HPV-Related Neovaginal Lesions in Transgender Women: Case Series & Review of Literature
OBJECTIVE:
Worldwide,
transgender women are an at-risk population for contracting sexually
transmitted infections. Little information exists on symptoms and
characteristics of neovaginal human papillomavirus (HPV) infections and
associated diseases. We describe a case series of transgender women with
symptomatic HPV-related neovaginal lesions and a review of current literature.
METHODS:
Transgender
women with symptomatic HPV-related neovaginal lesions were identified from a
departmental database comprising clinical and outpatient data on transgender
women who underwent vaginoplasty between 1990 and 2015. HPV status was
determined on excision and biopsy specimens by HPV DNA testing using GP5+6+-PCR
and p16INK4A immunohistochemistry. Current literature was
reviewed using the MEDLINE and EMBASE databases.
RESULTS:
This case
series includes four transgender women with symptomatic, HPV-related neovaginal
lesions. Two women presented with neovaginal and neovulvar pain and
condylomata/leukoplakia, which were excised. These lesions showed
moderate-to-severe dysplasia at histopathological examination, and were
positive for high-risk HPV (hrHPV) and p16INK4A.
Recurrence occurred in one patient and was treated with laser evaporation. Two
women presented with neovaginal coital pain, neovaginal bleeding and
condylomata. Neovulvar lesions were treated with podophyllotoxin. Neovaginal
lesions were excised or evaporated. These lesions were low-risk HPV (lrHPV)
positive. The literature search shows treatment options varying from
conservative, topical podophyllotoxin to excision or laser evaporation under
general anaesthesia.
CONCLUSIONS:
Neovaginal
HPV infection can lead to benign condylomata (lrHPV) and various grades of
dysplasia (hrHPV). We advise physicians to consider HPV infection and
associated lesions in transgender women with otherwise unexplainable neovaginal
pain or bleeding after vaginoplasty.
- 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
- 2Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.
- 3Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
- Sex Transm Infect. 2016 Mar 24. pii: sextrans-2015-052456. doi: 10.1136/sextrans-2015-052456.
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