Persistence of human papillomavirus infection (HPV) of the cervix after treatment for cervical intraepithelial neoplasia predisposes
to lesion recurrence. Given the weakness of natural immunity against HPV it has been suggested that certain anatomical sites could
act as viral reservoirs though which the infection could be retransmitted to the cervix even if the initial HPV tests after treatment are
negative. This review examined the possible role of various reservoirs such as the oral cavity, the anus, the fingers and the partner’s penis.
The available data are insufficient to confirm a significant risk of cervical re-infection from any site other than the penis. It seems
that the risk of transmission by the male partner can be reduced by consistent condom use; therefore this should be included in the patient’s
counselling. Further studies are required to elucidate the role of the other sites especially the anus where some reports imply a possibility
for transmission to the cervix. In this context expanding the indications for HPV vaccination to include women who have been
treated for CIN should be considered.
Keywords: Disease reservoirs, papillomavirus infections, HPV, transmission, anus, oropharynx, penis, natural immunity, neoplasia, cervix
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