A colposcopic case-control study of cervical squamous intraepithelial lesions in women with anogenital warts.

OBJECTIVE To assess whether anogenital warts, present or past, are an indication for women to be referred for colposcopy. DESIGN A case control study comparing patients with and without a history of anogenital warts. SETTING A department of genitourinary medicine in West London. PATIENTS 468 patients examined by colposcopy between January 1985 and December 1987 of whom 147 (31%) had abnormal cytology, 163 (35%) had anogenital warts and 158 (34%) had both. MAIN OUTCOME MEASURES Colposcopic findings and histology of cervical biopsies compared with behavioural and disease variables. RESULTS Human papillomavirus infection (HPVI) of the cervix showed no relationship with a life time history of vulval warts, or with the presence of anogenital warts on clinical examination, or with any parameter of sexual behaviour included in the study. Cervical intraepithelial neoplasia (CIN) was strongly associated with current IUCD usage (RR = 7.75) and coitarche under 16 years of age (RR = 3.72), but a history of vulval warts yielded a negative association (RR = 0.34), suggesting a protective effect. This relationship held true when cytological dyskaryosis was made the dependent variable (RR = 0.24). CONCLUSIONS Anogenital warts are not a risk for subclinical cervical HPVI or for CIN and therefore not an indication for colposcopy.