High-grade cervical intraepithelial neoplasia co-existing with vaginal intraepithelial neoplasia increased the risk of persistent human papillomavirus infection and residual/recurrent disease after LEEP

Abstract Purpose Cervical intraepithelial neoplasia (CIN) with co-existent vaginal intraepithelial neoplasia (VaIN) is a challenge in clinical management. This study was aimed to evaluate the association of having co-existent CIN and VaIN with persistent high-risk HPV (HR-HPV) infection and with residual/recurrent disease after treatment. Methods A retrospective study was performed involving women treated for co-existent CIN2/3 and VaIN and those treated for CIN2/3 only between January 2018 and December 2020. CIN2/3 was treated with LEEP, and VaIN was treated with electrocoagulation (fulguration) at the time of CIN treatment. First follow-up was conducted by HPV-based testing at 3–6 months after treatment. Persistent HPV infection and residual/recurrent disease after treatment are the outcomes of the study. Univariate and multivariate analyses were used to assess the risk factors of persistent HR-HPV infection and residual/recurrent disease. Results Among 676 women with CIN 2/3, 83 (12.3%) women had co-existent VaIN. Age ≥ 50 years (odds ratio, OR = 3.105, 95% confidence interval, CI = 1.399–6.889) and multiple HPV infections (OR = 2.692, 95% CI = 1.406–5.155) were associated with an increased risk of co-existent CIN and VaIN. At the 1st follow-up, 195 (28.8%) of 676 women had persistent HR-HPV infection, which was more common in women having co-existent CIN and VaIN compared those with CIN only (49.4% vs. 26.0%, P < 0.001). After adjusting for potential confounding factors, co-existent CIN and VaIN was an independent risk factor for persistent HR-HPV infection (OR = 2.844, 95% CI = 1.446–5.595) and for residual/recurrent disease (OR = 4.876, 95% CI = 1.131–21.028) after treatment. Conclusions Co-existent CIN and VaIN increased the risk of persistent HR-HPV infection and residual/recurrent disease after treatment. Close follow up was proper for women having co-existent CIN and VaIN.