Infection with the human papillomavirus (HPV) type 16 causes definite visual abnormalities on the cervix, but other types of HPV may not be as easily detected and women with multiple types of HPV may have no lesions at all, according to a report in the July issue of the 

American Journal of Obstetrics and Gynecology

Jose Jeronimo, MD, of the National Cancer Institute in Bethesda, Md., and colleagues conducted a study in which 20 expert colposcopists were assigned to evaluate 939 digitized cervigrams taken after the application of 5% acetic acid. At least two reviewers studied 112 images with matched histologic diagnoses and HPV type to rate them for the number and severity of lesions. 

When HPV DNA, particularly HPV16, was present, reviewers were more likely to agree with each other on the rating. However, individual reviews yielded only weak associations between HPV status and visual appearance. Many women with multiple HPV infections did not have any visible lesions. 

Jeronimo J, Massad LS, Schiffman M. Visual appearance of the uterine cervix: correlation with human papillomavirus detection and type. 