How is Low-grade Squamous Intraepithelial Lesion (LSIL) acquired?

From the Guidelines

Low-grade Squamous Intraepithelial Lesion (LSIL) is primarily acquired through infection with human papillomavirus (HPV), particularly high-risk HPV types such as HPV 16 and 18. This condition represents mild cervical dysplasia, where cells on the surface of the cervix show abnormal changes. HPV is transmitted through sexual contact, including vaginal, anal, and oral sex, as well as intimate skin-to-skin contact. Risk factors for developing LSIL include early sexual debut, multiple sexual partners, smoking, immunosuppression (such as HIV infection), and long-term use of oral contraceptives. Most HPV infections are transient and clear spontaneously within 1-2 years without causing LSIL, as noted in the study by 1. However, persistent infection with high-risk HPV types can lead to these cellular changes. Prevention strategies include HPV vaccination before sexual debut (vaccines like Gardasil 9), consistent condom use, limiting sexual partners, and regular cervical cancer screening through Pap tests and HPV testing. The body's immune system often clears HPV infections naturally, which is why many LSIL cases resolve without treatment within 1-2 years. Some key points to consider:

• The majority of LSIL cases are caused by high-risk HPV types, with HPV 16 and 18 being the most common, as stated in the study by 1.
• The risk of developing LSIL increases with early sexual debut, multiple sexual partners, and immunosuppression.
• Regular cervical cancer screening and HPV testing can help detect LSIL and prevent its progression to more severe lesions.
• HPV vaccination is an effective prevention strategy, especially when administered before sexual debut, as noted in the study by 1. It's essential to prioritize prevention and early detection to reduce the risk of LSIL and its potential progression to more severe cervical lesions. Given the available evidence, the most effective approach to preventing LSIL is through a combination of HPV vaccination, safe sexual practices, and regular cervical cancer screening, as supported by the study by 1.

From the Research

Acquisition of Low-grade Squamous Intraepithelial Lesion (LSIL)

• LSIL is primarily associated with human papillomavirus (HPV) infection, with more than 80% of all LSIL cases linked to HPV infection 2.
• The risk factors for acquiring HPV infection, which can lead to LSIL, include sexual behavior, history of herpes simplex virus, and history of vulvar warts 3.
• Current use of oral contraceptives has been found to have a protective effect against HPV infection 3.
• Daily cigarette smoking is a risk factor specific to LSIL development, supporting the role of tobacco in neoplastic development 3.

Transmission and Prevention

• The high-transmission rate of HPV infection to male partners represents a clinical risk, and preventive measures such as the use of condoms and circumcision can help prevent the occurrence of male diseases 2.
• HPV vaccination has been suggested as a potential preventive measure, although its effectiveness in this situation has not been validated 2.

Demographic Characteristics and Risk Factors

• Women with HPV-negative LSIL tend to have demographic characteristics consistent with a low-risk population, such as being over 35 years old and having few or no recent sexual partners 4.
• The absolute risk of a histologic diagnosis of cervical intraepithelial neoplasia (CIN) Grade 3/carcinoma is lower for women with HPV-negative LSIL compared to those with oncogenic HPV-positive LSIL 4.
• HIV-1-infected women have a high level of high-risk HPV infection, and abnormal cytology and high-risk HPV positivity are strongly correlated with low CD4 counts and high HIV viral loads 5.