Research Article
BibTex RIS Cite

Bir Yıl Sonunda Şehirde Yaşayan Türk Kadınındaki Human Papilloma Virus Persistans ve Klereansı

Year 2012, Volume: 25 Issue: 1, 10 - 16, 25.02.2015

Abstract

Amaç: Marmara Üniversitesi Hastanesi kadın hastalıkları polikliniğinde human papilloma virüs (HPV) pozitif saptanan kadınlarda değişik HPV genotiplerinin persistansını değerlendirmek.

Hastalar ve Yöntem: İlk prevalans çalışmasında HPV DNA testi pozitif saptanan 79 kadından 40'ı bir yıl sonra tekrar değerlendirildi. HPV tipleri polymerase chain reaction (PCR) ve mikroarray hibridizasyon teknikleri ile tanımlandı.

Bulgular: İlk değerlendirmenin bir yıl sonrasında kadınların %52,5'nin HPV enfeksiyonunun ortadan kalktığı; %35 ‘inin yeni bir HPV enfeksiyonu edindiği saptandı. 40 kadının %17,5'inde HPV DNA persistansı saptandı. Dokuz kadın aynı filogenetik ağaçtan HPV genotipi edinmişti. Yüksek riskli (YR) HPV tipi enfeksiyonun %43,33'ü ve düşük riskli (DR) HPV tipi enfeksiyonun %80'i ortadan kalkmıştı.

Sonuç: Yüksek riskli HPV tipleri saptanan kadınlarda persistans oranı artmıştı. Çok sayıda ve karışık tipte HPV enfeksiyonları HPV genotipinin persistansında önemli etkiye sahiptir. (Marmara Üniversitesi Tıp Fakültesi Dergisi 2012;25:10-5)

References

  • CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases.
  • Atkinson W, Wolfe S, Hambrosky J, et al, eds. 11th ed. Washington,
  • DC: Public Health Foundation; 2009.
  • Baseman J, Koutsky L. The epidomiology of human papillomavirus
  • infections. J Clin Virol 2005;32(Suppl 1):S16–24. doi
  • 1016/j.jcv.2004.12.008
  • Clifford GM, Gallus S, Herrero R, et al. Worldwide distribution of
  • human papillomavirus types in cytologically normal women in the
  • International Agency for Research on Cancer HPV prevalence surveys:
  • a pooled analysis. Lancet 2005; 366: 991–8. doi 10.1016/S0140-
  • (05)67069-9
  • Eren F, Erenus M, Bas E, et al. Prevalence of HPV infection by cytologic
  • diagnosis and HPV DNA extraction and prevalence of the HPV
  • genotypes detected in urban Turkish women, Int J Gynecol Obstet
  • ;109: 235-8. doi 10.1016/j.ijgo.2010.01.007
  • Hildesheim A, Schiffman MH,Gravitt PE, et al. Persistence of typespecific
  • human papillomavirus infection among cytologically normal
  • women. J Infect Dis 1994;169:235–40.
  • Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal
  • papillomavirus infection in young women. N Engl J Med
  • ;338:423–8. doi 10.1056/NEJM199802123380703
  • Elfgren K, Kalantari M, Moberger B, et al. A population based five-year
  • follow-up study of cervical human papillomavirus infection. Am J
  • Obstet Gynecol 2000;183:561–7. doi 10.1067/mob.2000.106749
  • Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is
  • a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;
  • : 12–19. doi 10.1002/(SICI)1096-9896(199909)189:1<12::AIDPATH431>3.0.CO;2-F
  • Bosch FX, Manos MM, Munoz N, et al. Prevalence of human
  • papillomavirus in cervical cancer: a worldwide perspective.
  • International biological study on cervical cancer (IBSCC study group).
  • J Natl Cancer Inst 1995; 87:796–802.
  • Marmara Medical Journal 2012;25:10-5
  • Yoldemir et al. 14 The Increased Persistence Rate with High Risk HPV Types
  • Rozendaal L, Walboomers JM, van der Linden JC, et al. PCR-based
  • high-risk HPV test in cervical cancer screening gives objective risk
  • assessment of women with cytomorphologically normal cervical
  • smears. Int J Cancer 1996;68:766–9. doi 10.1002/(SICI)1097-
  • (19961211)68:6<766::AID-IJC13>3.0.CO;2-Z
  • Kjaer SK, van den Brule AJ, Paull G, et al. Type specific persistence of
  • high risk human papillomavirus (HPV) as indicator of high grade
  • cervical squamous intraepithelial lesions in young women:
  • population based prospective follow up study. BMJ 2002;325:572–6.
  • Wallin KL, Wiklund F, Angström T, et al. Type-specific persistence of
  • human papillomavirus DNA before the development of invasive
  • cervical cancer. N Engl J Med 1999;341:1633-8. doi
  • 1056/NEJM199911253412201
  • Remmink AJ, Walboomers JM, Helmerhorst TJ, et al. The presence of
  • persistent high-risk HPV genotypes in dysplastic cervical lesions is
  • associated with progressive disease: natural history up to 36 months.
  • Int J Cancer 1995;61:306–11.
  • Schlecht NF, Kulaga S, Robitaille J, et al. Persistent human
  • papillomavirus infection as a predictor of cervical intraepithelial
  • neoplasia. JAMA 2001;286:3106–14.
  • Einstein MH, Burk RD. Persistent human papillomavirus infection:
  • definitions and clinical implications. Papillomavirus Report
  • ;12:119 -23.
  • Hinchliffe SA, VanVclzen D, Korporaal H, et al. Transience of cervical
  • HPV infection in sexually active young women with normal
  • cervicovaginal cylology. Br J Cancer 1995:72:943-5.
  • Ho GY, Burk RD, Klein S, et al. Persistent genital human papillomavirus
  • infection as a risk factor for persistent cervical dysplasia. J Natl Cancer
  • lnst 1995:87:1365-71.
  • Kirnbauer R, Booy F, Cheng N, et al. Papillomavirus L1 major capsid
  • protein self-assembles into virus like particles that are highly
  • immunogenic. Proc Natl Acad Sci USA 1992;89:80-4.
  • Woodman CB, Collins S, Winter H, et al. Natural history of cervical
  • human papillomavirus infection in young women: a longitudinal
  • cohort study. Lancet 2001;357: 1831–6. doi 10.1016/S0140-
  • (00)04956-4
  • Molano M, Van den Brule A, Plummer M, et al. Determinants of
  • clearance of human papillomavirus infections in Colombian women
  • with normal cytology: a population-based, 5-year follow-up study.
  • Am J Epidemiol 2003;158:486–94.
  • Franco EL, Villa LL, Sobrinho JP, et al. Epidemiology of acquisition and
  • clearance of cervical human papillomavirus infection in women from
  • a high-risk area for cervical cancer. J Infect Dis 1999;180:1415–23.
  • doi 10.1086/315086
  • Richardson H, Kelsall G, Tellier P, et al. The natural history of typespecific
  • human papillomavirus infections in female university
  • students. Cancer Epidemiol Biomarkers Prev 2003;12:485–90.
  • Brisson J, Bairati I, Morin C, et al. Determinants of persistent detection
  • of human papillomavirus DNA in the uterine cervix. J Infect Dis 1996;
  • : 794–9.
  • Thomas KK, Hughes JP, Kuypers JM, et al. Concurrent and sequential
  • acquisition of different genital human papillomavirus types. J Infect
  • Dis 2000;182:1097–102. doi 10.1086/315805
  • Perrons C, Jelley R, Kleter B, et al. Detection of persistent high risk
  • human papillomavirus infections with hybrid capture II and
  • SPF10/LiPA. J Clin Virol 2005;32: 278–85. doi
  • 1016/j.jcv.2004.08.009
  • Liaw KL, Hildesheim A, Burk RD, et al. A prospective study of human
  • papillomavirus (HPV) type 16 DNA detection by polymerase chain
  • reaction and its association with acquisition and persistence of other
  • HPV types. J Infect Dis 2001;183:8–15. doi 10.1086/317638
  • Rousseau MC, Abrahamowicz M, Villa LL, et al. Predictors of cervical
  • coinfection with multiple human papillomavirus types. Cancer
  • Epidemiol Biomarkers Prev 2003;12:1029–37.
  • Zielinski GD, Snijders PJF, Rozendaal L, et al. HPV presence precedes
  • abnormal cytology in women developing cervical cancer and signals
  • false negative smears Br J Cancer 2001; 85: 398–404. doi
  • 1054/bjoc.2001.1926
  • Lorincz AT, Castle PE, Sherman ME, et al. Viral load of human
  • papillomavirus and risk of CIN3 or cervical cancer. Lancet
  • ;360:228–9. doi 10.1016/S0140-6736(02)09463-1
  • Herrero R, Hildesheim A, Bratti C, et al. Population based study of
  • human papillomavirus infection and cervical neoplasia in rural Costa
  • Rica. J Natl Cancer Inst 2000;92:464–74.
  • Hall S, Lorincz A, Shah F, et al. Human papillomavirus DNA detection
  • in cervical specimens by hybrid capture: correlation with cytologic and
  • histologic diagnoses of squamous intraepithelial lesions of the cervix.
  • Gynecol Oncol 1996;62: 353–9. doi 10.1006/gyno.1996.0248
  • Nindl I, Greinke C, Zahm DM, et al. Human papillomavirus distribution
  • in cervical tissues of different morphology as determined by hybrid
  • capture assay and PCR. Int J Gynecol Pathol 1997; 16: 197–204.
  • Swan DC, Tucker RA, Tortolero-Luna G, et al. Human papillomavirus
  • (HPV) DNA copy number is dependent on grade of cervical disease
  • and HPV type. J Clin Microbiol 1999:37; 1030–4.
  • Heard I, Tassie JM, Schmitz V, et al. Increased risk of cervical disease
  • among human immunodeficiency virus-infected women with severe
  • immunosuppression and high human papillomavirus load(1). Obstet
  • Gynecol 2000;96: 403–9.
  • Clavel C, Masure M, Levert M, et al. Human papillomavirus detection
  • by the hybrid capture II assay: a reliable test to select women with
  • normal cervical smears at risk for developing cervical lesions. Diagn
  • Mol Pathol 2000;9:145–150.
  • van Duin M, Snijders PJ, Schrijnemakers HF, et al. Human
  • papillomavirus 16 load in normal and abnormal cervical scrapes: an
  • indicator of CIN II/III and viral clearance. Int J Cancer 2002;98:590–5.
  • Crum CP, Beach KJ, Hedley ML, et al. Dynamics of human
  • papillomavirus infection between biopsy and excision of cervical
  • intraepithelial neoplasia: results from the ZYC101a protocol. J Infect
  • Dis 2004;189: 1348–54. doi 10.1086/382956
  • Koshiol J, Lindsay L, Pimenta J M, et al. Persistent human papillomavirus
  • infection and cervical neoplasia: A systematic review and meta-analysis.
  • Am J Epidemiol 2008;168:123–37. doi 10.1093/aje/kwn036
  • Kovacic MB, Castle PE., Herrero R, et al. Relationships of human
  • papillomavirus type, qualitative viral load, and age with cytologic
  • abnormality. Cancer Res 2006; 66: 10112-9. doi 10.1158/0008-
  • CAN-06-1812
  • Nielsen A, Kjaer SK, Munk C, Iftner T. Type-specific HPV infection and
  • multiple HPV types: prevalence and risk factor profile in nearly 12000
  • younger and older Danish women. Sex Transm Dis 2008;35:276–82.
  • doi 10.1097/OLQ.0b013e31815ac5c7

The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year

Year 2012, Volume: 25 Issue: 1, 10 - 16, 25.02.2015

Abstract

Objective: To evaluate the persistence of the different human papillomavirus
(HPV) genotypes in women detected positive for HPV at Marmara University
Hospital gynecologic outpatient clinics.
Patients and Methods: Forty out of 79 women who had been tested
positive for HPV DNA in our initial prevalance study were re-assessed after
one year. HPV types were identified by polymerase chain reaction (PCR)
and hybridization using a microarray.
Results: One year after the initial assessment, 52.5% of the women had their
initial HPV infection resolved and 35% of the women had acquired another
HPV infection. The HPV DNA persistence was detected in 17.5% of the
40 women. Nine women had acquisition of HPV genotype by the same
phylogenetic clade. 43.33% of high risk (HR) HPV type and 80% of the low
risk (LR) HPV type infection had resolved.
Conclusions: The persistence rate was increased in women with HR HPV
types. Multiple and mixed HPV infections have an important impact on the
persistence of HPV genotype. (Marmara Medical Journal 2012;25:10-5)
Key Words: Cervical cytology, HPV genotype, HPV persistence, HPV clearance

References

  • CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases.
  • Atkinson W, Wolfe S, Hambrosky J, et al, eds. 11th ed. Washington,
  • DC: Public Health Foundation; 2009.
  • Baseman J, Koutsky L. The epidomiology of human papillomavirus
  • infections. J Clin Virol 2005;32(Suppl 1):S16–24. doi
  • 1016/j.jcv.2004.12.008
  • Clifford GM, Gallus S, Herrero R, et al. Worldwide distribution of
  • human papillomavirus types in cytologically normal women in the
  • International Agency for Research on Cancer HPV prevalence surveys:
  • a pooled analysis. Lancet 2005; 366: 991–8. doi 10.1016/S0140-
  • (05)67069-9
  • Eren F, Erenus M, Bas E, et al. Prevalence of HPV infection by cytologic
  • diagnosis and HPV DNA extraction and prevalence of the HPV
  • genotypes detected in urban Turkish women, Int J Gynecol Obstet
  • ;109: 235-8. doi 10.1016/j.ijgo.2010.01.007
  • Hildesheim A, Schiffman MH,Gravitt PE, et al. Persistence of typespecific
  • human papillomavirus infection among cytologically normal
  • women. J Infect Dis 1994;169:235–40.
  • Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal
  • papillomavirus infection in young women. N Engl J Med
  • ;338:423–8. doi 10.1056/NEJM199802123380703
  • Elfgren K, Kalantari M, Moberger B, et al. A population based five-year
  • follow-up study of cervical human papillomavirus infection. Am J
  • Obstet Gynecol 2000;183:561–7. doi 10.1067/mob.2000.106749
  • Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is
  • a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;
  • : 12–19. doi 10.1002/(SICI)1096-9896(199909)189:1<12::AIDPATH431>3.0.CO;2-F
  • Bosch FX, Manos MM, Munoz N, et al. Prevalence of human
  • papillomavirus in cervical cancer: a worldwide perspective.
  • International biological study on cervical cancer (IBSCC study group).
  • J Natl Cancer Inst 1995; 87:796–802.
  • Marmara Medical Journal 2012;25:10-5
  • Yoldemir et al. 14 The Increased Persistence Rate with High Risk HPV Types
  • Rozendaal L, Walboomers JM, van der Linden JC, et al. PCR-based
  • high-risk HPV test in cervical cancer screening gives objective risk
  • assessment of women with cytomorphologically normal cervical
  • smears. Int J Cancer 1996;68:766–9. doi 10.1002/(SICI)1097-
  • (19961211)68:6<766::AID-IJC13>3.0.CO;2-Z
  • Kjaer SK, van den Brule AJ, Paull G, et al. Type specific persistence of
  • high risk human papillomavirus (HPV) as indicator of high grade
  • cervical squamous intraepithelial lesions in young women:
  • population based prospective follow up study. BMJ 2002;325:572–6.
  • Wallin KL, Wiklund F, Angström T, et al. Type-specific persistence of
  • human papillomavirus DNA before the development of invasive
  • cervical cancer. N Engl J Med 1999;341:1633-8. doi
  • 1056/NEJM199911253412201
  • Remmink AJ, Walboomers JM, Helmerhorst TJ, et al. The presence of
  • persistent high-risk HPV genotypes in dysplastic cervical lesions is
  • associated with progressive disease: natural history up to 36 months.
  • Int J Cancer 1995;61:306–11.
  • Schlecht NF, Kulaga S, Robitaille J, et al. Persistent human
  • papillomavirus infection as a predictor of cervical intraepithelial
  • neoplasia. JAMA 2001;286:3106–14.
  • Einstein MH, Burk RD. Persistent human papillomavirus infection:
  • definitions and clinical implications. Papillomavirus Report
  • ;12:119 -23.
  • Hinchliffe SA, VanVclzen D, Korporaal H, et al. Transience of cervical
  • HPV infection in sexually active young women with normal
  • cervicovaginal cylology. Br J Cancer 1995:72:943-5.
  • Ho GY, Burk RD, Klein S, et al. Persistent genital human papillomavirus
  • infection as a risk factor for persistent cervical dysplasia. J Natl Cancer
  • lnst 1995:87:1365-71.
  • Kirnbauer R, Booy F, Cheng N, et al. Papillomavirus L1 major capsid
  • protein self-assembles into virus like particles that are highly
  • immunogenic. Proc Natl Acad Sci USA 1992;89:80-4.
  • Woodman CB, Collins S, Winter H, et al. Natural history of cervical
  • human papillomavirus infection in young women: a longitudinal
  • cohort study. Lancet 2001;357: 1831–6. doi 10.1016/S0140-
  • (00)04956-4
  • Molano M, Van den Brule A, Plummer M, et al. Determinants of
  • clearance of human papillomavirus infections in Colombian women
  • with normal cytology: a population-based, 5-year follow-up study.
  • Am J Epidemiol 2003;158:486–94.
  • Franco EL, Villa LL, Sobrinho JP, et al. Epidemiology of acquisition and
  • clearance of cervical human papillomavirus infection in women from
  • a high-risk area for cervical cancer. J Infect Dis 1999;180:1415–23.
  • doi 10.1086/315086
  • Richardson H, Kelsall G, Tellier P, et al. The natural history of typespecific
  • human papillomavirus infections in female university
  • students. Cancer Epidemiol Biomarkers Prev 2003;12:485–90.
  • Brisson J, Bairati I, Morin C, et al. Determinants of persistent detection
  • of human papillomavirus DNA in the uterine cervix. J Infect Dis 1996;
  • : 794–9.
  • Thomas KK, Hughes JP, Kuypers JM, et al. Concurrent and sequential
  • acquisition of different genital human papillomavirus types. J Infect
  • Dis 2000;182:1097–102. doi 10.1086/315805
  • Perrons C, Jelley R, Kleter B, et al. Detection of persistent high risk
  • human papillomavirus infections with hybrid capture II and
  • SPF10/LiPA. J Clin Virol 2005;32: 278–85. doi
  • 1016/j.jcv.2004.08.009
  • Liaw KL, Hildesheim A, Burk RD, et al. A prospective study of human
  • papillomavirus (HPV) type 16 DNA detection by polymerase chain
  • reaction and its association with acquisition and persistence of other
  • HPV types. J Infect Dis 2001;183:8–15. doi 10.1086/317638
  • Rousseau MC, Abrahamowicz M, Villa LL, et al. Predictors of cervical
  • coinfection with multiple human papillomavirus types. Cancer
  • Epidemiol Biomarkers Prev 2003;12:1029–37.
  • Zielinski GD, Snijders PJF, Rozendaal L, et al. HPV presence precedes
  • abnormal cytology in women developing cervical cancer and signals
  • false negative smears Br J Cancer 2001; 85: 398–404. doi
  • 1054/bjoc.2001.1926
  • Lorincz AT, Castle PE, Sherman ME, et al. Viral load of human
  • papillomavirus and risk of CIN3 or cervical cancer. Lancet
  • ;360:228–9. doi 10.1016/S0140-6736(02)09463-1
  • Herrero R, Hildesheim A, Bratti C, et al. Population based study of
  • human papillomavirus infection and cervical neoplasia in rural Costa
  • Rica. J Natl Cancer Inst 2000;92:464–74.
  • Hall S, Lorincz A, Shah F, et al. Human papillomavirus DNA detection
  • in cervical specimens by hybrid capture: correlation with cytologic and
  • histologic diagnoses of squamous intraepithelial lesions of the cervix.
  • Gynecol Oncol 1996;62: 353–9. doi 10.1006/gyno.1996.0248
  • Nindl I, Greinke C, Zahm DM, et al. Human papillomavirus distribution
  • in cervical tissues of different morphology as determined by hybrid
  • capture assay and PCR. Int J Gynecol Pathol 1997; 16: 197–204.
  • Swan DC, Tucker RA, Tortolero-Luna G, et al. Human papillomavirus
  • (HPV) DNA copy number is dependent on grade of cervical disease
  • and HPV type. J Clin Microbiol 1999:37; 1030–4.
  • Heard I, Tassie JM, Schmitz V, et al. Increased risk of cervical disease
  • among human immunodeficiency virus-infected women with severe
  • immunosuppression and high human papillomavirus load(1). Obstet
  • Gynecol 2000;96: 403–9.
  • Clavel C, Masure M, Levert M, et al. Human papillomavirus detection
  • by the hybrid capture II assay: a reliable test to select women with
  • normal cervical smears at risk for developing cervical lesions. Diagn
  • Mol Pathol 2000;9:145–150.
  • van Duin M, Snijders PJ, Schrijnemakers HF, et al. Human
  • papillomavirus 16 load in normal and abnormal cervical scrapes: an
  • indicator of CIN II/III and viral clearance. Int J Cancer 2002;98:590–5.
  • Crum CP, Beach KJ, Hedley ML, et al. Dynamics of human
  • papillomavirus infection between biopsy and excision of cervical
  • intraepithelial neoplasia: results from the ZYC101a protocol. J Infect
  • Dis 2004;189: 1348–54. doi 10.1086/382956
  • Koshiol J, Lindsay L, Pimenta J M, et al. Persistent human papillomavirus
  • infection and cervical neoplasia: A systematic review and meta-analysis.
  • Am J Epidemiol 2008;168:123–37. doi 10.1093/aje/kwn036
  • Kovacic MB, Castle PE., Herrero R, et al. Relationships of human
  • papillomavirus type, qualitative viral load, and age with cytologic
  • abnormality. Cancer Res 2006; 66: 10112-9. doi 10.1158/0008-
  • CAN-06-1812
  • Nielsen A, Kjaer SK, Munk C, Iftner T. Type-specific HPV infection and
  • multiple HPV types: prevalence and risk factor profile in nearly 12000
  • younger and older Danish women. Sex Transm Dis 2008;35:276–82.
  • doi 10.1097/OLQ.0b013e31815ac5c7
There are 143 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Articles
Authors

Tevfik Yoldemir This is me

Funda Eren This is me

Mithat Erenus This is me

Publication Date February 25, 2015
Published in Issue Year 2012 Volume: 25 Issue: 1

Cite

APA Yoldemir, T., Eren, F., & Erenus, M. (2015). The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year. Marmara Medical Journal, 25(1), 10-16.
AMA Yoldemir T, Eren F, Erenus M. The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year. Marmara Med J. August 2015;25(1):10-16.
Chicago Yoldemir, Tevfik, Funda Eren, and Mithat Erenus. “The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women After One Year”. Marmara Medical Journal 25, no. 1 (August 2015): 10-16.
EndNote Yoldemir T, Eren F, Erenus M (August 1, 2015) The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year. Marmara Medical Journal 25 1 10–16.
IEEE T. Yoldemir, F. Eren, and M. Erenus, “The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year”, Marmara Med J, vol. 25, no. 1, pp. 10–16, 2015.
ISNAD Yoldemir, Tevfik et al. “The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women After One Year”. Marmara Medical Journal 25/1 (August 2015), 10-16.
JAMA Yoldemir T, Eren F, Erenus M. The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year. Marmara Med J. 2015;25:10–16.
MLA Yoldemir, Tevfik et al. “The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women After One Year”. Marmara Medical Journal, vol. 25, no. 1, 2015, pp. 10-16.
Vancouver Yoldemir T, Eren F, Erenus M. The Persistence and Clearance Rate of Human Papilloma Virus Genotypes in Urban Turkish Women after One Year. Marmara Med J. 2015;25(1):10-6.