Aims: If human papillomavirus (HPV) testing is to be included within cervical screening programmes, the importance of multiple HPV infections in cervical neoplasia needs to be determined. This study investigated the diversity of multiple HPV types in a routine cervical screening population, and assessed associations with cervical neoplasia. Methods: Overall HPV prevalence, type specific prevalence, and extent of multiple infection were assessed in residual material from 3444 liquid based cytology samples, using real time GP5+/GP6+ polymerase chain reaction for screening and linear array assay for genotyping. HPV status was studied in relation to age and concurrent cytological evidence of dyskaryosis. Results: Twenty per cent of samples were HPV positive. HPV type diversity was broad, and multiple HPV infections occurred in half of the HPV positive samples. Younger women were significantly more likely to harbour multiple high risk HPV (HR-HPV) infections. Infections with multiple HR-HPV types were found in 3.4% of samples negative for neoplasia and in 33.3%, 41.8%, and 40.4% of samples with borderline, mild, or high grade dyskaryosis, respectively. Single HR-HPV infections were found in 4.9%, 38.6%, 45.0%, and 51.1% of negative, borderline, mild, or high grade dyskaryosis samples, respectively. Conclusions: Multiple HR-HPV infections were most prevalent in young women. Multiple HR-HPV infections were not more frequent in high grade than in low grade cervical neoplasia, reflecting common sexual transmission of multiple HR-HPV. Prospective cohort studies linking sequential loss or gain of HPV types with cytological analysis are required to assess the impact of multiple HR-HPV infections on neoplastic progression.T he implementation of cytology based cervical screening programmes has reduced the incidence of cervical carcinoma world wide. Consequently, the development of improved cytological preparation methods such as liquid based cytology (LBC) and thin layer slide preparation has been welcomed. The addition of high risk human papillomavirus (HR-HPV) testing may further enhance the accuracy of screening programmes. Accumulating evidence suggests that detection of persistent infection with the same HR-HPV type would highlight individuals at greater risk of disease progression,1 2 yet the extent and importance of multiple HR-HPV infections in the progression of cervical neoplasia and its management remain unknown. To investigate these issues it is necessary to use genotyping methods that can track the persistence of specific HPV types and detect infections with multiple HR-HPV types.''Accumulating evidence suggests that detection of persistent infection with the same high risk human papillomavirus (HR-HPV) type would highlight individuals at greater risk of disease progression, yet the extent and importance of multiple HR-HPV infections in the progression of cervical neoplasia and its management remain unknown'' A recent directive issued by the Scottish Executive has promoted the roll out of cervical LBC for use thr...

Aims-To assess the validity and practicality of real time polymerase chain reaction (PCR) for human papillomavirus (HPV) testing in combination with liquid based cytology samples for cervical screening. Methods-Real time PCR using consensus (GP5+/6+) and type specific primers was developed to detect genital HPV types. This provides rapid, eYcient amplification followed by denaturation of the product and computer analysis of the kinetics data that are generated. Liquid based cytology samples were obtained from patients attending routine cervical screening clinics. DNA was extracted from the residual cellular suspension after cytology using spin columns. Results-Real

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