We thank Dr Aderibigbe for his interest in our article regarding the association between high risk HPV infection at entry to care and preeclampsia. We agree that human papillomavirus (HPV) 11 is a low risk strain and is not associated with anogenital dysplasia or cancers. The HPV strains deemed high risk in our study were 16, 18, 31, 33, 35, 39, 45, 5, 52, 56, 58, 59, and 68. As detailed in the methods section of our manuscript, we did not intend to classify HPV 11 as high risk, nor did we test for it. It was merely mentioned in the introduction to provide background evidence of HPV trophoblast infection and alterations.

We also agree with Dr Aderibigbe that the recent American Society for Colposcopy and Cervical Pathology/American College of Obstetricians and Gynecologists guidelines point to the fact that low-grade squamous intraepithelial lesion (LSIL) can be present in a Papanicolaou smear sample without the presence of high risk HPV. We did include this issue as a limitation of our study. However, at the time when the patients included in our study were managed, HPV reflex DNA testing was not recommended for patients with LSIL. Women over 30 years old, for whom co-testing for HPV may have been performed at the time of Pap smear, would have been excluded from our analysis if their HPV testing was negative for high risk types, just as women with atypical squamous cells of undetermined significance and negative HPV or unavailable HPV testing were excluded. It was known before the most recent guidelines that LSIL on Pap smear is not always associated with high risk HPV. However, guidelines continue to advise against reflex testing for HPV with LSIL Pap smears. This is supported by data from the ASCUS-US LSIL Triage study that found that 27.6% of women with LSIL had CIN 2 within 2 years and 77% were HPV positive. As our study was retrospective, we were limited by the data that was collected on our patients. Therefore, we do not have data on the HPV types for patients with LSIL to undergo further analysis.

We appreciate Dr Aderibigbe’s comment about our attempts to advance knowledge in the field of preeclampsia, and believe that further research on the association between HPV and preeclampsia is warranted.