In their interesting article, High-risk HPV and entry to prenatal care and risk of preeclampsia in the February 2014 edition of your journal, McDonnold et al, concluded that high risk HPV is associated with an almost 2-fold increased risk of developing preeclampsia. The authors categorized human papillomavirus (HPV) 11 as high risk HPV. All evidence to date supports the fact that HPV 11 is low risk and together with HPV 6 is associated with most cases of genital warts whereas HPV 16 and 18 are responsible for most cases of abnormal cervical cytology.

The other point to note is that the recent American Society for Colposcopy and Cervical Pathology/American College of Obstetricians and Gynecologists guideline Management of Abnormal Cervical Cancer Screening does actually 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. LSIL, according to the recent guidelines, represents a transient HPV infection. It does appear that some patients can be categorized as LSIL, HPV negative. With this information, would the authors come to the same conclusion if they reanalyzed their data and excluded the patients who had LSIL but a negative HPV result? I would be interested in the authors’ comments regarding this.

Finally, I would like to thank the authors for their interesting work in trying to advance our knowledge regarding this common obstetric condition−preeclampsia.