HPV

Question 1

What type of virus is HPV?

Answer 1

Double stranded DNA virus
Papillomaviridae family
Infects only humans
> 200 types

Question 2

Which are low risk HPVs? What do they cause?

Answer 2

Most common types: 6, 11

Other types: 40, 42, 43, 44, 54, 61, 72, 73, 81

Cause:

• Genital and oral warts
• Low grade cervical abnormalities

Question 3

What are the high risk HPVs? What do they cause?

Answer 3

Most common types: 16, 18

Other types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,82

Cause:

• Low & high grade cervical abnormalities
• Cervical cancer
• Vulval, vaginal, penile, and anal cancer

Question 4

What types of cells are present in the ecto and endocervix?

Answer 4

SJC = squamo columnar junction

Question 5

What is the progression of cervical epithelium to carcinoma?

Answer 5

Question 6

What definescervical carcinoma? What are the two types?

Answer 6

Invasion through the basement membrane defines change from CIN to invasive carcinoma

Two types of cervical cancer

• Squamous cell carcinoma
• Adenocarcinoma (20% of all invasive cases) = HPV dependent or independent

Question 7

What happens when someone is infected with HPV?

Answer 7

Transient infection - For most people, nothing will happen

• The body’s immune system eliminates HPV
• HPV becomes undetectable within 2 yrs in ~90%
• Relatively few will develop symptoms

HPV viral persistence - Persistent infection with high-risk HPV types is associated with pre-cancerous and cancerous cervical changes

Question 8

Which two proteins encoded by HPV have transforming genes?

Answer 8

Two proteins E6 and E7 encoded by the virus have transforming genes.

Question 9

What are the effects of HPV proteins E6 and E7 on the body?

Answer 9

They bind to and inactivate two tumour suppressor genes:

• P53 (E6)
• Retinoblastoma gene (Rb) (E7)

Infection is either latent(HPV DNA resides in absal cells but no virions are produced) or productive(HPV DNA replication persists).

Question 10

What are the screening intervals for cervical cancer?

Answer 10

From 25yrs every 3 years until 49yrs
From 50yrs every 5 years until 64yrs
From 65yrs only if one of the last 3 tests was abnormal

Question 11

What ages is the HPV vaccine offered to?

Answer 11

• Girls and boys aged 12 to 13 years are offered the HPV vaccine as part of theNHS vaccination programme.
• MSM < 45yrs old
• Trans women
  2nd dose is offered 6-24 moonths after the 1st dose.

Question 12

What are the benefits of the HPV vaccine?

Answer 12

The vaccine helps protect against cancers caused by HPV, including:

• cervical cancer
• some cancers of the anal and genital areas and genital warts
• somehead and neck cancers

Question 13

What are the risk factors for HPV infection?

Answer 13

Multiple sexual partners
No condom use

Question 14

Which HPV strains are responsible for two thirds of cervical cancers globally?

Answer 14

HPV16 and 18

Question 15

What malignancies is HPV associated with in males?

Answer 15

Anal
Penile
Oropharyngeal
Oral cavit

Question 16

What HPV vaccines are available?

Answer 16

3 vaccines available in UK: Cervarix®, Gardasil® and Gardasil® 9.

Cervarix® protects against HPV16 and HPV18
Gardasil® protects against HPV16, HPV18 and HPV6 and HPV11 - so protects against genital warts too
Gardasil® 9, in addition also protects against HPV31, HPV33, HPV45, HPV52, and HPV58

Question 17

What is the efficacy of the HPV vaccines in protecting against cervical cancer?

Answer 17

87% among females vaccinated at age 12-13 years.
64% among females vaccinated at age 14-16 years.
34% among females vaccinated at age 16-18 years.

Question 18

What is the management of genital warts which are single vs multiple?

Answer 18

multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy