HPV Flashcards
Human Papilloma Virus (HPV)
-genital warts, anogenital warts
-incubation- 2 weeks to 8 months
-worldwide
-dsDNA virus
-most common STI worldwide
-more than 200 types of HPV
-inherent risk with causing cancer
-HPV6 and HPV11 are highly associated with anogenital warts -> 90%
-HPV 16 and HPV 18 linked to cervical cancer
-HPV16 is also highly associated with oropharyngeal, anal, vulvovaginal, and penile cancers
HPV signs and symptoms
-subclinical or asymptomatic
-anogenital warts- can appear externally on foreskin, glans penis, penile shaft, scrotum, perineum, anus, and vulva
-internal warts may appear within pharynx, intravaginally, cervix, or within rectum
-warts tend to be painless but can become inflamed or pruritic
-warts may be single or multiple, flat, raised, pedunculated, and/or cauliflower like in appearance
-color can vary from hypopigmented, skin toned, erythematous, to hyperpigmented
HPV diagnosis
-visual diagnosis
-biopsy can be obtained to confirm dx and to rule out cancer
-women should eb screened with Pap testing (cytology) to look for abnormal cells in accordance with American College of Obstetricians and Gynecologists (ACOG)
-abnormal pap typically followed by colposcopy and tissue biopsy
-2014- FDA approved DNA test that screens cell obtained from cervix for HPV strains
-co-testing with pap and hrHPV is recommended every 5 years for women age 30 and older
HPV treatment
-for external warts, provider-adminstered treatments include trichloroacetic acid (TCA), bichloroacetic acid (BCA), cryotherapy with liquid nitrogen, surgical removal, curettage, or electrocautery
-mainstay of treatment is obliteration of warts
-patient-administered treatments include podophyllotoxin 0.5% solution or gel or imiquimod 3.75% or 5% cream
-Intraurethral, intravaginal, cervical, and intra-anal warts must be removed by providers
-there are several HPV vaccines, with the HPV 9-valent vaccine providing the broadest coverage
HPV infections history
-richard shope (american, 1901-1966) discovered the papilloma virus in rabbits in 1933
-2 decades later in 1956 researchers identified HPV
-it was not until 1984 that harald zur hausen (german 1936) demonstrated an association between HPV and cervical cancer risk
-development of an HPV vaccine soon followed
HPV is a DNA virus
-DNA virus that belongs to family papillomaviridae
-among the > 120 HPV subtypes, some 40 of them are sexually transmitted and can infect the anogenital tracts= and other mucosal sites
-HPV6, 11, and 18 most commonly cause human infections**
-cervical cancer risk varies by subtype
-HPV6 and HPV11 which produce lesions on the vulvar, anal, and vaginal muscosa, pose the least risk for cervical cancers
-associated with condyloma acuminata- type of genital warts
-HPV16 and HPV18 pose the greatest risk for aggressive cervical cancers, causing nearly 3 quarters of them
transmission of HPV
-occurs through vaginal, anal, and oral sexual intercourse
-reflect involuntary genital scraping between infected and noninfected epithelial surfaces- regardless of symptomatic status
-most remian asymptomatic
-symptomatic cases often present with genital warts such as condyloma acuminate (CA)
-females- lesions can erupt on the external genitalia or on the cervical surface itself
-males- appear either on external genitalia or inside of urethra
-CA lesions can also appear in nongenital regions such as the mouth, head, and neck
noncervical HPV cancers
-associated with roughly 90% of all anal cancers, half of all vulvar cancers, and 2/3rds of vaginal cancers
-males- responsible for more than 1/3 of penile cancers
-HPV associated cancers have also been linked to those of the head and neck
obliteration of HPV warts
-mainstay of HPV treatment
-typical procedures rely on destruction by liquid nitrogen preparations or surgical excision
-when visible on hands or face obliteration may be done as much for aesthetic reasons as for symptom relief
-treatment decisions often reflect patients choice, clinician experience, and resource availability
epidemiology of HPV infections
-infection rate vary widely from 20-90%
-highest occur among teenagers, university, and prostitutes
-first two years of sexual activity are an especially high risk period
-findings of NHANES suggest prevalence of > 25% among PCR detected, vaginal swabs taken from females aged 14 to 59 years
-by ethnicity, hispanics have highest age adjusted HPV rates, 9.1 per 100,000
HPV subtypes and cancer
-HPV subtypes 16 and 18 are associated with significantly increased risk for HPV related cancers
-cancer risk among HPV infected individuals may approach a factor of 50 when compared to non HSV infected persons
-other risk factors- cigarette smoking, oral contraceptive use of more than 5 years duration and STI coinfections, especially HIV
HPV vaccination recommendations
-CDC recommends 2 HPV vaccine protocols:
-children < 15- 2 doses before 12
-15 and older- 3 doses
-vaccination of preadolescents girls appears to be more effective than vaccination of boys
-condoms have shown limited efficacy in HPV prevention
