HPV Flashcards
what is HPV?
The human papillomavirus is a double stranded DNA virus causing a number of clinical manifestations. While most are benign, HPV viruses are linked to the development of several cancers, including cervical cancer, presenting opportunities for timely identification and management.
How is HPV spread?
HPV is usually spread by sexual contact and infects the skin and mucosae of the anogenital and upper respiratory tracts.
which are the clinically relevant types of HPV?
High-risk: HPV 16,18,31,33
Low-risk: HPV 6,11
features of HPV?
Most cases of HPV infection are asymptomatic and self-limiting.
Patients may present with:
Symptoms of cervical, oropharyngeal (dysphagia, sore throat, haemoptysis, as well as systemic symptoms) or anogenital malignancy
Genital warts of varying characteristics, usually in areas of high friction. Associated symptoms may include irritation & discomfort, urinary symptoms and bleeding
ix for HPV?
High-risk HPV identified on cervical screening: cytology is performed and if abnormalities are seen, colposcopy & histology is done
Symptoms of HPV-associated malignancy: patients should be referred via the two-week wait pathway for biopsy and/or imaging
Anogenital warts: this is usually a clinical diagnosis, but if there are atypical features, a biopsy may be necessary
mx for anogenital HPV?
Conservative: 30% of people clear the virus spontaneously within 6 months
Medical: first-line is topical podophyllototoxin, imiquimod or sinecatechins
If available: cryotherapy, excision or electrocautery
Referral to genito-urinary medicine clinic
what is the cervical screening programme?
Women aged 25-64 years are offered screening for HPV and cellular changes that may progress to cancer. It involves taking a sample of cells from the cervix and testing for high-risk HPV, before cytological analysis if positive. If cellular changes are seen, women are referred for colposcopy and treatment. Otherwise, the cervical smear is repeated 12 months later to check for virus clearance.
who gets the HPV vaccine?
This covers several types of HPV including all high-risk types and those causing genital warts. It is offered to 12-13 year-olds as either a two or three dose schedule.
