Papillomavirus

From Anvita Health Wiki

Contents 1 Classification 2 Epidemiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Management 7 More General Terms 8 Additional Terms 9 References

Classification

• HPV types: 1-68
• high-risk: types 16 & 18
• low-risk: beta- HPV

Epidemiology

• prevalence of HPV 7% (USA, 2009-2010) [8]

• ~50% high-risk HPV, HPV-16 most common

• HPV is sexually transmitted

• prevalence 8-fold higher in people who have ever had sex
• risk of HPV increases with number of sexual partners
• 3.7% likelihood of heterosexual transmission in 1 month; 20% likelihood of heterosexual transmission in 6 months [7]

• prevalence is higher in men than women
• persistence of high-risk papillomavirus infection

• average clearance time

• 12 months in white women
• 18 months in black women [10]

• infection persistance after 2 years

• 24% of white women
• 56% of black women [10]

Pathology

• all warts are caused by papillomavirus

• common warts: HPV types 1,2,3,4
• plantar warts: HPV types 1,4
• flat warts: HPV types 3,10
• epidermodysplasia verruciformis: HPV types 3,5,8,9,10, 12,14,15,17,19-25, 28,29
• genital warts: HPV types 6,11 cause 90% also types: 16,18,30,31,33,34,35,39,40,42,43,44,45,51, 52,53,54, 55,56,57,58,59,66,68
• respiratory warts: HPV types 6,11,30

• cervical intraepithelial neoplasia & cervical cancer [1,3]

• HPV-16 & HPV-18 cause 70% of all cervical cancer

• anal cancer: HPV-16 & HPV-18
• penile cancer: HPV-16 & HPV-18
• oropharyngeal cancers ( tonsil, base of tongue, pharynx) [9]

• HPV+ cancers with better prognosis than HPV- cancers

• low-risk human papillomavirus strains (beta-HPV) are not associated with cutaneous squamous cell carcinoma [6]

Clinical-manifestations

• exophytic lesions 1-3 mm in diameter

• perianal area
• labia minora

• lesions enhanced by application of 3-5% acetic acid to mucosal & skin surfaces - tissues may turn white & appear shiny & raised

Laboratory

• Papanicolaou's (Pap) smear
• polymerase chain reaction ( PCR)
• southern blot
• dot blot

Management

• no treatment is universally effective
• recurrence rate of 25% at 3 months with destructive modalities

• cryotherapy
• laser therapy
• electrodessication
• podofilox

• condoms may prevent transmission
• vaccine for HPV-16/18 Gardasil [4]

More General Terms

• papovaviridae

Additional Terms

• HPV-16/18 vaccine (Gardasil, Cervarix)
• verruca vulgaris (warts)

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Anderson, Advance/Laboratory June 2001, pg 91
3. Journal Watch 22(4):30, 2002 Schlecht NF et al Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia. JAMA 286:3106, 2001 PMID: [1]
4. Journal Watch cites abstract from Infecitous Disease Society. Gardasil:Merck Manufacturer, phase 3 trial with > 12,000 women
5. Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, Harper DM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, Doroshenk MK, Kahn KG, Schmidt C, Shafey O, Smith RA, Partridge EE, Garcia F. American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28. PMID: [2]
6. Arron ST et al. Transcriptome sequencing demonstrates that human papillomavirus is not active in cutaneous squamous cell carcinoma. J Invest Dermatol 2011 Apr 14 <PubMed> PMID: [3] <Internet> [4]
7. Burchell AN et al. Genital transmission of human papillomavirus in recently formed heterosexual couples. J Infect Dis 2011 Dec 1; 204:1723 PMID: [5]
8. Gillison ML et al Prevalence of Oral HPV Infection in the United States, 2009-2010 JAMA. Published online January 26, 2012 <PubMed> PMID: [6] <Internet> [7]
   - Schlecht HP Oral Human Papillomavirus Infection <PubMed> PMID: [8] <Internet> [9]
9. Adelstein DJ et al. Head and neck squamous cell cancer and the human papillomavirus: Summary of a National Cancer Institute State of the Science Meeting, November 9010, 2008, Washington, D.C. Head Neck 2009 Nov; 31:1393. PMID: [10]
10. Messersmith AR et al Increased risk of persistent human papillomavirus infection and abnormal Pap tests in African American compared to European American women in a college-age cohort American Association for Cancer Research Annual Meeting Abstract: 550, April 1, 2012 [11]
11. HPV: NIH Institute and Center Resources [12]
12. National Guideline Clearinghouse
    - Human papillomavirus (HPV) infection. In: Sexually transmitted diseases treatment guidelines, 2010. Centers for Disease Control and Prevention ngc-guideline: [13]
    - Human papillomavirus (HPV). New York State Department of Health ngc-guideline: [14]
    - Human papillomavirus. American College of Obstetricians and Gynecologists ngc-guideline: [15]
    - Clinical manifestations and diagnosis of HPV-related disease. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [16]
    - Counselling. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [17]
    - Prevention. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [18]
    - Screening for cervical cancer. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [19]
    - The role of HPV testing. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [20]
    - Treatment of external genital warts and pre-invasive neoplasia of the lower tract. In: Canadian consensus guidelines on human papillomavirus. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [21]

papillomavirus