II. Epidemiology

  1. Women have been primary initial target for cervical Cancer Prevention
    1. High risk HPV Prevalence in U.S. females ages 15 to 19 years old: 20-25%
  2. Men have been added in U.S. as of 2012 for HPV-related Cancer Prevention
    1. Annual number of new cases of HPV-related cancers in american men: 9810
    2. HPV-related cancers in males include oral cavity, oropharynx, Larynx, anal cancer, penis

III. Types: High Risk

  1. HPV 16 (causes 50% of all Cervical Cancers, usually squamous cell cancers)
  2. HPV 18 (causes 20% of all Cervical Cancers, usually adenocarcinoma)

IV. Types: Low Risk (responsible for 95% of Genital Warts)

  1. HPV 6
  2. HPV 11

V. Pathophysiology

  1. Group of over 100 DNA viruses that infect epithelial cells
  2. Transmission of HPV from Genital Warts
    1. HPV is very contagious due to high viral loads
    2. Transmission rate: 65%
    3. Incubation period duration following exposure: 3 weeks to 8 months
    4. Oral transmission occurs at a lower rate
    5. Perinatal transmission is rare
  3. Course
    1. Spontaneous clearance of high risk or low risk HPV within 2 years for 90% of patients
    2. Genital Warts clear on average within 6 months with treatment
    3. Progression to cancer is a small percentage of overall HPV cases and typically develops over years to decades
  4. Cancer development
    1. HPV invades human cells
    2. HPV DNA integrates into host cell
    3. Viral oncoproteins (E6 and E7) are expressed
    4. Oncoproteins bind and block tumor suppression genes (TP53, RB1)

VI. Associated Conditions: Genital infections

  1. Caused by ~40 HPV types
  2. Transient HPV infection without lesions
    1. HPV is the most common STD in women
    2. Lifetime Prevalence in sexually active women: 80%
    3. HPV infection peaks at age 20 (and again post-Menopause in some patients)
  3. Genital Warts (Condyloma acuminata)
    1. Lifetime Prevalence (U.S.): 1%
  4. Cervical Cancer (caused by ~15 High Risk HPV types)
    1. HPV infection precedes Cervical Cancer diagnosis by 10-20 years
    2. Typically diagnosed after age 40
      1. HPV screening for ages 30-40 has highest yield
  5. Perianal warts
    1. Local spread from genitalia or
    2. Receptive anal intercourse
  6. Genital cancers that occur less commonly
    1. Vaginal cancer
    2. Vulvar Cancer
    3. Anal cancer
    4. Penile Cancer (uncircumsized men)
  7. Other lesions associated with HPV infection
    1. Oral squamous cell cancer
    2. Respiratory papillomatosis

VII. Associated Conditions: Non-genital

  1. Common Wart
  2. Plantar Wart
  3. Respiratory papillomatosis

VIII. Labs: HPV DNA testing by PCR

  1. Hybrid Capture II (Thirteen high risk HPV types)
  2. Cervista (HPV 16, 18)
  3. Cervista (HPV 14)

IX. Protocol: Cervical HPV testing

  1. HPV testing above has 90% sensitivity at Cervix
  2. Perform HPV DNA testing with Pap Smear at age 30 and if negative repeat in 3 years

X. Prevention

  1. HPV Vaccines
    1. Quadrivalent Vaccine
      1. Gardasil (HPV types 6, 11, 16, 18)
    2. Bivalent Vaccine
      1. Cervarix (HPV types 16, 18)
  2. Condoms
    1. Efficacy is 70% in HPV transmission prevention
  3. Tobacco Cessation
    1. Tobacco use is associated with Genital Wart development and persistent HPV infection
  4. Circumcision (routine at birth)
    1. Lower risk of HPV infection

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Ontology: Human papilloma virus infection (C0343641)

Concepts Disease or Syndrome (T047)
SnomedCT 186751006, 154362001, 240532009, 367507002, 75003008
Dutch humaan papillomavirus-infectie
French Infection à virus du papillome humain
German humanes Papillomvirus-Infektion
Italian Infezione da papilloma virus umano
Portuguese Infecção por vírus humano do papiloma
Spanish Infección por virus humano del papiloma, infección por HPV, infección por virus del papiloma humano (trastorno), infección por virus del papiloma humano, infección por papilomavirus humano (trastorno), infección por papilomavirus humano, infección por virus del papiloma humano (concepto no activo)
Japanese ヒト乳頭腫ウイルス感染, ヒトニュウトウシュウイルスカンセン
English human papilloma virus infection (diagnosis), human papilloma virus infection, Human papilloma virus infectio, Human papilloma virus infection, human infections papilloma virus, Human Papillomavirus Infection, Human Papilloma Virus Infection, Human papilloma virus infection of skin, Human papilloma virus infection of skin (disorder), Human papilloma virus infection (disorder), Human papilloma virus infection, NOS
Czech Infekce způsobená lidskými papillomaviry
Hungarian Human papilloma vírus fertőzés

Ontology: Papillomavirus Infections (C0950124)

Definition (MSH) Neoplasms of the skin and mucous membranes caused by papillomaviruses. They are usually benign but some have a high risk for malignant progression.
Concepts Disease or Syndrome (T047)
MSH D030361
SnomedCT 30415006
Italian Infezione da Papilloma virus, Infezioni da Papilloma virus, Infezione da Papilloma virus NAS, Infezioni da Papillomavirus
Dutch papillomavirusinfectie NAO, papillomavirusinfecties, papillomavirusinfectie, Infectie, papillomavirus-, Papillomavirusinfectie
French Infections à Papillomavirus SAI, Infection à papillomavirus, Infections à papillomavirus
German Papillomavirus-Infektion NNB, Papillomavirus-Infektion, Papillomavirus-Infektionen
Portuguese Infecção a papilomavírus NE, Infecções por Papilomavírus, Infecção a papilomavírus, Infecções a papilomavírus, Infecções por Papillomavirus
Spanish Infección por el virus del papiloma NEOM, Infecciones por Papilomavirus, enfermedad por HPV, enfermedad por el virus del papiloma humano (trastorno), enfermedad por el virus del papiloma humano, Infecciones por el virus del papiloma, Infección por el virus del papiloma, Infecciones por Papillomavirus
Japanese 乳頭腫ウイルス感染NOS, 乳頭腫ウイルス感染, ニュウトウシュウイルスカンセンNOS, ニュウトウシュウイルスカンセン
Swedish Papillomvirusinfektioner
English PAPILLOMAVIRUS INFECT, Papilloma viral infection NOS, Papilloma viral infections, Papillomavirus Infections [Disease/Finding], papillomavirus infection, Papillomavirus Infection, Papillomavirus Infections, Papilloma viral infection, Disease due to Papilloma virus (disorder), Disease due to Papilloma virus, Disease due to Papilloma virus, NOS
Czech papilomavirus - infekce, Papillomavirus - infekce, Infekce způsobená papillomaviry NOS, Infekce způsobené papillomaviry, Infekce způsobená papillomaviry
Finnish Papilloomavirusinfektiot
Polish Zakażenie wirusem brodawczaka ludzkiego, Zakażenie HPV, Zakażenia papillomawirusowe
Hungarian papillomavirus fertőzés k.m.n., papillomavirus fertőzés, Papilloma vírusos fertőzések
Norwegian Papillomavirusinfeksjoner