VPMD: Human Papillomavirus (HPV)

What is HPV?

Human Papilomavirus (HPV), is the virus behind common warts, genital warts and certain types of cancer. There are over 100 types of the virus with some associated with the development of sexually transmitted diseases such as genital warts and others associated with cancers such as cervical , anal and vulvar cancer. The public health significance of HPV is its ability to lead cause cancer. HPV is very contagious and passed from person to person through skin contact (causual or sexual) and those whom are immunocompromised are the most susceptible to infection and disease progression.

What are the symptoms of HPV related diseases?

As mentioned in the section before, HPV can manifest in many disease forms including infection and cancer. The symptoms that one experiences depends on the anatomy that is involved, but as with a lot of infections, there may be no notable symptoms at all.

Common Warts: Thickened painless growths on skin other than that of the genital region.

Genital Warts: Painless, thickened growths on genital skin.

Cancer (cervical, anal, penile etc): Oftentimes there are no symptoms, but may develop bleeding between periods, after sex with cervical cancer.

Given the early asymptomatic nature of cervical cancer, risk based screening guidelines have been established in the US (Pap smear & HPV testing). Other HPV related cancers are not screened for at this time.

How are HPV related diseases diagnosed?

In most cases of warts, it is diagnosed by clinical signs, symptoms and history.

As for the HPV related cancers, diagnosis is achieved by examination of affected tissue (biopsy) +/- genetic testing.

How are HPV related diseases treated?

We will discuss treatment grouped by the two major types of disease processes: warts and cancers.

Common and Genital Warts: The goal of treatment is to destroy the thickened growths of the skin using methods, that may eliminate the virus in conjunction with the person’s immune system. Most therapies include the application of topical treatment such as freezing or burning (cryotherapy), immune modulating therapies to hasten the destruction by the immune system (imiquomod), thermo burning warts (electrocautery), laser therapy, chemical burning (TCA).

Cancer: The goal of therapy is to halt the progression of and eliminate the presence of cancerous cells. Most cancers do not have a cure but the goal is to induce remission. This is often accomplished through use of physical removal through resection of abnormal cells with a margin of healthy cells as well as us of chemotherapeutic medications that mitigate the abnormal growth cycle of cells that contribute to cancerous growth.

How are HPV related diseases prevented?

Unfortunately, not all HPV related diseases have well proven prevention strategies, however, given our knowledge of how HPV is spread, attempts to miminize spread, such as practicing safe sex (barrier protection, selective partners) may be an effective mitgation strategy.

For HPV related genital warts and cervical cancer, the two-dose HPV vaccine has been recommeded for older children, commonly given between ages 11-12 yo, with six months between each dose. The rationale for vaccination at such a young age is the thought that the vaccine is most effective prior to exposure. The vaccine is also currently given to adults up to 45 years old.

Secondary prevention strategy for HPV related cervical cancer is achieved through risk based screening with Pap smear and HPV testing, usually, starting at 21 years old (sooner in the immunocompromised).

Sources: WHO, Cleveland Clinic, CDC