Background
- Oncogenic double-stranded DNA virus in the Papillomaviridae family, with hundreds of genotypes
- Infection with one genotype does not confer immunity to others
Epidemiology
- Lifetime prevalence is 70% in North America
- HPV infection is the primary risk factor for cervical cancer
- Transmission is from direct contact (including during sexual encounters) or vertical (before or during birth)
Clinical Manifestations
- Most commonly associated with warts (including genital warts), cervical cancer, and penile cancer
- Most warts resolve within 24 months without treatment
| Disease | Common Genotypes | Uncommon Genotypes |
|---|---|---|
| Plantar warts | 1, 2, 27 | 4, 26, 28, 29, 41, 57, 63, 65, 77, 117, 125, 128, 129, 130, 131, 132, 133, 148, 149, 179, 184 |
| Common warts | 1, 2, 4, 27 | |
| Warts of meat, poultry, and fish handlers | 2, 7 | 1, 3, 4, 10, 28 |
| Flat and intermediate warts | 3, 10 | 27, 28, 38, 41, 49, 75, 76, 126 |
| Epidermodysplasia verruciformis | 5, 8, 9, 12, 14, 15, 17 | 19, 20, 21, 22, 23, 24, 25, 36, 37, 38, 47, 49, 50, 75, 93 |
| Condylomata acuminata | 6, 11 | 16, 18, 26, 31, 33, 35, 40, 42, 43, 44, 45, 51, 52, 53, 54, 55, 56, 58, 59, 66, 68, 70, 153, 175, 178, 180, 200, 201, 202 |
| Intraepithelial neoplasia (unspecified) | 26, 30, 34, 39, 40, 53, 57, 59, 61, 62, 67, 68, 69, 71, 81, 83 | |
| Intraepithelial neoplasia (low-grade) | 6, 11 | 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, 54, 61, 70, 72, 74 |
| Intraepithelial neoplasia (high-grade) | 16, 18 | 6, 11, 31, 33, 34, 35, 39, 42, 44, 45, 51, 52, 56, 58, 66, 67 |
| Cervical carcinoma | 16, 18 | 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 67, 68, 73, 82 |
| Recurrent respiratory papillomatosis | 6, 11 | 16, 18, 31, 33, 35, 39 |
| Focal epithelial hyperplasia of Heck | 13, 32 | 18, 33, 45 |
| Conjunctival papillomas and carcinomas | 6, 11, 16 |
Recurrent Respiratory Papillomatosis
- Papillomas appear most commonly in larynx, but also trachea, bronchi, and lungs
- Hoarseness, dysphonia, airway obstruction, respiratory distress, and stridor
- In lungs, can cause nodules, atelectasis, and secondary bacterial pneumonia, with eventual bronchiectasis and vacitation
- Can progress to invasive squamous papillomatosis or even squamous cell carcinoma
- Genotypes 6 and 11 most commonly implicated
- In children it is caused by perinatal vertical transmission and can be life-threatening (juvenile-onset recurrent respiratory papillomatosis)
- 25% present by 1 year, 50% by 5 years, and 100% by 11 years
- In adults, most commonly seen in ages 20 to 40 years
Prevention
Vaccination
| Vaccine | Genotypes | Schedule | |||||
|---|---|---|---|---|---|---|---|
| Girls and Women | Boys and Men | ||||||
| 9 to 15 years | ≥15 years | Immunocompromised | 9 to 15 years | ≥15 years | Immunocompromised | ||
| Cervarix | 16, 18 | 2 or 3 dose | 3 dose | 3 dose | not indicated | ||
| Gardasil | 6, 11, 16, 18 | 2 or 3 dose | 3 dose | 3 dose | |||
| Gardasil-9 | 6, 11, 16, 18, 31, 33, 45, 51, 58 | ||||||
- Two-dose schedule
- Only indicated for children aged at least 9 to less than 15 years
- Given at 0 and 6 months
- Three-dose schedule
- Indicated for everyone, including children 9 years and older, men and women 15 years and older and immunocompromised people
- HPV-2: given at 0, 1, and 6 months
- HPV-4: given at 0, 2, and 6 months
- HPV-9: given at 0, 2, and 6 months
