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- Members of the Papillomaviridae family, the human papillomaviruses (HPV), which cause warts of the skin and mucous membranes
- Exophytic venereal warts or condylomata acuminata are primarily caused by HPV types 6 and 11.
- Warts can be found on the external genitalia and the urethra, vagina, cervix, anus, and mouth. HPV types 6 and 11 are also associated with squamous cell carcinoma of the external genitalia.
- Virus types 16, 18, 31, 33, and 35 typically cause subclinical infection in the anogenital region and have been associated with intraepithelial genital carcinomas.
- HPV can also cause recurrent respiratory papillomatosis (RRP) in infants and young children. RRP primarily impacts the larynx but can also cause lesions anywhere along the respiratory tract.
- Increasing evidence that HPV may play a role in squamous cell carcinomas of the oropharynx
- HPV is the most common viral sexually transmitted infection (STI).
- Genital warts and HPV infection are diseases of young adults 16 to 25 years of age.
- Cervical cancer is the 3rd most common female cancer worldwide.
- Genital HPV
- Peak prevalence among women 18 to 24 years of age
- At least 40% of sexually active adolescents are infected with HPV.
- <1% of adolescents develop genital warts.
- 500,000 new cases of cervical cancer diagnosed each year internationally
- RRP impacts 4.5 per 100,000 children, mostly those age 2 to 3 years.
- 67% of children with RRP are born to mothers who had condyloma during pregnancy.
- Primarily vertical transmission at birth
- Behavioral risks, including young age at first coitus, multiple partners, cigarette use, and having older male partners
- Biologic risk in adolescent girls secondary to cervical anatomy
- 9-valent HPV vaccine (HPV9 [types 6, 11, 16, 18, 31, 33, 45, 52, and 58]) is licensed by the FDA for use in females ages 9 through 26 years and in males ages 9 through 15 years. Condom use may diminish transmission.
- Examine partners; treat those infected.
- Pap smear in adult women to assess for cervical dysplasia
- HPV infection is not a reportable disease.
- Primarily through sexual contact
- Can also be acquired during the birth process
- Transmission from nongenital sites is rare.
- The incubation period is variable and ranges from 3 months to several years.
- The virus is trophic for epithelial cells and infects the basal layer of actively dividing cells.
- Infection results in koilocytosis and nuclear atypia. Genital infections may progress to severe dysplasia and carcinoma in situ (CIS).
- Spontaneous regression of clinical disease occurs in 90% of low-risk types and 75% of high-risk types.
- Recurrence is common.
Commonly Associated Conditions
- Epidermodysplasia verruciformis
- Other STIs