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papillomavirus

Classification: - HPV types: 1-68 - high-risk: types 16 & 18 - low-risk: beta-HPV Etiology: - exposure to HPV in connection with superficial injury or minor trauma Epidemiology: - prevalence of oral HPV 7% (U.S., 2009-2010) [8] - ~50% high-risk HPV, HPV-16 most common - 45% of men age 18-59 positive for HPV [22] - 1/3 of these infected/colonized with at least 1 strain susceptible to 9-valent vaccine [22] - 12% of men & 3% of women with oral HPV (2011-2014) [25] - high-risk oral HPV in 7% of men & 1% of women - 13% of men & 4% of women with same sex partners - 22% of homosexual men with multiple partners [25] - prevalence of oral HPV highest in men age 50-54 years - oral HPV more common in those with concurrent genital HPV [25] - HPV is sexually transmitted (genital warts) - prevalence of genital HPV ~40% in U.S. adults [23] - 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 - higher alcohol consumption in men linked to higher risk of HPV [16] - from 2000 to 2009 [12] - incidence of oropharyngeal & anal cancers increased - black men have the highest annual incidence rate of anal cancer - American Indian/Alaska Native men have the highest incidence of oropharyngeal cancer - incidence rates of cervical cancer decreased - exception: American Indian/Alaska Native - persistence of high-risk papillomavirus infection - average clearance time - 12 months in white women - 18 months in black women [10] - infection persistence after 2 years - 24% of white women - 56% of black women [10] - incidence declined by more than 1/2 in girls after introduction of HPV vaccine [13] - 39,000 papillomavirus-associated cancers/year or 11.7 per 100,000 people [21] - from 1999-2015 annual increases observed in HPV-associated squamous cell carcinomas [26] - oropharyngeal cancer: 2.7% for men,.8% for women - anal cancer: 2.1% for men, 2.9% for women - vulvar cancer: 1.3% Pathology: 1) all warts are caused by papillomavirus a) common warts: HPV types 1,2,3,4 b) plantar warts: HPV types 1,4 c) flat warts: HPV types 3,10 d) epidermodysplasia verruciformis: HPV types 3,5,8,9,10, 12,14,15,17,19-25, 28,29 e) genital warts: condyloma acuminata - 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 f) respiratory warts: HPV types 6,11,30 2) cervical intraepithelial neoplasia & cervical cancer [1,3] - HPV-16 & HPV-18 cause 70% of all cervical cancer 3) vulvar cancer 4) vaginal cancer 5) anal cancer: HPV-16 & HPV-18 6) penile cancer: HPV-16 & HPV-18 7) oropharyngeal cancer (tonsil, base of tongue, pharynx) [9] - oropharyngeal squamous cell carcinoma is most common oral HPV-associated cancer [25] - HPV-16 positive cancers with better prognosis than HPV-16- negative cancers [1,19] - HPV infection is less common in the oropharynx than in the genital tract - oral HPV infection often clears spontaneously - might be more likely to persist in older age [13] 8) low-risk human papillomavirus strains (beta-HPV) are not associated with cutaneous squamous cell carcinoma [6] Clinical manifestations: 1) exophytic lesions 1-3 mm in diameter a) perianal area b) labia minora c) tongue [24] 2) lesions enhanced by application of 3-5% acetic acid to mucosal & skin surfaces - tissues may turn white & appear shiny & raised * images [24] Complications: - survivors of HPV-associated cancers at risk for 2nd HPV-associated cancer - 81 per 10,000 person-years among women - 62 per 10,000 person-years among men [27] Laboratory: 1) Papanicolaou's (Pap) smear 2) human papillomavirus DNA - urinary HPV testing has good accuracy for detecting cervical HPV, especially in first-void samples [17] - papilloma virus genotyping identifies high-risk HPV 3) see ARUP consult [11] Management: 1) no treatment is universally effective 2) recurrence rate of 25% at 3 months with destructive modalities a) cryotherapy b) laser therapy c) electrodessication d) podofilox 3) condoms may prevent transmission 4) vaccine for HPV-16/18 Gardasil [4]

Related

HPV-16/18 vaccine (Gardasil, Cervarix) papillomavirus (HPV) DNA; high-risk HPV testing verruca vulgaris (warts)

General

papovaviridae

Properties

KINGDOM: virus GENOME-TYPE: deoxyribonucleic acid (DNA) DOUBLE-STRANDED GENOME-SIZE: 5-9 kB ENVELOPE: NONE CAPSID-SYMMETRY: ICOSAHEDRAL

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
  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: 11754676
  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: 17237032 (corresponding NGC guideline withdrawn Dec 2012)
  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 PMID: 21490616 http://www.nature.com/jid/journal/vaop/ncurrent/full/jid201191a.html
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  8. Gillison ML et al Prevalence of Oral HPV Infection in the United States, 2009-2010 JAMA. Published online January 26, 2012 PMID: 22282321 http://jama.ama-assn.org/content/early/2012/01/23/jama.2012.101.full - Schlecht HP Oral Human Papillomavirus Infection PMID: 22282320 http://jama.ama-assn.org/content/early/2012/01/23/jama.2012.117.full
  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: 19787782
  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 http://www.abstractsonline.com/Plan/ViewAbstract.aspx
  11. ARUP Consult: Human Papillomavirus - HPV The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/human-papillomavirus
  12. Jemal A et al Annual Report to the Nation on the Status of Cancer, 1975-2009, Featuring the Burden and Trends in Human Papillomavirus (HPV)-Associated Cancers and HPV Vaccination Coverage Levels JNCI J Natl Cancer Inst (2013) January 7 PMID: 23297039
  13. Markowitz LE et al Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 20032010. J Infect Dis. June 19, 2013 PMID: 23785124 http://jnci.oxfordjournals.org/content/early/2013/01/03/jnci.djs491.full
  14. Kreimer AR et al. Incidence and clearance of oral human papillomavirus infection in men: The HIM cohort study. Lancet 2013 July 2 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60809-0/fulltext
  15. Juckett G, Hartman-Adams H. Human papillomavirus: clinical manifestations and prevention. Am Fam Physician. 2010 Nov 15;82(10):1209-13. PMID: 21121531
  16. Schabath MB et al Alcohol consumption and prevalence of human papillomavirus (HPV) infection among US men in the HPV in Men (HIM) study Sex Transm Infect. Oct 2, 2014
  17. Pathak N et al. Accuracy of urinary human papillomavirus testing for presence of cervical HPV: Systematic review and meta-analysis. BMJ 2014 Sep 16; 349:g5264. PMID: 25232064 http://www.bmj.com/content/349/bmj.g5264 - Kitchener HC and Owens GL Urine testing for HPV. BMJ 2014 Sep 16; 349:g5542. PMID: 25230583 http://www.bmj.com/content/349/bmj.g5542
  18. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007 Sep 8;370(9590):890-907. PMID: 17826171
  19. Gillison ML, D'Souza G, Westra W et al Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Natl Cancer Inst. 2008 Mar 19;100(6):407-20 PMID: 18334711
  20. Gormley RH, Kovarik CL. Human papillomavirus-related genital disease in the immunocompromised host: Part II. J Am Acad Dermatol. 2012 Jun;66(6):883.e1-17 PMID: 22583721
  21. Viens LJ, Henley SJ, Watson M, et al. Human Papillomavirus-Associated Cancers-United States, 2008-2012. MMWR Morb Mortal Wkly Rep 2016;65:661-666 https://www.cdc.gov/mmwr/volumes/65/wr/mm6526a1.htm
  22. Han JJ, Beltran TH, Song JW et al Prevalence of Genital Human Papillomavirus Infection and Human Papillomavirus Vaccination Rates Among US Adult Men: National Health and Nutrition Examination Survey (NHANES) 2013-2014. JAMA Oncol. Published online January 19, 2017 PMID: 28114440 http://jamanetwork.com/journals/jamaoncology/fullarticle/2598492
  23. McQuillan G, Kruszon-Moran D, Markowitz LE et al Prevalence of HPV in Adults Aged 18-69: United States, 2011-2014. NCHS Data Brief No. 280, April 2017 https://www.cdc.gov/nchs/products/databriefs/db280.htm
  24. Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
  25. Sonawane K, Suk R, Chiao EY et al Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014. Ann Intern Med. 2017. Oct 17 PMID: 29049523 http://annals.org/aim/article/2657698/oral-human-papillomavirus-infection-differences-prevalence-between-sexes-concordance-genital - Gravitt PE Unraveling the Epidemiology of Oral Human Papillomavirus Infection. Ann Intern Med. 2017. Oct 17 PMID: 29049824 http://annals.org/aim/article/2658199/unraveling-epidemiology-oral-human-papillomavirus-infection
  26. Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in Human Papillomavirus-Associated Cancers - United States, 1999-2015. MMWR Morb Mortal Wkly Rep 2018;67:918-924 https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a2.htm
  27. Suk R, Mahale P, Sonawane K et al Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Network Open. 2018;1(5):e181999 PMID: 30646145 PMCID: PMC6324459 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2701740
  28. National Cancer Institute: HPV and Cancer https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer