Human Papilloma Virus HPV

Organism Human papilloma virus (HPV).

Clinical features The main clinical presentation is genital warts on the external genitalia or within the vagina, but a large proportion of infected persons show no clinical signs. When cellular immunity is depressed condylomata acuminata, large fleshy growths in moist areas of the perineum develop. However, the most serious consequence of HPV infection is the development of carcinoma, particularly of the cervix, but the anus and penis can also be involved.

Diagnosis Cervical smears stained by the Papanicolau method can detect pre-cancerous changes.

Transmission is by sexual intercourse, but direct contact, as with other warts, is possible.

Incubation period 2-3 months.

Period of communicability Probably for a considerable period of time as cancer of the cervix appears to be associated with the cumulative number of sexual encounters.

Occurrence and distribution It has been estimated that between 9% and 13% of the world population is infected with HPV, which is some 630 million people. Seventy percent of these infections are sub-clinical with only a proportion developing genital warts and some 28-40 million the pre-malignant condition. The prevalence of chronic persistent infection is about 15% in developing countries and 7% in developed. Eighty per cent of the worldwide incidence of cervical cancer is in developing countries.

Control and prevention The usual methods of reducing STI, such as delaying the age of first intercourse, monogamous relationship and the use of condoms will all assist in decreasing the likelihood of developing HPV infection. The promotion of cervical smear testing in developed countries has allowed detection of pre- and early cervical cancer amenable to surgical treatment, but few if any developing countries are able to afford such a service.

Three HPV vaccines are currently under trial and offer considerable hope that either the non-infected can be protected or that a therapeutic vaccine can be used in the already infected.

Treatment of the warts is by cryotherapy, podophyllin or with trichloroacetic acid, but HPV infection will remain.

Surveillance Cytological services for screening women at regular intervals have been shown to be cost-effective in reducing cervical cancer and should be set up wherever resources permit.

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