Genitourinary Diseases: Human Papilloma Virus (HPV)

Human Papilloma Virus (HPV)

Background

  • Causative Agent: Human Papilloma Virus
  • Over 100 different types.
  • Infects mucosal surfaces such as the cervix, vagina, urethra, and penis.
  • 40 different types are considered "high risk".

Epidemiology

  • Most common STD in the U.S. (linked to the number of partners).
  • Linked to 99% of cervical cancer cases worldwide.
  • On average, 12,000 women are diagnosed with cervical cancer each year in the U.S. (with women of color disproportionately affected).
  • Approximately 4,000 women die each year from cervical cancer.

Transmission

  • Direct Contact:
    • Skin-to-skin contact.
    • Anal, vaginal, and oral sex, primarily sexual intercourse.

Symptoms and Clearance

  • The majority of women clear HPV infections within 2 years.
  • Symptoms:
    • Abnormal vaginal bleeding.
    • Pain during intercourse.
    • Bleeding after intercourse.

Types of HPV

  • Low Risk (Non-Oncogenic):
    • HPV-6 and HPV-11: Cause genital warts.
  • High Risk (Oncogenic):
    • HPV-16 (more carcinogenic) and HPV-18: Linked to 70% of cervical cancer cases.
    • Can cause cancer of the cervix, penis, anus, or vulva.

Genital Warts

  • Non-cancerous, irregular growths that resemble cauliflower.
  • HPV-6 and HPV-11 cause 90% of cases.

Pathogenesis: Cervical Cancer

  • Virus produces E6 and E7 proteins.
  • These proteins bind to and inactivate p53.
  • p53: Tumor suppressor gene.
Function of p53 (Tumor Suppressor Gene)
  • Cell Cycle: Consists of a "prep" stage called Interphase.
  • Detects genetic mistakes made during the G1 phase of the cell cycle.
  • Arrests cell growth during cell division.

Prevention

  • Pap Smears: Important screening tool, starting at age 21.
  • Cells for Pap smears are collected from the cervix.
  • At age 30 and up: Regular Pap smears in conjunction with HPV DNA test using PCR (every 5 years).

Current Events

  • Current "epidemic" of oral warts, oral cancer, and throat cancer.
  • HPV can infect oral mucous membranes.

Additional Prevention Methods

  • Use condoms as ONE preventative measure.
  • See your gynecologist regularly.

HPV Vaccine (GARDASIL)

  • 9-valent vaccine, recently approved in 2014.
  • Inactivated (non-infectious) viral particles that stimulate an immune response
  • Recommended for both males and females to prevent HPV infection and associated cancers and genital warts.
  • Ideal age for vaccination is before the start of sexual activity.
  • Insurance coverage varies by age; consult with healthcare provider and insurance company for specific details.