Human papillomavirus

Background

Normal dermal anatomy.

• Abbreviation: HPV
• Most common STI in US.
• Over 200 HPV types, with 40 that infect the genital mucosa
• Associated with cervical, vulvar, penile, anal and oropharyngeal cancer.
• Vaccine available for adolescents 11 and older, and immunocompromised patients.

HPV Types and Associated Disease Entities

Disease	HPV type
Common warts	2, 7, 22
Plantar warts	1, 2, 4, 63
Verruca plana (flat)	3, 10, 28
Condyloma acuminata (anogenital)	6, 11, 42, 44 and others
Anal dysplasia (lesions)	6, 16, 18, 31, 53, 58
Genital cancers	Highest risk: 16, 18, 31, 45 Other high-risk: 33, 35, 39, 51, 52, 56, 58, 59 Probably high-risk: 26, 53, 66, 68, 73, 82
Epidermodysplasia verruciformis	more than 15 types
Focal epithelial hyperplasia (mouth)	13, 32
Mouth papillomas	6, 7, 11, 16, 32
Oropharyngeal cancer	16
Verrucous cyst	60
Laryngeal papillomatosis	6, 11

Clinical Features

Warts on toe.

Plantar wart on sole of foot.

• Most infections asymptomatic
• Anogenital warts (Condyloma acuminata)
  • painless flesh-colored papules or cauliflower-like projections
  • Contagious via skin contact
• Cervical cancer

Differential Diagnosis

Sexually transmitted diseases

• Chancroid
• Chlamydia trachomatis
• Granuloma inguinale
• Hepatitis B
• Herpes Simplex Virus-2
• HIV
• Human papillomavirus
• Lymphogranuloma venereum
• Neisseria gonorrhoeae
• Trichomonas
• Syphilis

Evaluation

• Clinical diagnosis
• Pap smear for cervical lesions

Management

• Safe-sex counseling (HPV-2)
• For genital warts can use:
  • Podofilox
  • Imiquimod
  • Cryotherapy
  • Trichloroacetic acid
  • Surgical removal

Disposition

• Outpatient follow up

See Also

• Sexually Transmitted Diseases (STD)

External Links

• http://www.cdc.gov/std/hpv/stdfact-hpv.htm