Fast Five Quiz: Test Your Knowledge of Human Papillomavirus

William James, MD

Disclosures

September 29, 2017

In 2015, the Advisory Committee on Immunization Practices (ACIP) issued updated recommendations for use of the 9-valent HPV vaccine (Gardasil 9; 9vHPV) in adults and adolescents. The bivalent (Cervarix) and quadrivalent (Gardasil) vaccines are no longer available in the United States. The 2017 US Centers for Disease Control and Prevention (CDC) immunization recommendations with 9vHPV include the following:

  • Females: Vaccination is recommended at 11 or 12 years of age (may be as young as 9 years) and for those aged 13-26 years if not previously vaccinated

  • Males: Vaccination is recommended at 11 or 12 years of age (may be as young as 9 years) and for those aged 13-21 years if not previously vaccinated; those aged 22-26 years may be vaccinated; vaccination is recommended for men who have sex with men through age 26 years if they did not get any or all doses when younger

  • Immunocompromised persons (including those with HIV infection): Vaccination is recommended through age 26 years for those who did not get any or all doses when younger

  • Pregnant women: Immunization for HPV is not recommended; however, pregnancy testing is not needed before vaccination. If a woman is found to be pregnant after vaccination is started, no intervention is needed, but the remainder of the three-dose series should be delayed until completion of pregnancy

Higher HPV infection rates have been reported in pregnant women. If condyloma develops, rapid growth can be observed. Factors responsible include suppression of immunity during pregnancy and hormonal changes. Small asymptomatic lesions need not be treated; larger lesions can be treated with keratolytics or cryotherapy.The risk for perinatal HPV transmission to the oropharyngeal mucosa of the neonate is low for mothers with latent infections or genital warts. The time between rupture of the amnion and delivery may be a critical factor in predicting transmission.

Two broad categories of medications are effective in treating HPV disease:

  • Immune-response modifiers—these include imiquimod and interferon alfa and are primarily used in treatment of external anogenital warts or condylomata acuminata

  • Cytotoxic agents—these include the antiproliferative drugs podofilox, podophyllin, and 5-fluorouracil, as well as the chemodestructive or keratolytic agents salicylic acid, trichloroacetic acid, and bichloracetic acid

None of these medicines have been shown to be uniformly effective or directly antiviral.

Warts on the shaft of the penis and vulva respond very well to cryotherapy. Cryotherapy of the rectum is painful and less successful. Cryotherapy is not recommended for use in the vagina because the depth of ablation cannot be controlled and damage to adjacent structures, such as the bladder and rectum, is possible.

For more on the treatment of HPV, read here.

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