eMedicine Specialties > Infectious Diseases > Viral Infections

Human Papillomavirus: Follow-up

Author: Peter A Gearhart, MD, Assistant Professor of Obstetrics and Gynecology, University of Pennsylvania School of Medicine
Coauthor(s): Thomas C Randall, MD, Assistant Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania School of Medicine; Roland Michael Buckley, Jr, MD, Clinical Professor of Medicine, University of Pennsylvania School of Medicine; Consultant, Department of Medicine, Division of Infectious Diseases, Pennsylvania Hospital
Contributor Information and Disclosures

Updated: Oct 22, 2009

Follow-up

Deterrence/Prevention

  • The vaccine currently marketed in the United States prevents infection by human papillomavirus (HPV) types 6, 11, 16, and 18. It is most effective when given before the onset of sexual activity. The impact of this vaccine on the incidence of cervical cancer will not be observable for years.6 Its effectiveness will depend on the duration of immunity and will be optimized by achieving maximum coverage of the target population.7
  • Vaccination against HPV types 16 and 18 is most effective in preventing infections from these viruses in females who have not previously been infected with these types.8
  • Most investigators agree that routine immunization in females should begin at approximately age 12 years. Since the vaccine has been widely available only for a few years, catch-up vaccinations are currently recommended in previously unvaccinated females beginning at age 13 years and ranging to an upper limit of age 18-26 years.9,10

Complications

Prognosis

  • Approximately two thirds of patients with nongenital cutaneous warts experience a spontaneous regression within 2 years; however, some new warts may appear.
  • Most patients with epidermodysplasia verruciformis (EV) experience progression of their disease in the third or forth decades of life. Malignant transformation usually arises from actinic keratoses, particularly in patients who are exposed to irradiation. Patients who remain protected from x-rays and sun exposure generally have satisfactory health.
  • Genital warts may spontaneously regress, remain unchanged, or increase in size. Treatment of these lesions does not affect the development of cervical cancer.
  • Histologic evidence of HPV infection on a cervical Pap smear is similar to mild dysplasia. This subclinical disease often spontaneously regresses.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The United States Centers for Disease Control (CDC) has specified Clinical Laboratory Improvement Amendments (CLIA) standards for cytologists to participate successfully in a cytology proficiency testing program to ensure the accuracy of interpretation of Pap smears. These guidelines can be found on the CDC Web site under the CLIA section for Gynecologic Cytology Standards. In order for laboratories in the United States to maintain certification for assessment of Pap smears and other laboratory testing, these standards must be followed.

Special Concerns

  • Pregnancy
    • The risk of perinatal human papillomavirus (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.
    • Infants with HPV-positive nasopharyngeal aspirates in the immediate postpartum period are considered contaminated rather than infected with HPV because the virus generally clears from the neonate over several months after birth. Cesarean delivery for the prevention of vertical HPV transmission to the newborn is not indicated. However, in rare cases, cesarean delivery may be indicated if the pelvic outlet is obstructed by large genital warts.
  • Sex partners
    • Although a high prevalence of HPV-associated penile SILs exists in the male sex partners of women with cervical SILs, examination of these men is not necessary for management of HPV disease. Nevertheless, sex partners of patients with HPV disease may benefit from examination and a detailed evaluation for STDs.
    • Condom use may reduce the transmission of HPV to uninfected sex partners, but it does not eliminate the risk. Furthermore, caution patients that treatment does not eliminate the possibility of HPV transmission because latent virus still may be present in tissues adjacent to treated areas.
 


More on Human Papillomavirus

Overview: Human Papillomavirus
Differential Diagnoses & Workup: Human Papillomavirus
Treatment & Medication: Human Papillomavirus
Follow-up: Human Papillomavirus
Multimedia: Human Papillomavirus
References
Further Reading
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Keywords

human papillomavirus, HPV, wart virus, cervical cancer, human papilloma virus, epithelial tumors, anogenital warts, mucosal warts, nongenital cutaneous warts, epidermodysplasia verruciformis, EV, sexually transmitted disease, STD, squamous intraepithelial lesions, SIL

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Contributor Information and Disclosures

Author

Peter A Gearhart, MD, Assistant Professor of Obstetrics and Gynecology, University of Pennsylvania School of Medicine
Peter A Gearhart, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists
Disclosure: Schering Plough Honoraria Speaking and teaching

Coauthor(s)

Thomas C Randall, MD, Assistant Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania School of Medicine
Thomas C Randall, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, and American College of Obstetricians and Gynecologists
Disclosure: Nothing to disclose.

Roland Michael Buckley, Jr, MD, Clinical Professor of Medicine, University of Pennsylvania School of Medicine; Consultant, Department of Medicine, Division of Infectious Diseases, Pennsylvania Hospital
Disclosure: Nothing to disclose.

Medical Editor

Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Mary Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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