Human Papillomavirus Follow-up

  • Author: Peter A Gearhart, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 29, 2011
 

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.[19] Its effectiveness will depend on the duration of immunity and will be optimized by achieving maximum coverage of the target population.[20]

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.[21]

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.[22, 23]

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Complications

Complications of wart treatment are rare. Complications are generally confined to the treatment site and include scarring and, in the case of genital warts, vulvodynia or hyperesthesia.

Surgical complications of treating SILs are discussed in the articles involving those diseases. See the following articles for discussion of complications:

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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.

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Patient Education

Educating women, particularly those who are socially and economically disadvantaged, about behaviors that enhance sexual risk reduction has a proven benefit in reducing the incidence of STDs. Reducing the incidence of STDs potentially could decrease HPV transmission and, consequently, the incidence of cervical carcinoma.

For excellent patient education resources, visit eMedicine's Women's Health Center, Pregnancy and Reproduction Center, Cancer and Tumors Center, and Warts Center.

Also, see eMedicine's patient education articles Birth Control Overview, Birth Control FAQs, Cervical Cancer, Warts, Genital Warts, Plantar Warts, and Pap Smear.

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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: Merck Honoraria Speaking and teaching

Coauthor(s)

Thomas C Randall  MD, Associate Professor of Clinical Obstetrics and Gynecology, University of Pennsylvania School of Medicine; Director, Gynecologic Oncology, Pennsylvania Hospital

Thomas C Randall 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.

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, 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; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

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.

References

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Human papillomavirus (HPV). Condyloma acuminatum in a patient with a history of an allograft renal transplant.
Human papillomavirus (HPV). Note the extensive labial involvement.
Human papillomavirus (HPV). Anal condyloma acuminatum.
Human papillomavirus (HPV). These condylomata extend to the anal verge.
Table. Diseases and Associated HPV Subtypes
Nongenital Cutaneous Disease HPV Type
Common warts (verrucae vulgaris)1, 2, 4, 26, 27, 29, 41, 57, 65
Plantar warts (myrmecias)1, 2, 4, 63
Flat warts (verrucae plana)3, 10, 27, 28, 38, 41, 49
Butcher's warts (common warts of people who handle meat, poultry, and fish)1, 2, 3, 4, 7, 10, 28
Mosaic warts2, 27, 57
Ungual squamous cell carcinoma16
Epidermodysplasia verruciformis (benign)2, 3, 10, 12, 15, 19, 36, 46, 47, 50
Epidermodysplasia verruciformis (malignant or benign)5, 8, 9, 10, 14, 17, 20, 21, 22, 23, 24, 25, 37, 38
Nonwarty skin lesions37, 38
Nongenital Mucosal Disease HPV Type
Respiratory papillomatosis6, 11
Squamous cell carcinoma of the lung6, 11, 16, 18
Laryngeal papilloma6, 11, 30
Laryngeal carcinoma16, 18
Maxillary sinus papilloma57
Squamous cell carcinoma of the sinuses16, 18
Conjunctival papillomas6, 11
Conjunctival carcinoma16
Oral focal epithelial hyperplasia (Heck disease)13, 32
Oral carcinoma16, 18
Oral leukoplakia16, 18
Squamous cell carcinoma of the esophagus16, 18
Anogenital Disease HPV Type
Condylomata acuminata6, 11, 30, 42, 43, 44, 45, 51, 52, 54
Bowenoid papulosis16, 18, 34, 39, 42, 45
Bowen disease16, 18, 31, 34
Giant condylomata (Buschke-Löwenstein tumors)6, 11
Unspecified intraepithelial neoplasia30, 34, 39, 40, 53, 57, 59, 61, 62, 64, 66, 67, 68, 69
Low-grade intraepithelial neoplasia6, 11, 43
Intermediate intraepithelial neoplasia31, 33, 35, 42, 44, 45, 51, 52
High-grade intraepithelial neoplasia16, 18, 56, 58
Carcinoma of vulva6, 11, 16, 18
Carcinoma of vagina16
Carcinoma of cervix16, 18, 31
Carcinoma of anus16, 31, 32, 33
Carcinoma in situ of penis (erythroplasia of Queyrat)16
Carcinoma of penis16, 18
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