Sections

DDx

Diagnostic Considerations

Failure to diagnosis genital warts correctly can result in considerable morbidity. Confusing condylomata lata for genital warts will miss the diagnosis of syphilis and will lead to inappropriate therapy. Confusing pearly penile papules or Fordyce spots with genital warts will result in unnecessary treatment and likely unwarranted psychosocial concern. Missing a diagnosis of verrucous carcinoma or squamous cell carcinoma is likely to delay appropriate therapy and may lead to needless morbidity or even mortality.

Most papillomas are sufficiently distinct to be clinically recognizable. Bowenoid papulosis may be mistaken for lichen planus, psoriasis, seborrheic keratoses, or condylomata acuminata.

In additions to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Acanthosis nigricans
Acrochordon
Actinic keratoses
Anogenital malignancy
Anogenital warts in children
Bowenoid papulosis
Carbon dioxide laser surgery for intraepithelial cervical neoplasms
Cervical polyp
Condyloma latum
Corns and calluses
Dermatitis papillaris
Endoscopic gynecologic surgery
Epidermodysplasia verruciformis
Fordyce spots
Hymenal remnants
Hypopigmentation
Keloid and hypertrophic scar
Keratoacanthoma
Laryngeal papillomatosis of neonates and infants
Malignant tumors of the mobile tongue
Micropapillomatosis labialis
Nevi
Pap test
Pityriasis versicolor
Psoriasis (plaque)
Recurrent respiratory papillomatosis
Seborrheic keratosis
Sinonasal papillomas, treatment
Skin tags (fibroepithelial polyps)
Verrucous carcinoma
Vestibular papillomatosis

Differential Diagnoses

Basal Cell Carcinoma
Benign Cervical Lesions
Benign Vulvar Lesions
Bowen Disease
Carbon Dioxide Laser Surgery of the Lower Genital Tract
Cervical Cancer
Chancroid
Conization of Cervix
Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Giant Condylomata Acuminata of Buschke and Lowenstein
Gynecologic Cryosurgery
Gynecologic Laparoscopy
Head and Neck Cutaneous Squamous Cell Carcinoma
Hemorrhoids
Herpes Simplex
Lichen Planus
Malignant Dermatologic Diseases of the Male Genitalia
Malignant Vulvar Lesions
Molluscum Contagiosum
Nonmalignant Dermatologic Diseases of the Male Genitalia
Pearly Penile Papules
Pediatric Syphilis
Penile Cancer
Rectal Cancer
Recurrent Respiratory Papillomatosis
Rehabilitation for Paget Disease
Sebaceous Hyperplasia
Surgical Treatment of Vulvar Cancer
Urethral Warts
Vaginal Cancer

Workup

[Guideline] ACOG Committee on Practice Bulletins--Gynecology. ACOG Practice Bulletin no. 109: Cervical cytology screening. Obstet Gynecol. 2009 Dec. 114(6):1409-20. [QxMD MEDLINE Link].
Sanchez-Aleman MA, Uribe-Salas FJ, Lazcano-Ponce EC, Conde-Glez CJ. Human papillomavirus incidence and risk factors among Mexican female college students. Sex Transm Dis. 2011 Apr. 38(4):275-8. [QxMD MEDLINE Link].
Castle PE, Rodriguez AC, Burk RD, et al. Long-term persistence of prevalently detected human papillomavirus infections in the absence of detectable cervical precancer and cancer. J Infect Dis. 2011 Mar 15. 203(6):814-22. [QxMD MEDLINE Link]. [Full Text].
Giuliano AR, Lee JH, Fulp W, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011 Mar 12. 377(9769):932-40. [QxMD MEDLINE Link]. [Full Text].
Chaturvedi AK, Katki HA, Hildesheim A, et al. Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease. J Infect Dis. 2011 Apr 1. 203(7):910-20. [QxMD MEDLINE Link]. [Full Text].
Becker TM, Stone KM, Alexander ER. Genital human papillomavirus infection. A growing concern. Obstet Gynecol Clin North Am. 1987 Jun. 14(2):389-96. [QxMD MEDLINE Link].
Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003 Feb 1. 157(3):218-26. [QxMD MEDLINE Link].
Chuang TY. Condylomata acuminata (genital warts). An epidemiologic view. J Am Acad Dermatol. 1987 Feb. 16(2 Pt 1):376-84. [QxMD MEDLINE Link].
Chuang TY, Perry HO, Kurland LT, Ilstrup DM. Condyloma acuminatum in Rochester, Minn, 1950-1978. II. Anaplasias and unfavorable outcomes. Arch Dermatol. 1984 Apr. 120(4):476-83. [QxMD MEDLINE Link].
Nebesio CL, Mirowski GW, Chuang TY. Human papillomavirus: clinical significance and malignant potential. Int J Dermatol. 2001 Jun. 40(6):373-9. [QxMD MEDLINE Link].
Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis. 2009 Jul 29. 9:119. [QxMD MEDLINE Link]. [Full Text].
Rhea WG Jr, Bourgeois BM, Sewell DR. Condyloma acuminata: a fatal disease?. Am Surg. 1998 Nov. 64(11):1082-7. [QxMD MEDLINE Link].
Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997 May 5. 102(5A):3-8. [QxMD MEDLINE Link].
Bernard HU, Burk RD, Chen Z, van Doorslaer K, Hausen Hz, de Villiers EM. Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments. Virology. 2010 May 25. 401(1):70-9. [QxMD MEDLINE Link]. [Full Text].
Lee LA, Cheng AJ, Fang TJ, Huang CG, Liao CT, Chang JT, et al. High incidence of malignant transformation of laryngeal papilloma in Taiwan. Laryngoscope. 2008 Jan. 118(1):50-5. [QxMD MEDLINE Link].
de Sanjose S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010 Nov. 11(11):1048-56. [QxMD MEDLINE Link].
Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. 2003 Jan 13. 88(1):63-73. [QxMD MEDLINE Link]. [Full Text].
Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004 Jan-Feb. 36(1):6-10. [QxMD MEDLINE Link].
Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health And Nutrition Examination Survey, 2003-2006. J Infect Dis. 2011 Aug 15. 204(4):566-73. [QxMD MEDLINE Link].
Chuang TY, Perry HO, Kurland LT, Ilstrup DM. Condyloma acuminatum in Rochester, Minn., 1950-1978. I. Epidemiology and clinical features. Arch Dermatol. 1984 Apr. 120(4):469-75. [QxMD MEDLINE Link].
Kliewer EV, Demers AA, Elliott L, Lotocki R, Butler JR, Brisson M. Twenty-year trends in the incidence and prevalence of diagnosed anogenital warts in Canada. Sex Transm Dis. 2009 Jun. 36(6):380-6. [QxMD MEDLINE Link].
Hoy T, Singhal PK, Willey VJ, Insinga RP. Assessing incidence and economic burden of genital warts with data from a US commercially insured population. Curr Med Res Opin. 2009 Oct. 25(10):2343-51. [QxMD MEDLINE Link].
Koutsky LA, Galloway DA, Holmes KK. Epidemiology of genital human papillomavirus infection. Epidemiol Rev. 1988. 10:122-63. [QxMD MEDLINE Link].
Nuovo GJ. Detection of human papillomavirus DNA in the lower genital tract. Infect Urol. 1994. 87-93.
Beutner KR, Reitano MV, Richwald GA, Wiley DJ. External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. Clin Infect Dis. 1998 Oct. 27(4):796-806. [QxMD MEDLINE Link].
Fleischer AB Jr, Parrish CA, Glenn R, Feldman SR. Condylomata acuminata (genital warts): patient demographics and treating physicians. Sex Transm Dis. 2001 Nov. 28(11):643-7. [QxMD MEDLINE Link].
Cates W Jr. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel. Sex Transm Dis. 1999 Apr. 26(4 Suppl):S2-7. [QxMD MEDLINE Link].
ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 61, April 2005. Human papillomavirus. Obstet Gynecol. 2005 Apr. 105(4):905-18. [QxMD MEDLINE Link].
Peng TC, Searle CP 3rd, Shah KV, Repke JT, Johnson TR. Prevalence of human papillomavirus infections in term pregnancy. Am J Perinatol. 1990 Apr. 7(2):189-92. [QxMD MEDLINE Link].
Rando RF, Lindheim S, Hasty L, Sedlacek TV, Woodland M, Eder C. Increased frequency of detection of human papillomavirus deoxyribonucleic acid in exfoliated cervical cells during pregnancy. Am J Obstet Gynecol. 1989 Jul. 161(1):50-5. [QxMD MEDLINE Link].
Schneider A, Hotz M, Gissmann L. Increased prevalence of human papillomaviruses in the lower genital tract of pregnant women. Int J Cancer. 1987 Aug 15. 40(2):198-201. [QxMD MEDLINE Link].
Shah K, Kashima H, Polk BF, Shah F, Abbey H, Abramson A. Rarity of cesarean delivery in cases of juvenile-onset respiratory papillomatosis. Obstet Gynecol. 1986 Dec. 68(6):795-9. [QxMD MEDLINE Link].
Bosch FX, Manos MM, Munoz N, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995 Jun 7. 87(11):796-802. [QxMD MEDLINE Link].
Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006 Aug 31. 24 Suppl 3:S3/11-25. [QxMD MEDLINE Link].
Syrjanen K, Syrjanen S. Epidemiology of human papilloma virus infections and genital neoplasia. Scand J Infect Dis Suppl. 1990. 69:7-17. [QxMD MEDLINE Link].
Pham TH, Nguyen TH, Herrero R, et al. Human papillomavirus infection among women in South and North Vietnam. Int J Cancer. 2003 Mar 20. 104(2):213-20. [QxMD MEDLINE Link].
Kjaer SK, Svare EI, Worm AM, Walboomers JM, Meijer CJ, van den Brule AJ. Human papillomavirus infection in Danish female sex workers. Decreasing prevalence with age despite continuously high sexual activity. Sex Transm Dis. 2000 Sep. 27(8):438-45. [QxMD MEDLINE Link].
Hippelainen M, Syrjanen S, Hippelainen M, et al. Prevalence and risk factors of genital human papillomavirus (HPV) infections in healthy males: a study on Finnish conscripts. Sex Transm Dis. 1993 Nov-Dec. 20(6):321-8. [QxMD MEDLINE Link].
Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Apr 2. 360(14):1385-94. [QxMD MEDLINE Link].
Schiffman M, Wacholder S. From India to the world--a better way to prevent cervical cancer. N Engl J Med. 2009 Apr 2. 360(14):1453-5. [QxMD MEDLINE Link].
Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch FX, de Sanjose S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010 Dec 15. 202(12):1789-99. [QxMD MEDLINE Link].
World Health Organization. Human papillomavirus (HPV) and cervical cancer. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer. January 24, 2019; Accessed: February 5, 2019.
Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA. 2007 Feb 28. 297(8):813-9. [QxMD MEDLINE Link].
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998 Feb 12. 338(7):423-8. [QxMD MEDLINE Link].
Burk RD, Ho GY, Beardsley L, Lempa M, Peters M, Bierman R. Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis. 1996 Oct. 174(4):679-89. [QxMD MEDLINE Link].
Figueroa JP, Ward E, Luthi TE, Vermund SH, Brathwaite AR, Burk RD. Prevalence of human papillomavirus among STD clinic attenders in Jamaica: association of younger age and increased sexual activity. Sex Transm Dis. 1995 Mar-Apr. 22(2):114-8. [QxMD MEDLINE Link].
Dinh TH, Sternberg M, Dunne EF, Markowitz LE. Genital warts among 18- to 59-year-olds in the United States, national health and nutrition examination survey, 1999--2004. Sex Transm Dis. 2008 Apr. 35(4):357-60. [QxMD MEDLINE Link].
Meisels A. Cytologic diagnosis of human papillomavirus. Influence of age and pregnancy stage. Acta Cytol. 1992 Jul-Aug. 36(4):480-2. [QxMD MEDLINE Link].
Evander M, Edlund K, Gustafsson A, Jonsson M, Karlsson R, Rylander E, et al. Human papillomavirus infection is transient in young women: a population-based cohort study. J Infect Dis. 1995 Apr. 171(4):1026-30. [QxMD MEDLINE Link].
Dempsey AF, Koutsky LA. National burden of genital warts: a first step in defining the problem. Sex Transm Dis. 2008 Apr. 35(4):361-2. [QxMD MEDLINE Link].
Davis AJ, Emans SJ. Human papilloma virus infection in the pediatric and adolescent patient. J Pediatr. 1989 Jul. 115(1):1-9. [QxMD MEDLINE Link].
Shelton TB, Jerkins GR, Noe HN. Condylomata acuminata in the pediatric patient. J Urol. 1986 Mar. 135(3):548-9. [QxMD MEDLINE Link].
Cannistra SA, Niloff JM. Cancer of the uterine cervix. N Engl J Med. 1996 Apr 18. 334(16):1030-8. [QxMD MEDLINE Link].
Stoler MH. Human papillomaviruses and cervical neoplasia: a model for carcinogenesis. Int J Gynecol Pathol. 2000 Jan. 19(1):16-28. [QxMD MEDLINE Link].
Arima Y, Winer RL, Feng Q, Hughes JP, Lee SK, Stern ME, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. J Infect Dis. 2010 Oct 15. 202(8):1181-4. [QxMD MEDLINE Link].
Sturgiss EA, Jin F, Martin SJ, Grulich A, Bowden FJ. Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic. Sex Health. 2010 Mar. 7(1):55-9. [QxMD MEDLINE Link].
Barclay L. New guidance recommends HPV DNA test for primary screening. January 9, 2015. Medscape Medical News. WebMD Inc. Available at http://www.medscape.com/viewarticle/837832.
Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol. 2015 Feb. 125(2):330-7. [QxMD MEDLINE Link].
[Guideline] U.S. Preventive Services Task Force. Screening for Cervical Cancer. U.S. Preventive Services Task Force. Available at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed: August 29, 2012.
[Guideline] Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012 May-Jun. 62(3):147-72. [QxMD MEDLINE Link].
Kalliala I, Anttila A, Dyba T, Hakulinen T, Halttunen M, Nieminen P. Pregnancy incidence and outcome among patients with cervical intraepithelial neoplasia: a retrospective cohort study. BJOG. 2012 Jan. 119(2):227-35. [QxMD MEDLINE Link].
Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, et al. Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial. Lancet. 2011 Nov 26. 378(9806):1868-73. [QxMD MEDLINE Link].
Lee JK, Kim MK, Song SH, et al. Comparison of human papillomavirus detection and typing by hybrid capture 2, linear array, DNA chip, and cycle sequencing in cervical swab samples. Int J Gynecol Cancer. 2009 Feb. 19(2):266-72. [QxMD MEDLINE Link].
Nelson R. FDA OKs HPV DNA Test for Primary Cervical Cancer Screening. Medscape Medical News. Apr 24 2014. [Full Text].
Auborn KJ, Carter TH. Treatment of human papillomavirus gynecologic infections. Clin Lab Med. 2000 Jun. 20(2):407-22. [QxMD MEDLINE Link].
Beutner KR, Wiley DJ, Douglas JM, Tyring SK, Fife K, Trofatter K, et al. Genital warts and their treatment. Clin Infect Dis. 1999 Jan. 28 Suppl 1:S37-56. [QxMD MEDLINE Link].
Bergman A, Bhatia NN, Broen EM. Cryotherapy for treatment of genital condylomata during pregnancy. J Reprod Med. 1984 Jul. 29(7):432-5. [QxMD MEDLINE Link].
Garland SM, Ault KA, Gall SA, et al. Pregnancy and infant outcomes in the clinical trials of a human papillomavirus type 6/11/16/18 vaccine: a combined analysis of five randomized controlled trials. Obstet Gynecol. 2009 Dec. 114(6):1179-88. [QxMD MEDLINE Link].
Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect Dis. 2012 May 15. 205(10):1544-53. [QxMD MEDLINE Link].
Genital warts and sexual abuse in children. American Academy of Dermatology Task Force on Pediatric Dermatology. J Am Acad Dermatol. 1984 Sep. 11(3):529-30. [QxMD MEDLINE Link].
Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett. 2009 Jun. 14(5):1-3, 5. [QxMD MEDLINE Link].
Garland SM, Waddell R, Mindel A, Denham IM, McCloskey JC. An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women. Int J STD AIDS. 2006 Jul. 17(7):448-52. [QxMD MEDLINE Link].
Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs. 2007. 67(15):2187-210. [QxMD MEDLINE Link].
Welander CE, Homesley HD, Smiles KA, Peets EA. Intralesional interferon alfa-2b for the treatment of genital warts. Am J Obstet Gynecol. 1990 Feb. 162(2):348-54. [QxMD MEDLINE Link].
Eron LJ, Judson F, Tucker S, Prawer S, Mills J, Murphy K, et al. Interferon therapy for condylomata acuminata. N Engl J Med. 1986 Oct 23. 315(17):1059-64. [QxMD MEDLINE Link].
Monsonego J, Cessot G, Ince SE, Galazka AR, Abdul-Ahad AK. Randomised double-blind trial of recombinant interferon-beta for condyloma acuminatum. Genitourin Med. 1996 Apr. 72(2):111-4. [QxMD MEDLINE Link]. [Full Text].
Bornstein J, Pascal B, Zarfati D, Goldshmid N, Abramovici H. Recombinant human interferon-beta for condylomata acuminata: a randomized, double-blind, placebo-controlled study of intralesional therapy. Int J STD AIDS. 1997 Oct. 8(10):614-21. [QxMD MEDLINE Link].
Yang J, Pu YG, Zeng ZM, Yu ZJ, Huang N, Deng QW. Interferon for the treatment of genital warts: a systematic review. BMC Infect Dis. 2009 Sep 21. 9:156. [QxMD MEDLINE Link]. [Full Text].
Hellberg D, Svarrer T, Nilsson S, Valentin J. Self-treatment of female external genital warts with 0.5% podophyllotoxin cream (Condyline) vs weekly applications of 20% podophyllin solution. Int J STD AIDS. 1995 Jul-Aug. 6(4):257-61. [QxMD MEDLINE Link].
Krebs HB. Treatment of extensive vulvar condylomata acuminata with topical 5-fluorouracil. South Med J. 1990 Jul. 83(7):761-4. [QxMD MEDLINE Link].
Basita CS, Atallah AN, Saconato, da Silva EMK. 5-FU for genital warts in non-compromised individuals. Cochrane Database of Systematic Reviews. John Wiley and Sons, Ltd; 2010. 4.
Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis. 1993 Nov-Dec. 20(6):344-5. [QxMD MEDLINE Link].
Tatti S, Swinehart JM, Thielert C, Tawfik H, Mescheder A, Beutner KR. Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts: a randomized controlled trial. Obstet Gynecol. 2008 Jun. 111(6):1371-9. [QxMD MEDLINE Link].
Meltzer SM, Monk BJ, Tewari KS. Green tea catechins for treatment of external genital warts. Am J Obstet Gynecol. 2009 Mar. 200(3):233.e1-7. [QxMD MEDLINE Link].
Langley PC. A cost-effectiveness analysis of sinecatechins in the treatment of external genital warts. J Med Econ. 2010 Mar. 13(1):1-7. [QxMD MEDLINE Link].
Gilson RJ, Ross J, Maw R, Rowen D, Sonnex C, Lacey CJ. A multicentre, randomised, double-blind, placebo controlled study of cryotherapy versus cryotherapy and podophyllotoxin cream as treatment for external anogenital warts. Sex Transm Infect. 2009 Dec. 85(7):514-9. [QxMD MEDLINE Link].
Duus BR, Philipsen T, Christensen JD, Lundvall F, Sondergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985 Feb. 61(1):59-61. [QxMD MEDLINE Link]. [Full Text].
Lipow M. Laser physics made simple. Curr Prob in Obstet Gynecol Fertil. 1986. 9:445-493.
Aynaud O, Buffet M, Roman P, Plantier F, Dupin N. Study of persistence and recurrence rates in 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment. Eur J Dermatol. 2008 Mar-Apr. 18(2):153-8. [QxMD MEDLINE Link].
Immunogenicity and Tolerability of Broad Spectrum Human Papillomavirus (HPV) Vaccine in Adult and Young Adult Women (V503-004) - NCT03158220. ClinicalTrials.gov. 2018 March 13; Accessed: 2018 Oct 11.
U.S. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. FDA News Release. 2018 Oct 05. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm.
[Guideline] Advisory Committee on Immunization Practices (ACIP). Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. February 3, 2020; Accessed: February 19, 2020.
Haug CJ. Human papillomavirus vaccination--reasons for caution. N Engl J Med. 2008 Aug 21. 359(8):861-2. [QxMD MEDLINE Link].
Kim JJ, Goldie SJ. Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008 Aug 21. 359(8):821-32. [QxMD MEDLINE Link]. [Full Text].
Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007 May 10. 356(19):1915-27. [QxMD MEDLINE Link].
Catch-Up Immunization Schedule for Persons Aged 4 Months Through 18 Years Who Start Late or Who Are More Than 1 Month Behind. Centers for Disease Control and Prevention (CDC). Available at https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html. 2018 Feb 06; Accessed: 2018 Oct 11.
Walker TY, Elam-Evans LD, Yankey D, Markowitz LE, Williams CL, Mbaeyi SA, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2017. MMWR Morb Mortal Wkly Rep. 2018 Aug 24. 67 (33):909-917. [QxMD MEDLINE Link]. [Full Text].
Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. 2002 Nov 21. 347(21):1645-51. [QxMD MEDLINE Link].
Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005 May. 6(5):271-8. [QxMD MEDLINE Link].
Read TR, Hocking JS, Chen MY, Donovan B, Bradshaw CS, Fairley CK. The near disappearance of genital warts in young women 4 years after commencing a national human papillomavirus (HPV) vaccination programme. Sex Transm Infect. 2011 Dec. 87(7):544-7. [QxMD MEDLINE Link].
Brown DR, Kjaer SK, Sigurdsson K, et al. The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in generally HPV-naive women aged 16-26 years. J Infect Dis. 2009 Apr 1. 199(7):926-35. [QxMD MEDLINE Link].
Fairley CK, Hocking JS, Gurrin LC, Chen MY, Donovan B, Bradshaw CS. Rapid decline in presentations of genital warts after the implementation of a national quadrivalent human papillomavirus vaccination programme for young women. Sex Transm Infect. 2009 Dec. 85(7):499-502. [QxMD MEDLINE Link].
Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007 May 10. 356(19):1928-43. [QxMD MEDLINE Link].
Brooks M. Real-World' Study Confirms Value of HPV Vaccine in Women. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821591. Accessed: March 17, 2014.
Crowe E, Pandeya N, Brotherton JM, Dobson AJ, Kisely S, Lambert SB, et al. Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia. BMJ. 2014 Mar 4. 348:g1458. [QxMD MEDLINE Link]. [Full Text].
Hitt E. Quadrivalent HPV vaccine appears safe, but skeptics remain. Medscape Medical News. Available at http://www.medscape.com/viewarticle/772019. Accessed: October 16, 2012.
Klein NP, Hansen J, Chao C, Velicer C, Emery M, Slezak J, et al. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Arch Pediatr Adolesc Med. 2012 Oct 1. 1-9. [QxMD MEDLINE Link].
Neale T. No Clot Risk Seen With HPV Vaccine. Medscape Medical News. Available at http://www.medpagetoday.com/Cardiology/VenousThrombosis/46677. Accessed: July 14, 2014.
Scheller NM, Pasternak B, Svanstrom H, Hviid A. Quadrivalent human papillomavirus vaccine and the risk of venous thromboembolism. JAMA. 2014 Jul. 312(2):187-8. [QxMD MEDLINE Link].
Giuliano AR, Palefsky JM, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011 Feb 3. 364(5):401-11. [QxMD MEDLINE Link].
Palefsky JM, Giuliano AR, Goldstone S, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011 Oct 27. 365(17):1576-85. [QxMD MEDLINE Link].
Kim JJ. Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis. Lancet Infect Dis. 2010 Dec. 10(12):845-52. [QxMD MEDLINE Link].
Wawer MJ, Tobian AA, Kigozi G, et al. Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet. 2011 Jan 15. 377(9761):209-18. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Saslow D, Andrews KS, Manassaram-Baptiste D, Loomer L, Lam KE, Fisher-Borne M, et al. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. CA Cancer J Clin. 2016 Sep. 66 (5):375-85. [QxMD MEDLINE Link].
[Guideline] Swift D. Two HPV vaccine doses advised for children under age 15. Medscape Medical News. Available at http://www.medscape.com/viewarticle/870722. October 20, 2016;
Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. March 27, 2015. 64(11):300-304. [Full Text].
Lowes R. Just-Approved Gardasil 9 Packs More HPV/Cancer Protection. Medscape Medical News. Dec 10 2014. [Full Text].
FDA. FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV. US Food and Drug Administration. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm. Accessed: Dec 18 2014.
Gardasil 9 (human papillomavirus 9-valent vaccine, recombinant) [package insert]. Whitehouse Station, NJ: Merck & Co, Inc. December, 2015. Available at [Full Text].
Joura E, et al. Efficacy and immunogenicity of a novel 9-valent HPV L1 virus-like particle vaccine in 16- to 26-year-old women. Abstract (SS 8-4) presented at EUROGIN 2014 November 5, 2013.
VanDamme P, et al. Immunogenicity and safety of a novel 9-valent HPV L1 virus-like particle vaccine in boys and girls 9-15 years old; comparison to women 16-26 years old. Abstract (SS 8-5) presented at EUROGIN 2014 November 5, 2013.
Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007 Mar 23. 56:1-24. [QxMD MEDLINE Link].
[Guideline] Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. 2007 Jan-Feb. 57(1):7-28. [QxMD MEDLINE Link].
[Guideline] FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28. 59(20):626-9. [QxMD MEDLINE Link]. [Full Text].
Recommendations on the use of quadrivalent human papillomavirus vaccine in males--Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Dec 23. 60(50):1705-8. [QxMD MEDLINE Link].
FDA. FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28. 59(20):630-2. [QxMD MEDLINE Link].
Davidson EJ, Boswell CM, Sehr P, et al. Immunological and clinical responses in women with vulval intraepithelial neoplasia vaccinated with a vaccinia virus encoding human papillomavirus 16/18 oncoproteins. Cancer Res. 2003 Sep 15. 63(18):6032-41. [QxMD MEDLINE Link].
Baldwin PJ, van der Burg SH, Boswell CM, et al. Vaccinia-expressed human papillomavirus 16 and 18 e6 and e7 as a therapeutic vaccination for vulval and vaginal intraepithelial neoplasia. Clin Cancer Res. 2003 Nov 1. 9(14):5205-13. [QxMD MEDLINE Link].
Grens K. HPV Tied to Higher Esophageal Cancer Risk. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/808770. Accessed: August 19, 2013.
Liyanage SS, Rahman B, Ridda I, Newall AT, Tabrizi SN, Garland SM, et al. The aetiological role of human papillomavirus in oesophageal squamous cell carcinoma: a meta-analysis. PLoS One. 2013. 8(7):e69238. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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.
Verrucous warts in patient with HIV infection.
Plantar warts.
Flat wart.
"Cauliflower" condyloma of penis.
Small papilloma on shaft of penis.
Human papillomavirus (HPV). Verruca vulgaris on the lateral border of the tongue exhibits the multiple, sharp-tipped, white, verrucous appearance, which is classic for this lesion in the oral cavity. Not all verrucae are so clinically diagnostic. Courtesy of Rose Yin Geist, DDS.
This is a verruca vulgaris of the anterior maxillary gingiva in a healthy young male. He had recently resolved a wart on his finger.
These small papillomas on the lateral tongue of a young woman showed histologic evidence of HPV in the form of extensive koilocytosis.
Human papillomavirus (HPV) lesion on the lingual frenum. Some patients with condyloma acuminatum present with multiple oral lesions. Courtesy of A.K. ElGeneidy, DDS.
Human papillomavirus (HPV). Condylomata on the lower lip, as well as other sites at the initial presentation. This presentation is unusually extensive. Multiple condylomata may be synchronous or metachronous. This patient did not present with genital condylomata. Courtesy of A.K. ElGeneidy, DDS.
Human papillomavirus (HPV). Heck disease in the buccal mucosa of a 7-year-old boy. Courtesy of Sheldon Mintz, DDS.
Human papillomavirus (HPV). Verrucae and papillomas appear as frondlike epithelial proliferations. Verrucae tend to be more keratinized with sharper projections than papillomas.
Human papillomavirus (HPV). Condyloma acuminatum generally has a papillary architecture and may microscopically resemble verruca vulgaris and papilloma (hematoxylin and eosin stain, original magnification X10). Courtesy of AK ElGeneidy, DDS.
Human papillomavirus (HPV). Koilocytes in the upper epithelium are a helpful, although not completely reliable, indication that a lesion is associated with human papillomavirus. Koilocytes display a dark small nucleus with clear cytoplasm (hematoxylin and eosin stain, original magnification X100). Courtesy of Sheldon Mintz, DDS.
Human papillomavirus (HPV). Condyloma acuminatum may show brisk mitotic activity, although oral condyloma acuminatum is not considered a premalignant lesion (hematoxylin and eosin stain, original magnification X40). Courtesy of A.K. ElGeneidy, DDS.
The left panel is transudation of serum antibodies to the site of human papillomavirus infection, and the right panel is exudation of serum antibodies to the site of human papillomavirus infection.
The figure shows proposed mechanisms used by the human papillomavirus vaccine to neutralize antibodies and protect against infection.
Figure showing how human papillomavirus penetrates the basal layer and eventually is released at the surface.

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Table 1. Diseases Associated With Specific HPV Types

Nongenital Cutaneous Disease	HPV Type
Common warts (verrucae vulgaris)	1, 2, 4, 26, 27, 29, 41, 57, 65, 75-78
Plantar warts (myrmecias)	1, 2, 4, 60, 63
Flat warts (verrucae planae)	3, 10, 27, 28, 38, 41, 49
Butcher’s warts (common warts of people who handle meat, poultry, and fish)	1-4, 7, 10, 28
Mosaic warts	2, 27, 57
Ungual squamous cell carcinoma	16
Epidermodysplasia verruciformis (benign)	2, 3, 10, 12, 15, 19, 36, 46, 47, 50
Epidermodysplasia verruciformis (malignant or benign)	5, 8-10, 14, 17, 20-25, 37, 38
Nonwarty skin lesions	37, 38
Nongenital Mucosal Disease	HPV Type
Respiratory papillomatosis	6, 11
Squamous cell carcinoma of the lung	6, 11, 16, 18
Laryngeal papilloma (recurrent respiratory papillomatosis)^[15]	2, 6, 11, 16, 30, 40, 57
Laryngeal carcinoma	6, 11
Maxillary sinus papilloma	57
Squamous cell carcinoma of the sinuses	16, 18
Conjunctival papillomas	6, 11
Conjunctival carcinoma	16
Oral focal epithelial hyperplasia (Heck disease)	13, 32
Oral carcinoma	16, 18
Oral leukoplakia	16, 18
Squamous cell carcinoma of the esophagus	16, 18
Anogenital Disease	HPV Type
Condylomata acuminata	1-6, 10, 11, 16, 18, 30, 31, 33, 35, 39-45, 51-59, 70, 83
Bowenoid papulosis	16, 18, 34, 39, 40, 42, 45
Bowen disease	16, 18, 31, 34
Giant condylomata (Buschke-Löwenstein tumors)	6, 11, 57, 72, 73
Unspecified intraepithelial neoplasia	30, 34, 39, 40, 53, 57, 59, 61, 62, 64, 66-69
Low-grade squamous intraepithelial lesions (LGSIL)	6, 11, 16, 18, 26, 27, 30, 31, 33-35, 40, 42-45, 51-58, 61, 62, 67-69, 71-74, 79, 81-84
High-grade squamous intraepithelial lesions (HGSIL)	6, 11, 16, 18, 31, 33, 35, 39, 42, 44, 45, 51, 52, 56, 58, 59, 61, 64, 66, 68, 82
Carcinoma of vulva	6, 11, 16, 18
Carcinoma of vagina	16
Carcinoma of cervix^{[16, 17]}	16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 70, 73, 82
Carcinoma of anus	16, 31, 32, 33
Carcinoma in situ of penis (erythroplasia of Queyrat)	16
Carcinoma of penis	16, 18

Table 2. HPV Vaccine: Indications Approved in the United States for Females

Disease	HPV 9-valent
Cervical cancer, vulvar cancer, vaginal cancer, anal cancer	HPV types 16, 18, 31, 33, 45, 52, and 58
Genital warts (condyloma acuminata)	HPV types 6 and 11
Cervical intraepithelial neoplasia (CIN) grade 1-3 and cervical adenocarcinoma in situ (AIS)	HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
Vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VaIN) grades 2 and 3	HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
Anal intraepithelial neoplasia (AIN) grades 1-3	HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58

Table 3. HPV Vaccine: Indications Approved in the United States for Males

Disease	HPV 9-valent
Anal cancer	HPV types 16, 18, 31, 33, 45, 52, and 58
Genital warts (condyloma acuminata)	HPV types 6 and 11
Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3	HPV types 16, 18, 31, 33, 45, 52, and 58

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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: Received honoraria from Merck for 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, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, 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.

Robert V Higgins, MD Professor, Department of Obstetrics/Gynecology, Division of Gynecologic Oncology, Medical College of Georgia at Augusta University

Robert V Higgins, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey D Band, MD Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Ryan Brashear, MD Staff Physician, Department of Dermatology, Indiana University School of Medicine

Ryan Brashear, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Tsu-Yi Chuang, MD, MPH Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Staff Dermatologist, Desert Oasis Healthcare

Tsu-Yi Chuang, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

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.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose

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

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

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.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American GeriatricsSociety, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Societyof America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

John D Shanley, MD, MPH Professor Emeritus, University of Connecticut; Professor of Preventive Medicine, Stony Brook Medical Center

John D Shanley, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

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

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