CONCISE REVIEW FOR CLINICIANS
Human Papillomavirus and Vaccination

https://doi.org/10.4065/83.6.701Get rights and content

Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. Modeling estimates suggest that more than 80% of sexually active women will have acquired genital HPV by age 50 years. Although most infections are transient and asymptomatic, persistent infection with high-risk types of HPV can lead to precancerous lesions and progress to cancer. In June 2006, the US Food and Drug Administration licensed the first vaccine to prevent cervical cancers and other diseases in women. This quadrivalent vaccine protects against HPV-6, HPV-11, HPV-16, and HPV-18, which are responsible for 70% of cervical cancers and 90% of genital warts. Several studies have been published examining the vaccine's efficacy, duration, immunogenicity, and safety. Questions and controversy remain regarding mandatory vaccination, need for booster doses, and cost-effectiveness.

Section snippets

PATHOPHYSIOLOGY

Human papillomaviruses are small, nonenveloped, double-stranded DNA viruses; their 8-kB circular genome encodes the encapsulating structural proteins L1 and L2, as well as several early genes that enable viral transcription and replication and interact with the host genome. Approximately 100 types of HPV have been identified; those that infect the genital area have a predilection for mucous membranes. The low-risk types can cause benign or low-grade cervical cell changes, genital warts, and

CLINICAL SEQUELAE

Since the 1950s, the number of deaths due to cervical cancer in the United States has decreased by more than 70% and continues to decline by nearly 4% a year,3 with widespread use of Pap testing. This decrease has been observed primarily in squamous cell cancers rather than adenocarcinomas, which are more difficult to detect with Pap tests. The clinical sequelae of HPV infection are not limited to cervical cancer and its precursor lesions; they have also been associated with several other types

RISK FACTORS

Genital HPV infection is transmitted primarily by genital contact. Sexual activity remains the most consistent predictor of infection. In a study of women aged 18 to 25 years, HPV infection was found in 14.3% of women with 1 lifetime sex partner, in 22.3% of women with 2 lifetime sex partners, and in 31.5% of women with more than 3 lifetime sex partners.6, 9 In the 2002 National Survey of Family Growth, 24% of female respondents in the United States were sexually active by age 15 years, 40% by

HPV VACCINE

On June 8, 2006, the US Food and Drug Administration licensed the quadrivalent HPV vaccine by Merck and Co., Inc. Recombinant DNA technology is used to express the L1 major capsid protein of HPV in yeasts (Saccharomyces cerevisiae), which self-assemble to form empty shells resembling a virus, called viruslike particles (VLPs). The VLPs have the same outer L1 protein coat as HPV but contain no genetic material. The vaccine uses these VLPs as antigens to induce a strong protective immune

CONCLUSION

Human papillomavirus infection is the most common sexually transmitted infection in the United States. Persistent infection with high-risk types can lead to precancerous and cancerous lesions. The new quadrivalent HPV vaccine appears to confer a high degree of protection against HPV-6, HPV-11, HPV-16, and HPV-18, which are responsible for 70% of cervical cancers and 90% of genital warts. If the vaccine's duration of protection proves to be sufficient or can be maintained through booster

CME Questions About HPV Vaccine

  • 1.

    Which one of the following best describes the percentage of genital warts and cervical cancers covered by the quadrivalent vaccine's protection against HPV-6, HPV-11, HPV-16, and HPV-18?

    • a.

      70% of genital warts and 90% of cervical cancers

    • b.

      90% of genital warts and 70% of cervical cancers

    • c.

      30% of genital warts and 50% of cervical cancers

    • d.

      50% of genital warts and 30% of cervical cancers

    • e.

      100% of both genital warts and cervical cancers

  • 2.

    Which one of the following is the most common mode of HPV

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  • LE Manhart et al.

    Human papillomavirus infection among sexually active young women in the United States: implications for developing a vaccination strategy

    Sex Transm Dis

    (2006)
  • Cited by (27)

    • Barriers to Human Papillomavirus Vaccine Acceptability in Israel

      2013, Vaccine
      Citation Excerpt :

      The two vaccines are accessible in the private market and are partially covered by supplementary health insurance policies. To promote vaccine uptake, the Advisory Committee on Immunization Practices (ACIP) in the United States recommended universal vaccination of all 11–12 year-old girls as part of routine preventive care visits, and comprehensive “catch-up” vaccination of adolescent and young adult women between the ages of 13 and 26 years [5]. Despite ACIP recommendation, vaccination coverage rates in the United States remain low: in 2010, 47.7% of 13–17 year-old girls had received one or more doses of HPV vaccine.

    • Human Papillomavirus Vaccination. Current Indications and Future Directions.

      2013, Obstetrics and Gynecology Clinics of North America
      Citation Excerpt :

      Women aged 19 to 26 years of age, perhaps, have the highest rates of HPV infection and HPV-related diseases.73,74 Seventy-four percent of the new HPV infections annually occur among women aged 15 to 24 years.75 However, reports by the CDC 2 to 5 months after HPV vaccination approval showed that only 10% of women aged 18 to 26 years had initiated the vaccine series.76

    • Knowledge about cervical cancer among Polish and Finnish female students

      2011, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      In the meantime, the rising incidence of cervical cancer among women aged 15–34, in both Poland and Finland, is a problem of growing importance [10,13]. The trend can be put down to changing sexual behaviour: among other factors the average number of women's sexual partners has grown [2,10], while the age of sexual initiation has decreased [10,14]. Changing sexual behaviours increase the risk of acquiring human papillomavirus (HPV) infection [3].

    • Quadrivalent Human Papillomavirus recombinant vaccine associated lipoatrophy

      2009, Vaccine
      Citation Excerpt :

      However, both patients remain concerned about the appearance and cosmetic implication of their lesions. Human Papillomavirus is the most common sexually transmitted infection in the United States, with approximately 6 million new cases annually [5–7]. It is responsible for almost 100% of cervical cancer [8], which is the second most common cancer among women worldwide [9–11].

    View all citing articles on Scopus

    On completion of this article, you should be able to (1) review pathophysiology and transmission of human papillomavirus, (2) cite efficacy and safety profile of the new human papillomavirus vaccine, and (3) summarize current guidelines for use of the vaccine.

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