Human papillomavirus (HPV) infection
Human papillomavirus is a nonenveloped DNA virus with low-risk types (6, 11) that cause warts and high-risk types (16, 18, and others) that drive cervical, anal, vulvar, penile, and oropharyngeal cancer, prevented by 9-valent vaccination and managed by type-specific screening rather than treatment of the virus itself.
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What this article covers
- Overview
A nonenveloped DNA virus with a dual clinical identity: human papillomavirus (HPV) causes both benign warts (low-risk types, chiefly 6 and 11) and premalignant/malignant epithelial disease (high-risk…
- Epidemiology
HPV is an extremely common sexually and skin-transmitted infection, acquired through skin-to-skin or mucosal contact; nononcogenic wart-causing types need no virologic testing since the clinical appearance is sufficient.
- Risk factors
Multiple or new sexual partners and early age of first intercourse: the principal drivers of cervical neoplasia risk and HPV acquisition.
- Pathophysiology
Direct inoculation of basal keratinocytes: HPV is a nonenveloped, double-stranded DNA virus that infects the basal layer of squamous epithelium, most often at the cervical squamocolumnar transformation zone for genital-tract disease.
- Clinical features
Most infection is asymptomatic and detected only by screening: cervical HPV-related dysplasia is typically silent and identified on a Pap smear rather than through symptoms.
- Differential diagnosis
Condylomata lata of secondary syphilis: Syphilis Treponema pallidum infection produces broad, moist, highly infectious plaques rather than discrete verrucous papules, confirmed by positive syphilis serology rather than inspection alone.
- Diagnosis
First, HPV infection is diagnosed and graded by manifestation, not by a single universal HPV test: cervical disease uses the Bethesda cytology system (ASCUS, low-grade squamous intraepithelial lesion…
- Management
First, recognize that no antiviral therapy eradicates HPV itself: management targets the manifestation (wart, dysplasia, or cancer), not the virus, and vaccination prevents new infection but does not treat established infection.
- Complications
Invasive cervical, anal, vulvar, vaginal, or penile squamous cell carcinoma: the defining oncologic complication of persistent high-risk HPV infection.
- Prognosis
Excellent for most infections, including most warts: the large majority of new HPV infections are cleared by host immunity, and low-risk-type disease is not life-threatening.
- Prevention
9-valent HPV vaccination is the central preventive intervention: give 0.5 mL intramuscularly per dose, beginning at age 11-12 years (as early as age 9); use a 2-dose series (0 and 6-12 months) if…
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