Human papillomavirus (HPV) infection
EBM Guidelines
Sep 14, 2022 • Latest change Jun 14, 2023
Table of contents
Extract
- Human papillomavirus (HPV) infection is very common. At least three out of four persons become infected during their lifetime. The infection is most common around the age of 20 to 25 years.
- HPV infection, in itself, is not a disease, but rather a risk factor.
- HPV infection resolves spontaneously in the majority of cases.
- Cervical cancer does not develop without a prior HPV infection. Cancer develops through premalignant stages.
- The stronger premalignant changes caused by HPV should be treated, mild changes may be followed up (tendency to spontaneous cure).
- Visible condylomata should be treated if they do not disappear spontaneously.
- HPV vaccine very efficiently prevents HPV infections The bivalent and quadrivalent HPV L1 virus-like particle vaccines induce a high degree of protection against HPV-16/18 or HPV 6/11/16/18 infection and associated cervical lesions as compared with placebo, and are safe. The antibody responses in young females are similar with two-dose compared to three-dose HPV vaccine schedules.A.
- Development of cancer can be prevented by finding and treating premalignant lesions through organized cervical cancer screening Pap (cervical) smear and endometrial biopsy1.
Linked evidence summaries
- The bivalent and quadrivalent HPV L1 virus-like particle vaccines induce a high degree of protection against HPV-16/18 or HPV 6/11/16/18 infection and associated cervical lesions as compared with placebo, and are safe. The antibody responses in young females are similar with two-dose compared to three-dose HPV vaccine schedules.A
- Human papillomavirus tests (HPV tests) are effective and more sensitive for finding cytological cervical lesions than conventional cytology but are less specific. However, a negative HPV test is more reassuring than a negative cytological test.A
- Podophyllotoxin is effective for clearance of genital warts compared with placebo.A
- Imiquimod is effective for clearance of genital warts compared with placebo, but appears to be less effective than electrotherpay or carbon dioxide laser.A
- Surgical excision is effective for anogenital warts.A
- Cryotherapy is effective for external genital warts compared with placebo .A
- Electrotherapy is effective for clearing genital warts compared with placebo.A
- Carbon dioxide laser is effective for anogenital warts.A
- In women positive for HPV DNA, HPV-16/18 vaccination appears not to reduce the risk of precancer lesions or accelerate clearance of the virus.B
- HPV vaccination given before the age of 17 appears to reduce risk of invasive cervical cancer.B
Search terms
A63.0, ASCUS, Anal Canal, Biopsy, Condylomata Acuminata, Gynaecology, HPV, Human papillomavirus infections, Infectious diseases, Laser Surgery, Neoplastic diseases, Papilloma, Perineum, Podophyllotoxin, Sexually Transmitted Diseases, Urethra, Uterine Cervical Dysplasia, Vagina, Vaginal Smears, Vulva, Warts, acetic-acid wash, coilocytic atypia, flat condyloma