Human papillomavirus natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Most infections with HPV are subclinical, asymptomatic and resolves without any complications in immunocompetent individuals. Time to develop symptoms and signs is not well defined but it may take 3 weeks to 3 months for genital warts, several months to years for cellular abnormalities (metaplasia and dysplasia) and years for development of cancers. 90% of infections resolve within 2 years due to host immune response.[1]Persistent HPV infection is associated with risk factors such as multiple sexual partners, alcohol consumption, immunosuppression, older age, and multiple types of HPV detected previously. Without treatment, persistent infection with low-risk types (low-grade intraepithelial lesions) may resolve spontaneously or persist and proliferate as warty lesions. However, high-risk HPV types (16,18,31,32) may lead to high-grade intraepithelial lesions which ultimately to carcinoma(cervical, anal, vaginal, vulvar, penile and oropharyngeal).[2][3][4][5]Prognosis of HPV infection depends primarily on type of HPV causing infection.[6][7][8][9][10]

Natural history

Most infections with HPV are subclinical, asymptomatic and resolves without any complications in immunocompetent individuals. Time to develop symptoms and signs is not well defined but it may take 3 weeks to 3 months for genital warts, several months to years for cellular abnormalities (metaplasia and dysplasia) and years for development of cancers. 90% of infections resolve within 2 years due to host immune response.[1]

Persistent HPV infection is associated with risk factors such as multiple sexual partners, alcohol consumption, immunosuppression, older age, and multiple types of HPV detected previously. Without treatment, persistent infection with low-risk types (low-grade intraepithelial lesions) may resolve spontaneously or persist and proliferate as warty lesions. However, high-risk HPV types (16,18,31,32) may lead to high-grade intraepithelial lesions which ultimately to carcinoma(cervical, anal, vaginal, vulvar, penile and oropharyngeal).[2][3][4][5]Complications associated with the human papillomavirus infection include:[11][12][13][14][15][16][17][18]genital warts, cervical cancer, vaginal cancer, vulvar cancer, anal cancer, penile cancer, head and neck cancer.

Complications

Complications associated with the human papilloma virus infection include:[11][12][13][14][15][16][17][18]

Prognosis

Prognosis of HPV infection depends primarily on type of HPV causing infection.[6][7][8][9][10][19][20][21][22]

Good prognostic factors

Bad prognostic factors

References

  1. ↑ 1.0 1.1 Ault KA (2006). "Epidemiology and natural history of human papillomavirus infections in the female genital tract". Infect Dis Obstet Gynecol. 2006 Suppl: 40470. doi:10.1155/IDOG/2006/40470. PMC 1581465. PMID 16967912.
  2. ↑ 2.0 2.1 Castle PE, Schiffman M, Herrero R, Hildesheim A, Rodriguez AC, Bratti MC; et al. (2005). "A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica". J Infect Dis. 191 (11): 1808–16. doi:10.1086/428779. PMID 15871112.
  3. ↑ 3.0 3.1 Woodman CB, Collins S, Winter H, Bailey A, Ellis J, Prior P; et al. (2001). "Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study". Lancet. 357 (9271): 1831–6. doi:10.1016/S0140-6736(00)04956-4. PMID 11410191.
  4. ↑ 4.0 4.1 Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD (1998). "Natural history of cervicovaginal papillomavirus infection in young women". N Engl J Med. 338 (7): 423–8. doi:10.1056/NEJM199802123380703. PMID 9459645.
  5. ↑ 5.0 5.1 http://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html Accessed on October 13, 2016
  6. ↑ 6.0 6.1 6.2 Yang SH, Kong SK, Lee SH, Lim SY, Park CY (2014). "Human papillomavirus 18 as a poor prognostic factor in stage I-IIA cervical cancer following primary surgical treatment". Obstet Gynecol Sci. 57 (6): 492–500. doi:10.5468/ogs.2014.57.6.492. PMC 4245343. PMID 25469338.
  7. ↑ 7.0 7.1 7.2 No JH, Sung MW, Hah JH, Choi SH, Lee MC, Kim HS; et al. (2015). "Prevalence and prognostic value of human papillomavirus genotypes in tonsillar squamous cell carcinoma: a Korean multicenter study". Cancer. 121 (4): 535–44. doi:10.1002/cncr.29086. PMID 25283642.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Lin BM, Wang H, D'Souza G, Zhang Z, Fakhry C, Joseph AW; et al. (2013). "Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma". Cancer. 119 (19): 3462–71. doi:10.1002/cncr.28250. PMC 3788050. PMID 23861037.
  9. ↑ 9.0 9.1 9.2 9.3 Beutner KR, Wiley DJ, Douglas JM, Tyring SK, Fife K, Trofatter K; et al. (1999). "Genital warts and their treatment". Clin Infect Dis. 28 Suppl 1: S37–56. doi:10.1086/514722. PMID 10028109.
  10. ↑ 10.0 10.1 10.2 10.3 Ferenczy A, Coutlée F, Franco E, Hankins C (2003). "Human papillomavirus and HIV coinfection and the risk of neoplasias of the lower genital tract: a review of recent developments". CMAJ. 169 (5): 431–4. PMC 183297. PMID 12952805.
  11. ↑ 11.0 11.1 http://www.cdc.gov/hpv/parents/vaccine.html Accessed on October 11, 2016
  12. ↑ 12.0 12.1 Tilston P (1997). "Anal human papillomavirus and anal cancer". J Clin Pathol. 50 (8): 625–34. PMC 500098. PMID 9301544.
  13. ↑ 13.0 13.1 Palefsky JM, Holly EA, Ralston ML, Jay N (1998). "Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men". J Infect Dis. 177 (2): 361–7. PMID 9466522.
  14. ↑ 14.0 14.1 Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL; et al. (1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst. 85 (1): 19–24. PMID 8380060.
  15. ↑ 15.0 15.1 Varma VA, Sanchez-Lanier M, Unger ER, Clark C, Tickman R, Hewan-Lowe K; et al. (1991). "Association of human papillomavirus with penile carcinoma: a study using polymerase chain reaction and in situ hybridization". Hum Pathol. 22 (9): 908–13. PMID 1655618.
  16. ↑ 16.0 16.1 Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L; et al. (2000). "Evidence for a causal association between human papillomavirus and a subset of head and neck cancers". J Natl Cancer Inst. 92 (9): 709–20. PMID 10793107.
  17. ↑ 17.0 17.1 Beachler DC, DʼSouza G (2013). "Oral human papillomavirus infection and head and neck cancers in HIV-infected individuals". Curr Opin Oncol. 25 (5): 503–10. doi:10.1097/CCO.0b013e32836242b4. PMC 3896303. PMID 23852381.
  18. ↑ 18.0 18.1 de Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B; et al. (2010). "Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study". Lancet Oncol. 11 (11): 1048–56. doi:10.1016/S1470-2045(10)70230-8. PMID 20952254.
  19. ↑ 19.0 19.1 Zampronha Rde A, Freitas-Junior R, Murta EF, Michelin MA, Barbaresco AA, Adad SJ; et al. (2013). "Human papillomavirus types 16 and 18 and the prognosis of patients with stage I cervical cancer". Clinics (Sao Paulo). 68 (6): 809–14. doi:10.6061/clinics/2013(06)14. PMC 3674251. PMID 23778490.
  20. ↑ 20.0 20.1 Tamim H, Finan RR, Sharida HE, Rashid M, Almawi WY (2002). "Cervicovaginal coinfections with human papillomavirus and Chlamydia trachomatis". Diagn Microbiol Infect Dis. 43 (4): 277–81. PMID 12151187.
  21. ↑ 21.0 21.1 21.2 Martins AE, Lucena-Silva N, Garcia RG, Welkovic S, Barbosa A, Menezes ML; et al. (2014). "Prognostic evaluation of DNA index in HIV-HPV co-infected women cervical samples attending in reference centers for HIV-AIDS in Recife". PLoS One. 9 (8): e104801. doi:10.1371/journal.pone.0104801. PMC 4140713. PMID 25144309.
  22. ↑ 22.0 22.1 Fitzgerald DW, Bezak K, Ocheretina O, Riviere C, Wright TC, Milne GL; et al. (2012). "The effect of HIV and HPV coinfection on cervical COX-2 expression and systemic prostaglandin E2 levels". Cancer Prev Res (Phila). 5 (1): 34–40. doi:10.1158/1940-6207.CAPR-11-0496. PMC 3252428. PMID 22135046.
  23. ↑ 23.0 23.1 Yanofsky VR, Patel RV, Goldenberg G (2012). "Genital warts: a comprehensive review". J Clin Aesthet Dermatol. 5 (6): 25–36. PMC 3390234. PMID 22768354.
  24. ↑ Fuller AF, Elliott N, Kosloff C, Hoskins WJ, Lewis JL (1989). "Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix". Gynecol Oncol. 33 (1): 34–9. PMID 2703164.
  25. ↑ Brennan JA, Boyle JO, Koch WM, Goodman SN, Hruban RH, Eby YJ; et al. (1995). "Association between cigarette smoking and mutation of the p53 gene in squamous-cell carcinoma of the head and neck". N Engl J Med. 332 (11): 712–7. doi:10.1056/NEJM199503163321104. PMID 7854378.
  26. ↑ Maxwell JH, Kumar B, Feng FY, Worden FP, Lee JS, Eisbruch A; et al. (2010). "Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence". Clin Cancer Res. 16 (4): 1226–35. doi:10.1158/1078-0432.CCR-09-2350. PMC 2822887. PMID 20145161.

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