Human papillomavirus prevention: Difference between revisions

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==Overview==
==Overview==


Most people become infected with various cutaneous HPV types during childhood. Papillomaviruses have a sturdy outer protein shell or "[[capsid]]" that renders them capable of lingering in the environment for long periods of time. Avoiding contact with contaminated surfaces, such as the floors of communal showers or airport security lines, might reduce the risk of cutaneous HPV infection. Treating common warts soon after they first appear may also reduce the spread of the infection to additional sites.
Most people become infected with various cutaneous [[HPV]] types during childhood. [[Papillomavirus|Papillomaviruses]] have a sturdy outer protein shell or "[[capsid]]" that renders them capable of lingering in the environment for long periods of time. Avoiding contact with contaminated surfaces, such as the floors of communal showers or airport security lines, might reduce the risk of cutaneous [[Human papillomavirus|HPV]] infection. Treating common [[warts]] soon after they first appear may also reduce the spread of the [[infection]] to additional sites.


Genital HPV infections may be distributed widely over genital skin and mucosal surfaces, and transmission can occur even when there are no overt symptoms. Several strategies should be employed to minimize the risk of developing diseases caused by genital HPVs:
Genital [[HPV]] infections may be distributed widely over genital skin and mucosal surfaces, and transmission can occur even when there are no overt symptoms. Several strategies should be employed to minimize the risk of developing diseases caused by genital [[HPV]]<nowiki/>s:


==Prevention==
==Prevention==
Primary preventive measures to prevent HPV infection include the following:<ref>{{cite journal |author=Harper DM, Franco EL, Wheeler CM, ''et al'' |title=Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial |journal=Lancet |volume=367 |issue=9518 |pages=1247-55 |year=2006 |pmid=16631880 |doi=10.1016/S0140-6736(06)68439-0}}</ref><ref name=CDC_HPV>{{cite web |url=http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm |title=STD Facts - HPV Vaccine |date = 2006-08-01 | accessdate=2007-08-17}}</ref><ref>{{cite web |url=http://women.webmd.com/news/20060608/cervical-cancer-vaccine-approved |title=Cervical Cancer Vaccine Approved |accessdate=2007-08-17 |work=WebMD}}</ref><ref>{{cite journal |author=Holmes KK, Levine R, Weaver M |title=Effectiveness of condoms in preventing sexually transmitted infections |journal=Bull. World Health Organ. |volume=82 |issue=6 |pages=454-61 |year=2004 |pmid=15356939}}</ref><ref name="Winer">{{cite journal |author=Winer RL, Hughes JP, Feng Q, ''et al'' |title=Condom use and the risk of genital human papillomavirus infection in young women |journal=N. Engl. J. Med. |volume=354 |issue=25 |pages=2645-54 |year=2006 |pmid=16790697 |doi=10.1056/NEJMoa053284}}</ref><ref>{{cite journal |author=Bleeker MC, Berkhof J, Hogewoning CJ, ''et al'' |title=HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions |journal=Br. J. Cancer |volume=92 |issue=8 |pages=1388-92 |year=2005 |pmid=15812547 |doi=10.1038/sj.bjc.6602524}}</ref>
Primary preventive measures to prevent [[Human papillomavirus|HPV]] infection include the following:<ref>{{cite journal |author=Harper DM, Franco EL, Wheeler CM, ''et al'' |title=Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial |journal=Lancet |volume=367 |issue=9518 |pages=1247-55 |year=2006 |pmid=16631880 |doi=10.1016/S0140-6736(06)68439-0}}</ref><ref name=CDC_HPV>{{cite web |url=http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm |title=STD Facts - HPV Vaccine |date = 2006-08-01 | accessdate=2007-08-17}}</ref><ref>{{cite web |url=http://women.webmd.com/news/20060608/cervical-cancer-vaccine-approved |title=Cervical Cancer Vaccine Approved |accessdate=2007-08-17 |work=WebMD}}</ref><ref>{{cite journal |author=Holmes KK, Levine R, Weaver M |title=Effectiveness of condoms in preventing sexually transmitted infections |journal=Bull. World Health Organ. |volume=82 |issue=6 |pages=454-61 |year=2004 |pmid=15356939}}</ref><ref name="Winer">{{cite journal |author=Winer RL, Hughes JP, Feng Q, ''et al'' |title=Condom use and the risk of genital human papillomavirus infection in young women |journal=N. Engl. J. Med. |volume=354 |issue=25 |pages=2645-54 |year=2006 |pmid=16790697 |doi=10.1056/NEJMoa053284}}</ref><ref>{{cite journal |author=Bleeker MC, Berkhof J, Hogewoning CJ, ''et al'' |title=HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions |journal=Br. J. Cancer |volume=92 |issue=8 |pages=1388-92 |year=2005 |pmid=15812547 |doi=10.1038/sj.bjc.6602524}}</ref><ref>{{cite journal |author=Moscicki AB |title=Impact of HPV infection in adolescent populations |journal=The Journal of adolescent health : official publication of the Society for Adolescent Medicine |volume=37 |issue=6 Suppl |pages=S3-9 |year=2005 |pmid=16310138}}</ref><ref>{{cite journal |author=Bleeker MC, Berkhof J, Hogewoning CJ, ''et al'' |title=HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions |journal=Br. J. Cancer |volume=92 |issue=8 |pages=1388-92 |year=2005 |pmid=15812547 |doi=10.1038/sj.bjc.6602524}}</ref><ref name="pmid21288094">{{cite journal| author=Giuliano AR, Palefsky JM, Goldstone S, Moreira ED, Penny ME, Aranda C et al.| title=Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 5 | pages= 401-11 | pmid=21288094 | doi=10.1056/NEJMoa0909537 | pmc=3495065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21288094  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21576528 Review in: Ann Intern Med. 2011 May 17;154(10):JC5-10]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21561929 Review in: Evid Based Med. 2011 Oct;16(5):157-8] </ref>


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! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Recommendations}}
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| style="padding: 5px 5px; background: #DCDCDC;" | '''HPV vaccine'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[HPV Vaccine|HPV vaccine]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Recommendations
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*Recommended in both males hand females
*Recommended in both males hand females<ref name="pmid21288094">{{cite journal| author=Giuliano AR, Palefsky JM, Goldstone S, Moreira ED, Penny ME, Aranda C et al.| title=Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. | journal=N Engl J Med | year= 2011 | volume= 364 | issue= 5 | pages= 401-11 | pmid=21288094 | doi=10.1056/NEJMoa0909537 | pmc=3495065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21288094  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21576528 Review in: Ann Intern Med. 2011 May 17;154(10):JC5-10]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21561929 Review in: Evid Based Med. 2011 Oct;16(5):157-8] </ref>
*Started at age 11 or 12  
*Started at age 11 or 12  
*Females can get vaccinated through age 26, males through 21
*Females can get vaccinated through age 26, males through 21
*Three doses of vaccine, at 1-2 months apart with third dose at 6 months
*Three doses of vaccine, at 1-2 months apart with third dose at 6 months
*Two types of vaccine available
*Gardasil (HPV9), 9-valent vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58)
*Gardasil (HPV4), 4-valent vaccine (6, 11, 16, 18)
*Cervarix (HPV2), bivalent (16, 18)
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Other lifestyle measures'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Other lifestyle measures'''
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*Abstinence from sex
*Abstinence from sex
*Avoiding high risk sexual bahaviours(MSM)
*Avoiding high-risk sexual behaviors (MSM)
*Regular use of condoms
*Regular use of condoms<ref name="pmid16790697">{{cite journal| author=Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK et al.| title=Condom use and the risk of genital human papillomavirus infection in young women. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 25 | pages= 2645-54 | pmid=16790697 | doi=10.1056/NEJMoa053284 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16790697  }} </ref>
*Male circumcision<ref name="pmid19321868">{{cite journal| author=Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O et al.| title=Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 13 | pages= 1298-309 | pmid=19321868 | doi=10.1056/NEJMoa0802556 | pmc=2676895 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19321868  }} </ref>
* Avoid sexual contact with a person having HPV infection
* Avoid sexual contact with a person having HPV infection
*Following regualr screening recommendations
*Following regular screening recommendations
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The CDC specifically recommends:<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
*Condoms used consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases (e.g., genital warts or cervical cancer). However, because HPV can infect areas not covered by a condom, condoms might not fully protect against HPV.
*Limiting the number of sex partners can reduce the risk for HPV. However, even persons with only one lifetime sex partner can get HPV.
*Abstaining from sexual activity is the most reliable method for preventing genital HPV infection


Patients with [[chronic hepatitis B]] should be aware of the following:<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name=MMWR-Hepatitis-B>Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016 </ref>
==Risk for travellers==
{| style="border: 0px; font-size: 100%; margin: 3px; align:center;" align=center width="900px"
Transmission of HPV occurs most commonly through sexual activity.
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|'''Education and Prevention of Hepatitis B'''}}
==Vaccine==
|-
*Two vaccines against HPV infection are available.
|style="padding: 5px 5px; background: #DCDCDC;" |
**Bivalent (2 genotypes); 2 doses protect against [[genital cancer]].
*Importance of lifestyle modifications, such as reduction of alcohol consumption
**Tetravalent (4 genotypes); 3 doses protect against [[Genital cancer|genital cancers]] and [[warts]].
*Risk of transmission to others:
**9-valent (9 genotypes); 2 doses (at 0- and 6–12-month intervals), protect against most of the types that cause [[genital cancer]]s and warts
:*Household memebers with negative test results for HBV serologic markers should be vaccinated.
*The vaccines are intended primarily for girls 9-14 years of age. Catch-up vaccination is indicated through age 26 years for those not vaccinated previously.
:*Regular sexual partners with negative test results for HBV serologic markers should be vaccinated.
*Consider 3 doses in immunocompromised patients.
:*Casual sexual partners or unvaccinated regular sexual partners should prefer barrier protection methods.
:*Pregnant HBsAg-positive women should inform their healthcare providers, so that Hepatitis B Immune Globulin and hepatitis B vaccine may be administered to the infant after delivery.
:*Healthcare workers infected with hepatitis B should consult an expert review panel.
:*In case of organ transplant, in which anti-HBc-positive organ donors are used for HBV seronegative recipients, HBV infection should be prevented with the administration of antiviral therapy. 6-12 months of prophylactic therapy may be sufficient for organ transplants, other than hepatic. For hepatic transplants, it is recommended life-long antiviral therapy.
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=== Vaccine ===
{{main|HPV vaccine}}
On June 8, 2006, the FDA approved [[Gardasil]], a prophylactic [[HPV vaccine]] which is marketed by [[Merck & Co.|Merck]]. The vaccine trial,<ref>{{cite journal |author=Harper DM, Franco EL, Wheeler CM, ''et al'' |title=Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial |journal=Lancet |volume=367 |issue=9518 |pages=1247-55 |year=2006 |pmid=16631880 |doi=10.1016/S0140-6736(06)68439-0}}</ref> conducted in adult women with a mean age of 23, showed protection against initial infection with HPV types 16 and 18, which together cause 70 percent of cervical cancers. HPV types 16 and 18 also cause [[anal cancer]] in men and women.  


The trial also showed 100% efficacy against persistent infections, not just incident infections. The vaccine also protects against HPV types 6 and 11, which cause 90 percent of genital warts. Women aged nine through twenty-six can be vaccinated, though the trial did not test minors. [[GlaxoSmithKline]] is expected to seek approval for a prophylactic vaccine targeting HPV types 16 and 18 early in 2007, known as [[Cervarix]]. Since the current vaccine will not protect women against all the HPV types that cause cervical cancer, it will be important for women to continue to seek Pap smear testing, even after receiving the vaccine. In addition, the [[Centers for Disease Control and Prevention]] (CDC) recommends vaccinating women who have already been diagnosed with HPV.
==References==


The vaccine has no side effects with the exception of soreness around the injection area. The FDA and CDC consider the vaccine to be completely safe. It does not contain mercury, thimerosal or live virus (only dead virus).<ref name=CDC_HPV>{{cite web |url=http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm |title=STD Facts - HPV Vaccine |date = 2006-08-01 | accessdate=2007-08-17}}</ref> Merck, the manufacturer of Gardasil, will continue to test women who have received the vaccine to determine the vaccine's efficacy over the period of a lifetime.
{{Reflist|2}}


Both men and women are carriers of HPV. To eradicate the disease, men will eventually need to be vaccinated. Studies are being conducted now to determine the efficacy of vaccinating boys with the current vaccine.<ref>{{cite web |url=http://women.webmd.com/news/20060608/cervical-cancer-vaccine-approved |title=Cervical Cancer Vaccine Approved |accessdate=2007-08-17 |work=WebMD}}</ref>
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The vaccine (commonly known as Gardasil) is delivered in a series of three shots over six months at a cost of approximately $360 (US dollars). The CDC recommends that girls and women between the ages of 11 and 26 be vaccinated,<ref name=CDC_HPV /> though girls as young as 9 may benefit.<ref>{{cite web |url=http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-hcp.htm |title=HPV and HPV Vaccine - HCP |date = 2006-08-01 | accessdate=2007-08-17}}</ref>
 
=== Condoms ===
 
Although condoms are highly effective for preventing the transmission of other [[sexually transmitted disease]]s (STDs), recent studies have concluded that condoms only offer partial protection, at best, against the transmission of genital HPVs.<ref>{{cite journal |author=Holmes KK, Levine R, Weaver M |title=Effectiveness of condoms in preventing sexually transmitted infections |journal=Bull. World Health Organ. |volume=82 |issue=6 |pages=454-61 |year=2004 |pmid=15356939}}</ref><ref name="Winer">{{cite journal |author=Winer RL, Hughes JP, Feng Q, ''et al'' |title=Condom use and the risk of genital human papillomavirus infection in young women |journal=N. Engl. J. Med. |volume=354 |issue=25 |pages=2645-54 |year=2006 |pmid=16790697 |doi=10.1056/NEJMoa053284}}</ref>
 
This may be due to the fact that HPVs can infect genital skin areas that are not covered by condoms. On the other hand, some studies have suggested that regular condom use can effectively limit the ongoing persistence and spread of HPV to additional genital sites in individuals who are already infected.<ref>{{cite journal |author=Moscicki AB |title=Impact of HPV infection in adolescent populations |journal=The Journal of adolescent health : official publication of the Society for Adolescent Medicine |volume=37 |issue=6 Suppl |pages=S3-9 |year=2005 |pmid=16310138}}</ref><ref>{{cite journal |author=Bleeker MC, Berkhof J, Hogewoning CJ, ''et al'' |title=HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions |journal=Br. J. Cancer |volume=92 |issue=8 |pages=1388-92 |year=2005 |pmid=15812547 |doi=10.1038/sj.bjc.6602524}}</ref>
 
Thus, condom use may reduce the risk that infected individuals will progress to cervical cancer or develop additional genital warts. A 2006 study of 82 college students suggests that condoms can be up to 70% effective for preventing genital HPV infection if used for every sexual encounter.<ref name="Winer" /> [[Planned Parenthood]] recommends condom use to reduce the risk of contracting HPV,<ref>{{cite web |url=http://www.plannedparenthood.org/sexual-health/std/hpv.htm |title=Planned Parenthood - HPV |accessdate=2007-08-17}}</ref> but the [[Centers for Disease Control and Prevention]] maintain that "While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease."<ref>{{cite web |url=http://www.cdc.gov/std/HPV/STDFact-HPV.htm |title=STD Facts - Human papillomavirus (HPV) |accessdate=2007-08-17 |format= |work=}}</ref>
 
=== Microbicides ===
 
Ongoing research has suggested that several inexpensive chemicals might serve to block HPV transmission if applied to the genitals prior to sexual contact.<ref>{{cite journal |author=Howett MK, Kuhl JP |title=Microbicides for prevention of transmission of sexually transmitted diseases |journal=Curr. Pharm. Des. |volume=11 |issue=29 |pages=3731-46 |year=2005 |pmid=16305508}}</ref> These candidate agents, known as [[microbicide|topical microbicides]], are currently undergoing clinical efficacy testing. A recent study indicates that some [[Personal lubricant|sexual lubricant]] brands that use a gelling agent called [[carrageenan]] can inhibit papillomavirus infection ''[[in vitro]]''.<ref>{{cite journal |author=Buck CB, Thompson CD, Roberts JN, Müller M, Lowy DR, Schiller JT |title=Carrageenan is a potent inhibitor of papillomavirus infection |journal=PLoS Pathog. |volume=2 |issue=7 |pages=e69 |year=2006 |pmid=16839203}}</ref> See [[Carrageenan#Sexual lubricant and microbicide]] for details.
 
Clinical trials are needed to determine whether carrageenan-based sexual lubricant gels are effective for blocking the sexual transmission of HPVs ''[[in vivo]]''.
 
=== Nutrition ===
 
==== Vitamin A ====
In a clinic-based case-control study to assess serum micronutrients as risk factors for cervical dysplasia, subjects in the lowest serum [[retinol]] quartile were at increased risk of [[Cervical intraepithelial neoplasia|CIN]] I compared with women in the highest quartile.<ref>{{cite journal |author=Yeo AS, Schiff MA, Montoya G, Masuk M, van Asselt-King L, Becker TM |title=Serum micronutrients and cervical dysplasia in Southwestern American Indian women |journal=Nutrition and cancer |volume=38 |issue=2 |pages=141-50 |year=2000 |pmid=11525590 |doi=}}</ref>
 
==== Vitamin C ====
Risk of type-specific, persistent HPV infection was lower among women reporting intake values of [[vitamin C]] in the upper quartile compared with those reporting intake in the lowest quartile.<ref>{{cite journal |author=Giuliano AR, Siegel EM, Roe DJ, ''et al'' |title=Dietary intake and risk of persistent human papillomavirus (HPV) infection: the Ludwig-McGill HPV Natural History Study |journal=J. Infect. Dis. |volume=188 |issue=10 |pages=1508-16 |year=2003 |pmid=14624376 |doi=}}</ref>
 
==== Vitamin E ====
HPV clearance time was significantly shorter among women with the highest compared with the lowest serum levels of [[tocopherol]]s, but significant trends in these associations were limited to infections lasting </=120 days. Clearance of persistent HPV infection (lasting >120 days) was not significantly associated with circulating levels of tocopherols. Results from this investigation support an association of micronutrients with the rapid clearance of incident oncogenic HPV infection of the uterine cervix.<ref name=Goodman_2007>{{cite journal |author=Goodman MT, Shvetsov YB, McDuffie K, ''et al'' |title=Hawaii cohort study of serum micronutrient concentrations and clearance of incident oncogenic human papillomavirus infection of the cervix |journal=Cancer Res. |volume=67 |issue=12 |pages=5987-96 |year=2007 |pmid=17553901 |doi=10.1158/0008-5472.CAN-07-0313 |url=http://cancerres.aacrjournals.org/cgi/content/full/67/12/5987}}</ref>
 
A statistically significantly lower level of [[alpha-tocopherol]] was observed in the blood serum of HPV-positive patients with cervical intraepithelial neoplasia. The risk of dysplasia was four times higher for an alpha-tocopherol level < 7.95 mumol/l.<ref>{{cite journal |author=Kwaśniewska A, Tukendorf A, Semczuk M |title=Content of alpha-tocopherol in blood serum of human Papillomavirus-infected women with cervical dysplasias |journal=Nutrition and cancer |volume=28 |issue=3 |pages=248-51 |year=1997 |pmid=9343832 |doi=}}</ref>
 
==== Folic acid ====
Higher folate status was inversely associated with becoming HPV test-positive. Women with higher folate status were significantly less likely to be repeatedly HPV test-positive and more likely to become test-negative. Studies have shown that lower levels of antioxidants coexisting with low levels of folic acid increases the risk of CIN development. Improving folate status in subjects at risk of getting infected or already infected with high-risk HPV may have a beneficial impact in the prevention of cervical cancer.<ref>{{cite journal |author=Piyathilake CJ, Henao OL, Macaluso M, ''et al'' |title=Folate is associated with the natural history of high-risk human papillomaviruses |journal=Cancer Res. |volume=64 |issue=23 |pages=8788-93 |year=2004 |pmid=15574793 |doi=10.1158/0008-5472.CAN-04-2402 |url=http://cancerres.aacrjournals.org/cgi/content/full/64/23/8788}}</ref><ref>{{cite journal |author=Kwaśniewska A, Tukendorf A, Goździcka-Józefiak A, Semczuk-Sikora A, Korobowicz E |title=Content of folic acid and free homocysteine in blood serum of human papillomavirus-infected women with cervical dysplasia |journal=Eur. J. Gynaecol. Oncol. |volume=23 |issue=4 |pages=311-6 |year=2002 |pmid=12214730 |doi=}}</ref>
 
==== Carotenoids ====
Higher circulating levels of [[carotenoids]] were associated with a significant decrease in the clearance time of type-specific HPV infection, particularly during the early stages of infection (</=120 days). Clearance of persistent HPV infection (lasting >120 days) was not significantly associated with circulating levels of carotenoids.<ref name=Goodman_2007 />
 
The likelihood of clearing an oncogenic HPV infection is significantly higher with increasing levels of [[lycopene]]s.<ref>{{cite journal |author=Sedjo RL, Papenfuss MR, Craft NE, Giuliano AR |title=Effect of plasma micronutrients on clearance of oncogenic human papillomavirus (HPV) infection (United States) |journal=Cancer Causes Control |volume=14 |issue=4 |pages=319-26 |year=2003 |pmid=12846362 |doi=}}</ref> A 56% reduction in HPV persistence risk was observed in women with the highest plasma [lycopene] concentrations compared with women with the lowest plasma lycopene concentrations. These data suggests that vegetable consumption and circulating lycopene may be protective against HPV persistence.<ref name=Sedjo_2002>{{cite journal |author=Sedjo RL, Roe DJ, Abrahamsen M, ''et al'' |title=Vitamin A, carotenoids, and risk of persistent oncogenic human papillomavirus infection |journal=Cancer Epidemiol. Biomarkers Prev. |volume=11 |issue=9 |pages=876-84 |year=2002 |pmid=12223432 |doi=}}</ref><ref name=Giuliano_2003>{{cite journal |author=Giuliano AR, Siegel EM, Roe DJ, ''et al'' |title=Dietary intake and risk of persistent human papillomavirus (HPV) infection: the Ludwig-McGill HPV Natural History Study |journal=J. Infect. Dis. |volume=188 |issue=10 |pages=1508-16 |year=2003 |pmid=14624376 |doi=}}</ref><ref>{{cite journal |author=Giuliano AR, Papenfuss M, Nour M, Canfield LM, Schneider A, Hatch K |title=Antioxidant nutrients: associations with persistent human papillomavirus infection |journal=Cancer Epidemiol. Biomarkers Prev. |volume=6 |issue=11 |pages=917-23 |year=1997 |pmid=9367065 |doi=}}</ref>
 
====CoQ10====
Women who had either CIN or cervical cancer had markedly lower levels of [[CoQ10]] in their blood and in their cervical cells than the women who were healthy.
 
==== Fruits and Vegetables ====
Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence.<ref name=Sedjo_2002 /> Consumption of papaya at least once a week was inversely associated with persistent HPV infection.<ref name=Giuliano_2003 />
 
====Fish Oil====
In a 1999 study, [[Docosahexaenoic acid]] inhibited growth of HPV16 immortalized cells.<ref>{{cite journal |author=Chen D, Auborn K |title=Fish oil constituent docosahexa-enoic acid selectively inhibits growth of human papillomavirus immortalized keratinocytes |journal=Carcinogenesis |volume=20 |issue=2 |pages=249-54 |year=1999 |pmid=10069461 |doi=}}</ref>
 
==References==


{{Reflist|2}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Sexually transmitted infections]]
[[Category:Dermatology]]
[[Category:Viruses]]
[[Category:Viral diseases]]
[[Category:Disease]]
[[Category:Gynecology]]
[[Category:Gynecology]]
{{WH}}
[[Category:Urology]]
{{WS}}

Latest revision as of 00:20, 21 September 2021

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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 people become infected with various cutaneous HPV types during childhood. Papillomaviruses have a sturdy outer protein shell or "capsid" that renders them capable of lingering in the environment for long periods of time. Avoiding contact with contaminated surfaces, such as the floors of communal showers or airport security lines, might reduce the risk of cutaneous HPV infection. Treating common warts soon after they first appear may also reduce the spread of the infection to additional sites.

Genital HPV infections may be distributed widely over genital skin and mucosal surfaces, and transmission can occur even when there are no overt symptoms. Several strategies should be employed to minimize the risk of developing diseases caused by genital HPVs:

Prevention

Primary preventive measures to prevent HPV infection include the following:[1][2][3][4][5][6][7][8][9]

Primary Prevention Recommendations
HPV vaccine
  • Recommended in both males hand females[9]
  • Started at age 11 or 12
  • Females can get vaccinated through age 26, males through 21
  • Three doses of vaccine, at 1-2 months apart with third dose at 6 months
  • Two types of vaccine available
  • Gardasil (HPV9), 9-valent vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58)
  • Gardasil (HPV4), 4-valent vaccine (6, 11, 16, 18)
  • Cervarix (HPV2), bivalent (16, 18)
Other lifestyle measures
  • Abstinence from sex
  • Avoiding high-risk sexual behaviors (MSM)
  • Regular use of condoms[10]
  • Male circumcision[11]
  • Avoid sexual contact with a person having HPV infection
  • Following regular screening recommendations

The CDC specifically recommends:[12]

  • Condoms used consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases (e.g., genital warts or cervical cancer). However, because HPV can infect areas not covered by a condom, condoms might not fully protect against HPV.
  • Limiting the number of sex partners can reduce the risk for HPV. However, even persons with only one lifetime sex partner can get HPV.
  • Abstaining from sexual activity is the most reliable method for preventing genital HPV infection

Risk for travellers

Transmission of HPV occurs most commonly through sexual activity.

Vaccine

  • Two vaccines against HPV infection are available.
    • Bivalent (2 genotypes); 2 doses protect against genital cancer.
    • Tetravalent (4 genotypes); 3 doses protect against genital cancers and warts.
    • 9-valent (9 genotypes); 2 doses (at 0- and 6–12-month intervals), protect against most of the types that cause genital cancers and warts
  • The vaccines are intended primarily for girls 9-14 years of age. Catch-up vaccination is indicated through age 26 years for those not vaccinated previously.
  • Consider 3 doses in immunocompromised patients.

References

  1. ↑ Harper DM, Franco EL, Wheeler CM; et al. (2006). "Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial". Lancet. 367 (9518): 1247–55. doi:10.1016/S0140-6736(06)68439-0. PMID 16631880.
  2. ↑ "STD Facts - HPV Vaccine". 2006-08-01. Retrieved 2007-08-17.
  3. ↑ "Cervical Cancer Vaccine Approved". WebMD. Retrieved 2007-08-17.
  4. ↑ Holmes KK, Levine R, Weaver M (2004). "Effectiveness of condoms in preventing sexually transmitted infections". Bull. World Health Organ. 82 (6): 454–61. PMID 15356939.
  5. ↑ Winer RL, Hughes JP, Feng Q; et al. (2006). "Condom use and the risk of genital human papillomavirus infection in young women". N. Engl. J. Med. 354 (25): 2645–54. doi:10.1056/NEJMoa053284. PMID 16790697.
  6. ↑ Bleeker MC, Berkhof J, Hogewoning CJ; et al. (2005). "HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions". Br. J. Cancer. 92 (8): 1388–92. doi:10.1038/sj.bjc.6602524. PMID 15812547.
  7. ↑ Moscicki AB (2005). "Impact of HPV infection in adolescent populations". The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 37 (6 Suppl): S3–9. PMID 16310138.
  8. ↑ Bleeker MC, Berkhof J, Hogewoning CJ; et al. (2005). "HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions". Br. J. Cancer. 92 (8): 1388–92. doi:10.1038/sj.bjc.6602524. PMID 15812547.
  9. ↑ 9.0 9.1 Giuliano AR, Palefsky JM, Goldstone S, Moreira ED, Penny ME, Aranda C; et al. (2011). "Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males". N Engl J Med. 364 (5): 401–11. doi:10.1056/NEJMoa0909537. PMC 3495065. PMID 21288094. Review in: Ann Intern Med. 2011 May 17;154(10):JC5-10 Review in: Evid Based Med. 2011 Oct;16(5):157-8
  10. ↑ Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK; et al. (2006). "Condom use and the risk of genital human papillomavirus infection in young women". N Engl J Med. 354 (25): 2645–54. doi:10.1056/NEJMoa053284. PMID 16790697.
  11. ↑ Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O; et al. (2009). "Male circumcision for the prevention of HSV-2 and HPV infections and syphilis". N Engl J Med. 360 (13): 1298–309. doi:10.1056/NEJMoa0802556. PMC 2676895. PMID 19321868.
  12. ↑ Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).

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