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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><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>
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>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Recommendations}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Recommendations}}
|-
|-
| 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
| style="padding: 5px 5px; background: #F5F5F5;" |  
*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>
*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)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Other lifestyle measures'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Other lifestyle measures'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Abstinence from sex
*Abstinence from sex
*Avoiding high risk sexual bahaviours(MSM)
*Avoiding high-risk sexual behaviors (MSM)
*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>
*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>
*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
|}
|}
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
==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 cancer|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 cancer]]s 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==
==References==


{{Reflist|2}}
{{Reflist|2}}
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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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