Human papillomavirus epidemiology and demographics: Difference between revisions
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Genital HPV infection is very common, with estimates suggesting that more than 50% of women will become infected with one or more of the sexually transmitted HPV types at some point during adulthood.<ref name="Baseman">{{cite journal |author=Baseman JG, Koutsky LA |title=The epidemiology of human papillomavirus infections |journal=J. Clin. Virol. |volume=32 Suppl 1 |issue= |pages=S16-24 |year=2005 |pmid=15753008 |doi=10.1016/j.jcv.2004.12.008}} *Note: The authors state on page S17 "Overall, these DNA-based studies, combined with measurements of type-specific antibodies against HPV capsid antigens, have shown that most (>50%) sexually active women have been infected by one or more genital HPV types at some point in time."</ref> | Genital HPV infection is very common, with estimates suggesting that more than 50% of women will become infected with one or more of the sexually transmitted HPV types at some point during adulthood.<ref name="Baseman">{{cite journal |author=Baseman JG, Koutsky LA |title=The epidemiology of human papillomavirus infections |journal=J. Clin. Virol. |volume=32 Suppl 1 |issue= |pages=S16-24 |year=2005 |pmid=15753008 |doi=10.1016/j.jcv.2004.12.008}} *Note: The authors state on page S17 "Overall, these DNA-based studies, combined with measurements of type-specific antibodies against HPV capsid antigens, have shown that most (>50%) sexually active women have been infected by one or more genital HPV types at some point in time."</ref> | ||
== Epidemiology == | == Epidemiology and Demographics == | ||
==== Cutaneous HPVs ==== | ==== Cutaneous HPVs ==== | ||
Infection with cutaneous HPVs is ubiquitous.<ref>{{cite journal |author=Antonsson A, Forslund O, Ekberg H, Sterner G, Hansson BG |title=The ubiquity and impressive genomic diversity of human skin papillomaviruses suggest a commensalic nature of these viruses |journal=J. Virol. |volume=74 |issue=24 |pages=11636-41 |year=2000 |pmid=11090162 |doi=}}</ref> Some HPV types, such as HPV-5, may establish infections that persist for the lifetime of the individual without ever manifesting any clinical symptoms. Like remora suckerfish that hitchhike harmlessly on sharks, these HPV types can be thought of as human [[Commensalism|commensals]]. Other cutaneous HPVs, such as HPV types 1 or 2, may cause common warts in some infected individuals. Skin warts are most common in childhood and typically appear and regress spontaneously over the course of weeks to months. About 10% of adults also suffer from recurring skin warts. All HPVs are believed to be capable of establishing long-term "latent" infections in small numbers of [[stem cell]]s present in the skin. Although these latent infections may never be fully eradicated, immunological control is thought to block the appearance of symptoms such as warts. Immunological control is likely HPV type-specific, meaning that an individual may become immunologically resistant to one HPV type while remaining susceptible to other types. | Infection with cutaneous HPVs is ubiquitous.<ref>{{cite journal |author=Antonsson A, Forslund O, Ekberg H, Sterner G, Hansson BG |title=The ubiquity and impressive genomic diversity of human skin papillomaviruses suggest a commensalic nature of these viruses |journal=J. Virol. |volume=74 |issue=24 |pages=11636-41 |year=2000 |pmid=11090162 |doi=}}</ref> Some HPV types, such as HPV-5, may establish infections that persist for the lifetime of the individual without ever manifesting any clinical symptoms. Like remora suckerfish that hitchhike harmlessly on sharks, these HPV types can be thought of as human [[Commensalism|commensals]]. Other cutaneous HPVs, such as HPV types 1 or 2, may cause common warts in some infected individuals. Skin warts are most common in childhood and typically appear and regress spontaneously over the course of weeks to months. About 10% of adults also suffer from recurring skin warts. All HPVs are believed to be capable of establishing long-term "latent" infections in small numbers of [[stem cell]]s present in the skin. Although these latent infections may never be fully eradicated, immunological control is thought to block the appearance of symptoms such as warts. Immunological control is likely HPV type-specific, meaning that an individual may become immunologically resistant to one HPV type while remaining susceptible to other types. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Genital HPV infection is very common, with estimates suggesting that more than 50% of women will become infected with one or more of the sexually transmitted HPV types at some point during adulthood.[1]
Epidemiology and Demographics
Cutaneous HPVs
Infection with cutaneous HPVs is ubiquitous.[2] Some HPV types, such as HPV-5, may establish infections that persist for the lifetime of the individual without ever manifesting any clinical symptoms. Like remora suckerfish that hitchhike harmlessly on sharks, these HPV types can be thought of as human commensals. Other cutaneous HPVs, such as HPV types 1 or 2, may cause common warts in some infected individuals. Skin warts are most common in childhood and typically appear and regress spontaneously over the course of weeks to months. About 10% of adults also suffer from recurring skin warts. All HPVs are believed to be capable of establishing long-term "latent" infections in small numbers of stem cells present in the skin. Although these latent infections may never be fully eradicated, immunological control is thought to block the appearance of symptoms such as warts. Immunological control is likely HPV type-specific, meaning that an individual may become immunologically resistant to one HPV type while remaining susceptible to other types.
Genital HPVs
A large increase in the incidence of genital HPV infection occurs at the age when individuals begin to engage in sexual activity (see figure). The great majority of genital HPV infections never cause any overt symptoms and are cleared by the immune system in a matter of months. As with cutaneous HPVs, immunity is believed to be HPV type-specific. A subset of infected individuals may fail to bring genital HPV infection under immunological control. Lingering infection with high-risk HPV types, such as HPVs 16, 18, 31 and 45, can lead to the development of cervical cancer or other types of cancer.[3]
High-risk HPV types 16 and 18 are together responsible for over 65% of cervical cancer cases.[4][1]
Type 16 causes 41 to 54% of cervical cancers,[5][1] and accounts for an even greater majority of HPV-induced vaginal/vulvar cancers,[6] penile cancers, anal cancers and head and neck cancers.[7]
Public Health and Genital HPVs
According to the Centers for Disease Control, by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV. All women are encouraged get a yearly pap smear solely to detect cellular abnormalities caused by HPV.[8]
The HPV vaccine, Gardasil, protects against the two strains of HPV that cause 70% of cervical cancer cases, and two strains of HPV that cause 90% of genital warts.
The CDC recommends that girls and women between the ages of 11 and 26 be vaccinated.[8]
Perinatal Transmission
Although genital HPV types are sometimes transmitted from mother to child during birth, the appearance of genital HPV-related diseases in newborns is rare. Perinatal transmission of HPV types 6 and 11 can result in the development of juvenile-onset recurrent respiratory papillomatosis (JORRP). JORRP is very rare, with rates of about 2 cases per 100,000 children in the United States.[9] Although JORRP rates are substantially higher if a woman presents with genital warts at the time of giving birth, the risk of JORRP in such cases is still less than 1%.
Genital HPV Prevalence in the United States
Quoted statistics of HPV infection vary, with one review finding reported values anywhere from 14% to 90%.[10] The major reason numbers conflict is simply a lack of context. A report of the number of women that have ever been infected by any type will be much higher than the number that are currently infected by one of the high-risk types. The confusion surrounding the issue is highlighted by news coverage of a comprehensive study published in February 2007. Some headlines read "more women than expected have HPV", while others said that infection was "rarer than first estimated".[11][12] Both are actually true, in context:
The study found that, during 2003–2004, at any given time, 26.8% of women aged 14 to 59 were infected with at least one type of HPV. This was higher than previous estimates. Of the four types prevented by the Gardasil vaccine, however, only 3.4% were infected, which was lower than previous estimates. Of the high-risk types that cause cancer, 15.2% were infected.[13]
The American Social Health Association projections in 2006 were yet more pessimistic, predicting that about 75% of the reproductive population will have been infected with genital HPV infection in their lifetime.[14] Studies show that HPV infection is much more prevalent in the gay community. Studies show a link between HPV infection and penile and anal cancer, and the risk for anal cancer is 17 to 31 times higher among gay and bisexual men than among heterosexual men.[15][16]
Although it is possible to test for HPV DNA in men,[17] there are no FDA-approved tests for general screening, since the testing is inconclusive and considered medically unnecessary.[15][18]
There is no screening test for HPV infection in men. However, although there are no formal guidelines, some experts believe that men who receive anal sex should have a routine anal Pap test, especially if they also have HIV infection. Ask your health professional whether and how often you should be tested.[19]
Information from the CDC
According to the Centers for Disease Control (CDC), by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV. All women are encouraged to get a yearly pap smear solely to detect cellular abnormalities caused by HPV.[8]
Genital HPV is the most common sexual transmitted infection in the United States. About 6.2 million Americans will get infected with genital HPV this year. According to the National Cervical Cancer Coalition (NCCC), 11% of American women do not have regular cervical cancer screenings; women who do not have cervical cancer screenings on a regular basis dramatically increase their chances of developing cervical cancer. About 14,000 women in the United States are diagnosed with cervical cancer disease each year, and more than 3,900 women die in the United States each year from this disease.
Information from the AMA
According to the Journal of the American Medical Association (Dunne, Eileen F. et al, 2007) the prevalence of HPV infection among females in the United States is as follows:[13]
- 24.5% prevalence of HPV among females 14 to 19 years old
- 44.8% prevalence of HPV among females 20 to 24 years old
- 27.4% prevalence of HPV among females 25 to 29 years old
- 27.5% prevalence of HPV among females 30 to 39 years old
- 25.2% prevalence of HPV among females 40 to 49 years old
- 19.6% prevalence of HPV among females 50 to 59 years old
References
- ↑ 1.0 1.1 1.2 Baseman JG, Koutsky LA (2005). "The epidemiology of human papillomavirus infections". J. Clin. Virol. 32 Suppl 1: S16–24. doi:10.1016/j.jcv.2004.12.008. PMID 15753008. *Note: The authors state on page S17 "Overall, these DNA-based studies, combined with measurements of type-specific antibodies against HPV capsid antigens, have shown that most (>50%) sexually active women have been infected by one or more genital HPV types at some point in time."
- ↑ Antonsson A, Forslund O, Ekberg H, Sterner G, Hansson BG (2000). "The ubiquity and impressive genomic diversity of human skin papillomaviruses suggest a commensalic nature of these viruses". J. Virol. 74 (24): 11636–41. PMID 11090162.
- ↑ Schiffman M, Castle PE (2005). "The promise of global cervical-cancer prevention". N. Engl. J. Med. 353 (20): 2101–4. doi:10.1056/NEJMp058171. PMID 16291978.
- ↑ Cohen J (2005). "Public health. High hopes and dilemmas for a cervical cancer vaccine". Science. 308 (5722): 618–21. doi:10.1126/science.308.5722.618. PMID 15860602.
- ↑ Noel J, Lespagnard L, Fayt I, Verhest A, Dargent J (2001). "Evidence of human papilloma virus infection but lack of Epstein-Barr virus in lymphoepithelioma-like carcinoma of uterine cervix: report of two cases and review of the literature". Hum. Pathol. 32 (1): 135–8. PMID 11172309.
- ↑ Edwards QT, Saunders-Goldson S, Morgan PD, Maradiegue A, Macri C (2005). "Vulvar intraepithelial neoplasia: varied signs, varied symptoms: what you need to know". Advance for nurse practitioners. 13 (3): 49–52. PMID 15777042.
- ↑ Bolt J, Vo QN, Kim WJ, McWhorter AJ, Thomson J, Hagensee ME, Friedlander P, Brown KD, Gilbert J (2005). "The ATM/p53 pathway is commonly targeted for inactivation in squamous cell carcinoma of the head and neck (SCCHN) by multiple molecular mechanisms". Oral Oncol. 41 (10): 1013–20. PMID 16139561.
- ↑ 8.0 8.1 8.2 "STD Facts - HPV Vaccine". 2006-08-01. Retrieved 2007-08-17.
- ↑
- ↑ Revzina NV, Diclemente RJ (2005). "Prevalence and incidence of human papillomavirus infection in women in the USA: a systematic review". International journal of STD & AIDS. 16 (8): 528–37. doi:10.1258/0956462054679214. PMID 16105186."The prevalence of HPV reported in the assessed studies ranged from 14% to more than 90%."
- ↑
McCullough, Marie (2007-02-28). "Cancer-virus strains rarer than first estimated". The Philadelphia Inquirer. Retrieved 2007-03-02. Check date values in:
|date=(help) - ↑
Brown, David (2007-02-28). "Study finds more women than expected have HPV". San Francisco Chronicle. Retrieved 2007-03-02. Check date values in:
|date=(help) (originally published in the Washington Post as "More American Women Have HPV Than Previously Thought") - ↑ 13.0 13.1 Dunne EF, Unger ER, Sternberg M; et al. (2007). "Prevalence of HPV infection among females in the United States". JAMA. 297 (8): 813–9. doi:10.1001/jama.297.8.813. PMID 17327523.
- ↑ "American Social Health Association - HPV Resource Center". Retrieved 2007-08-17.
- ↑ 15.0 15.1 "STD Facts - HPV and Men". Retrieved 2007-08-17.
- ↑ Frisch M, Smith E, Grulich A, Johansen C (2003). "Cancer in a population-based cohort of men and women in registered homosexual partnerships". Am. J. Epidemiol. 157 (11): 966–72. PMID 12777359.
However, the risk for invasive anal squamous carcinoma, which is believed to be caused by certain types of sexually transmitted human papillomaviruses, notably type 16, was significantly 31-fold elevated at a crude incidence of 25.6 per 100,000 person-years.
- ↑ Dunne EF, Nielson CM, Stone KM, Markowitz LE, Giuliano AR (2006). "Prevalence of HPV infection among men: A systematic review of the literature". J. Infect. Dis. 194 (8): 1044–57. doi:10.1086/507432. PMID 16991079.
- ↑ "What Men Need to Know About HPV". 2006. Retrieved 2007-04-04.
There is currently no FDA-approved test to detect HPV in men. That is because an effective, reliable way to collect a sample of male genital skin cells, which would allow detection of HPV, has yet to be developed.
- ↑ "WebMD -- Error 404". Retrieved 2007-08-17.