Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine

Abstract

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and persistent HPV infection is strongly associated with risk of cervical cancer and genital warts. The recently approved quadrivalent HPV vaccine targets the HPV strains responsible for approximately 70% of cervical cancers and 90% of genital warts. It is also effective in reducing the incidence of HPV-related conditions, especially when given prior to exposure to HPV. The vaccine is recommended for all girls aged 11 to 12 with catch-up vaccination for women up to age 26, and most insurance plans cover the vaccine. A second bivalent HPV vaccine is currently pending approval by the US Food and Drug Administration (FDA). HPV vaccination reduces the incidence of HPV-related cancers and precancerous lesions in the United States and abroad, though decisions regarding implementation of vaccination remain.

Keywords: Cervical cancer; Genital warts; Human papillomavirus; Sexually transmitted disease; Vaccination.

Figure 1

Cumulative incidence of human papillomavirus (HPV) infection from time of first sexual intercourse (n = 94) among women in Washington State, 1990–2000. Vertical bars, 95% confidence intervals at 12, 24, 36, 48, and 60 months. Reprinted with permission from Winer RL et al., “Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students,” American Journal of Epidemiology, 2003, Volume 157, Number 3, pp. 218–226, by permission of Oxford University Press.

Figure 2

Human papillomavirus (HPV) clearance versus progression. CIN, cervical intraepithelial neoplasia.

Figure 3

Histology of squamous intraepithelial lesions. CIN, cervical intraepithelial neoplasia; CIS, carcinoma in situ; HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade intraepithelial lesion. Reprinted with permission from Bonnez W.