Update on HPV Infection

Should I be tested for HPV infection? Can it be treated?Do I need to tell my partner that I am infected?An estimated 20million Americansare currentlyinfectedwith humanpapillomavirus (HPV). Assuch, HPV is now the mostprevalent sexually transmitteddisease (STD) in thiscountry. Answers to commonquestions like the onesabove are therefore of particularinterest to physicians.The issue of when and howto use testing for HPV hasbecome especially crucial.A recent article byUnger and Duarte-Franco¹offers insights into thesepressing questions. Theseauthors provide a detailedoverview of HPV epidemiology,disease associations,and testing options. Theyalso address some of thecurrent controversies aboutcounseling, prevention, andtreatment strategies--andinclude a short section onvaccination prospects.Here, I will briefly reviewthe highlights.ABOUT HPVHPVs are divided intocutaneous types, whichcause warts on the handsand feet, and approximately30 mucosal types that affectthe anogenital tract ofboth women and men. Theassociation of HPV withcervical cancer was first describedin 1974, and evidenceto support the linkhas been increasing eversince. Unger and Duarte-Franco note that the degreeof risk between certainHPV types (especiallytypes 16 and 18) and cervicalcancer is greater thanthe magnitude of the riskbetween tobacco smokingand lung cancer.WHICH TEST?Current options fortesting include:

• Hybrid Capture II--theonly FDA-approved test--amonoclonal antibody assaythat uses an endocervicalbrush for sampling.
• Tissue-based methods,such as PCR assays and insitu hybridization.

WHEN TO TEST?

Unger and Duarte-Franco found that HPV testingis not helpful for womenwith low-grade squamousintraepithelial lesions (LSIL)because almost all patientswith this finding are positivefor the high-risk HPVtypes. Such testing could behelpful for patients withatypical squamous cells ofundetermined significance(ASCUS), however, becauseit can help definewho should undergo colposcopicexamination. Patientswith ASCUS resultson a Papanicolaou smearcould have the HPV test--and only those with highriskHPV types would undergocolposcopy.

THERAPY

No therapy is yet availablefor HPV infection, althoughthere are treatmentsfor the associated complications,including genitalwarts (Figure) and cervicalneoplasia. It is recommendedthat patients with HPVrefrain from other associatedrisks, especially smoking,and that they use condomsto prevent future STDtransmission.There are currentlyseveral phase I trials ofHPV vaccines. Many questionsregarding vaccine useremain, however.

References:

REFERENCE:

1.

Unger ER, Duarte-Franco E.Human papillomaviruses: into thenew millennium.

Obstet Gynecol ClinNorth Am.

2001;28:653-666.