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Understanding and Managing HPV: Prevention & Treatment Options

Human papillomavirus (HPV) is the most common STI. Most infections clear spontaneously, but persistent high-risk types cause cancer.

HPV Types

  • Low-Risk (6, 11): Genital warts (condylomata), respiratory papillomatosis.
  • High-Risk (16, 18, 31, 33, 45, 52, 58): Cervical, anal, oropharyngeal, vaginal, vulvar, penile cancers. HPV16/18 cause 70% cervical, 90% anal/oropharyngeal.

Prevention

  1. Vaccination (9-valent Gardasil 9): Covers 6, 11, 16, 18, 31, 33, 45, 52, 58.
    • Routine: 11–12 years (2-dose if <15; 3-dose if ≥15 or immunocompromised).
    • Catch-up: Through age 26.
    • Shared decision-making: 27–45 years (benefit decreases with prior exposure).
  2. Screening:
    • Cervical: Pap + HPV co-test (30–65) or HPV primary (25–65).
    • Anal: High-risk groups (MSM, HIV+, immunosuppressed).
  3. Behavioral: Condoms (partial protection), limit partners, circumcision (reduces male acquisition/transmission).

Treatment

  • Genital Warts: Patient-applied (imiquimod, podofilox, sinecatechins) or provider (cryotherapy, TCA, surgical excision, laser). Recurrence common.
  • Precancer (CIN/AIN): Ablation (cryo, laser) or excision (LEEP, cold knife cone).
  • Cancer: Surgery, radiation, chemotherapy, immunotherapy (pembrolizumab for recurrent/metastatic).
  • RRP: Serial surgical debulking; adjuvant cidofovir, bevacizumab, HPV vaccines (investigational).

Key Messages

  • Vaccination prevents 90%+ of HPV cancers.
  • Screening catches precancers early.
  • Most HPV clears; persistence = risk.
  • Partner communication reduces stigma.

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