HPV (Human Papillomavirus): Also Called the Human Wart Virus

HPV is a group of >200 related viruses. **~40 types infect the genital tract.** They are categorized by cancer risk:

Low-Risk (Non-Oncogenic)

• HPV 6, 11 → **90% of genital warts** (condylomata acuminata).
• Also cause recurrent respiratory papillomatosis (RRP).

High-Risk (Oncogenic)

• HPV 16, 18 → **70% of cervical cancers**; major cause of oropharyngeal, anal, vulvar, vaginal, penile cancers.
• Others: 31, 33, 45, 52, 58, etc.

Transmission & Natural History

• Skin-to-skin sexual contact (penetration not required).
• **Most infections clear spontaneously** in 1-2 years (cell-mediated immunity).
• Persistent high-risk infection → precancer → cancer (10-30 years).

Prevention

• HPV vaccine (Gardasil 9): Covers 6, 11, 16, 18, 31, 33, 45, 52, 58. **Recommended 11-12 yrs (9-26 routine); shared decision-making 27-45.**
• Condoms reduce but don't eliminate risk (uncovered skin).
• Cervical screening: Pap + HPV co-testing (30-65) or primary HPV (25-65).

Treatment

• Warts: Topical (imiquimod, podofilox, sinecatechins), ablative (cryo, TCA, laser, excision).
• Precancer (CIN): Excision (LEEP, cold knife cone), ablation.
• Cancer: Surgery, radiation, chemo, immunotherapy.

HPV is ubiquitous; vaccination + screening prevent virtually all cervical cancer.