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Human Papillomavirus (HPV)

What is HPV?

Human papillomavirus (HPV) is a very common virus. There are more than 100 types of HPV and most are harmless,[i] but approximately 30 types can infect the genital area of both genders.[ii] Approximately 15 of these are oncogenic and can cause cervical cancer, and other cancers of the genital area. 


How common is genital HPV infection and who gets it?

  • A significant majority of women – 80% – will become infected by age 50.[iii]
  • Most HPV infections have no signs or symptoms, and clear naturally.[v]


What impact can HPV infection have?

  • Infection with “high-risk” HPVs – types 16 & 18 and others – if persistent, can lead to cervical cancer and other genital cancers.[vi]
    • HPV 16 and 18 account for an estimated 70% of all cervical cancers.[vii]
    • HPV 16 and 18 account for an estimated 25% of all low grade precancerous lesions.
    • HPV 16 and 18 account for an estimated 50% of all high grade precancerous lesions.
  • Infection with “Low-risk” HPVs - types 6 & 11 and others – can cause the development of low-grade pre cancerous lesions and genital warts.
    • HPV types 6 and 11 are responsible for approximately 10% of low grade pre cancerous lesions.
    • HPV types 6 and 11 are responsible for approximately 90% of all genital warts.[viii]
  • Both high and low-risk HPV types can cause cervical lesions and abnormal smear (Pap) tests[ix] (used to detect cancer and cellular changes in the cervix).[x]


How does HPV progress to cancer?

  • Some infections with high-risk HPV types may lead to cervical cancer. Cervical lesions are due to abnormal cervical cells. These are known as:
    • CIN 1 (Cervical Intraepithelial Neoplasia) – mild dysplasia[xi]
    • CIN 2/3 – moderate and severe dysplasia, respectively (high grade cervical lesions or pre cancerous lesions). 
  • Following initial infection, progression to cervical cancer depends on the type of HPV.
    • Low-risk types (such as HPV 6 or 11) have a negligible risk of progressing but may persist[xii].
    • Most low risk infections clear within 24 months[xiii].
    • High-risk types (such as types HPV 16 and 18) have the potential to progress from CIN 1 to CIN 2/3. 


How is HPV infection diagnosed?

  • In New Zealand there is no routine screening for HPV infection.
  • Pap smears, screening the cervix, often identify abnormalities caused by HPV infection.[xiv] However, as many HPV infections clear, the Pap smear is not directly a test for HPV infection.
  • For some women with high grade lesions a molecular test, used with Pap smear results, identifies HPV infection more definitively.[xv]


How is HPV infection treated?

  • There are no current anti-viral medications to treat HPV infection.[xvi]
  • There are a variety of treatments for conditions caused by HPV infection – genital warts, pre-cancerous lesions and cervical cancer.[xvii] 


How can HPV infection be prevented or the risk reduced?

  • Risk may be reduced by staying in a mutually monogamous relationship or by limiting the number of sexual partners.[xviii]
  • Proper condom use reduces risk.[xix]
  • GARDASIL is effective for the prevention of disease caused by the HPV types (16, 18, 6 & 11).



References

[i] Human Papilloma viruses and Cancer: Questions and Answers. Cancer Facts. National Cancer Institute Date reviewed: 12/01/2004. Available at http://cis.nci.nih.gov/fact/3_20.htm. Accessed January 2005. 
[ii] Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005 
[iii] Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005 
[iv] Koutsky L. Epidemiology of Genital Human Papillomavirus Infection. Am J Med 1997;102:3-8 
[v] Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005 
[vii] Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527 
[viii] Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527. 
[ix] International Journal of STD & AIDS 2001, European Guidelines for the management of anogenital warts, G. von Krogh 
[x] Centers for Disease Control & Prevention. Prevention of Genital HPV Infection and Sequelae: Report of an External Consultants’ Meeting. Available at http://www.cdc.gov/nchstp/dstd/Reports_Publications/99HPVReport.htm. 
[xi] Centers for Disease Control and Prevention. Highlights in Minority Health, January 2005. Last updated January 2005. Available at http://www.cdc.gov/omh/Highlights/2005/HJan05.htm. Accessed June 2005. 
[xii] Bonnez W. Papillomavirus. In: Richman DD, Whitley RJ, Hayden FJ, eds. Clinical Virology. 2nd ed. Washington, DC: American Society for Microbiology Press; 2002: 569–612. 
[xiii] Pinto AP, Crum CP. Natural history of cervical neoplasia: Defining progression and its consequence. Clin Obstet Gynecol. 2000;43:352–362. 
[xiv] Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338:423–428. [1] Centers for Disease Control, Office of Minority Health, Highlights in Minority Health, January 2005. Available at http://www.cdc.gov/omh/highlights/2005/hjan05.htm. 
[xv] Apgar B, Brotzman G. HPV Tesing in the Evaluation of the Minimally Abnormal Papanicolaou Smear. American Family Physician. May 15, 1999; 59(10). 
[xvi] Papillomavirus: Clinical Virology, Churchill Livingston: 2002:557-596, D. Richman, R. Whitley & F. Hayden. 
[xvii] Papillomavirus: Clinical Virology, Churchill Livingston: 2002:557-596, D. Richman, R. Whitley & F. Hayden. 
[xviii] Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005 
[xix] Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005


Gardasil Consumer Mandatory
GARDASIL® is an unfunded medicine. Patient is required to pay full cost. GARDASIL is a vaccine that helps prevent the following diseases caused by Human Papillomavirus (HPV) Types 6, 11, 16 and 18: cervical cancer ; abnormal and precancerous cervical lesions as found by a Pap test; vulvar and vaginal cancers; genital warts; and HPV infection. Each 0.5-mL dose contains approximately 20 mcg of HPV 6 L1 protein, 40 mcg of HPV 11 L1 protein, 40 mcg of HPV 16 L1 protein, and 20 mcg of HPV 18 L1 protein. Do not, or do not let your child have the vaccine if you or your child had an allergy to GARDASIL or any of the ingredients. Side effects may include: Pain, tenderness or soreness at the injection site; Local reaction around the injection site such as soreness, redness, swelling or bruising; Fever; Difficulty breathing (bronchospasm); or allergic reaction. If you or your child has any unusual or severe symptoms after receiving GARDASIL, contact your doctor or health care provider right away. Women who become pregnant before the completion of the 3-dose schedule should complete their vaccination schedule after childbirth. GARDASIL should be given with caution to patients: with any blood or bleeding diseases; or with a weakened immune system, for example due to a genetic defect or Human Immunodeficiency Virus (HIV) infection. GARDASIL is a Prescription Medicine. Medicines have benefits and some may have risks. Use strictly as directed. If symptoms persist or you have side effects, consult your doctor, pharmacist or health professional. Ask your doctor if GARDASIL is right for you. Full Consumer Medicine Information (CMI) is available from bioCSL (NZ) Ltd www.biocsl.co.nz or 0800 502 757 or on the Medsafe website: www.medsafe.govt.nz. GARDASIL® is a registered trademark of MERCK & CO., Inc., Whitehouse Station, NJ, 08889 USA. bioCSL (NZ) Limited, PO Box 62 590, Greenlane, Auckland 1546. GARD-018-07/06 TAPS PP3428 Prescription Medicine GARDASIL is not funded on the pharmaceutical schedule. A patient charge applies. 
Dosing Schedule - GARDASIL is given in 3 separate doses, the first dose at Day 1, the second dose after 2 months, and the final dose 6 months after your first dose.

TAPS no: PP3428.


Note: Information on this site is not intended to replace the advice given by your doctor or other health professional. 


Helpful Links


IE icon The National HPV Immunisation Programme
Gardasil - HPV vaccine website 

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