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Human Papillomavirus (HPV)
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Whattoisedit
HPV
Infection?
Genital human papillomavirus (also called HPV) is the
most common sexually transmitted infection in the
United States.
 There are more than 40 HPV types that can infect the
genital areas of males and females.
 These HPV types can also infect the mouth and
throat.
Source CDC, 2011
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Whattoisedit
HPV
Infection?
Most people who become infected with HPV do not
even know they have it.
 At least 50% of sexually active people will have
genital HPV at some time in their lives.
 HPV is not the same as herpes or HIV (the virus that
causes AIDS) even though it is sexually transmitted.
Source CDC, 2011
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Symptoms and Pathogenesis
Source : CDC
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 Most people with HPV do not develop symptoms or
health problems from it.
 In 90% of cases, the body’s immune system clears HPV
naturally within two years.
 The types of HPV that can cause genital warts are not the
same as the types that can cause cancers.
Source CDC
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 There is no way to know which people who get HPV will
go on to develop cancer or other health problems.
Source CDC
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 But, sometimes, HPV infections are not cleared and
can cause:
Genital warts
Rarely, warts in the throat
Cervical cancer and other, less common but serious
cancers( cancers of the vulva, vagina, penis, anus, and back
of throat).
Source CDC
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 Genital warts usually appear as a small bump or group of
bumps in the genital area.
 Warts can appear within weeks or months after sexual
contact with an infected partner (even with asymptomatic
infected partner).
 Untreated genital warts might go away, remain
unchanged, or increase in size or number.
 They will not turn into cancer.
Source CDC
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 Cervical cancer usually does not have symptoms
until it is quite advanced.
 It is therefore important for women to get
regular screening for cervical cancer.
 Screening tests can find early signs of disease so
that problems can be treated early, before they ever turn
into cancer.
Source CDC
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 Recurrent Respiratory Papillomatosis (RRP) is a
condition in which warts grow in the throat.
 When this occurs in children it is called juvenileonset RRP (JORRP).
 These growths can sometimes block the airway,
causing a hoarse voice or troubled breathing.
Source CDC
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Oral warts
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warts
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warts
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Mouth Cancer from HPV
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Epidemiology
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 Approximately 20 million Americans are currently
infected with HPV.
 6 million people become newly infected each year.
 HPV is so common that at least 50% of sexually active
men and women get it at some point in their lives.
Source CDC
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 Genital warts: about 1% of sexually active adults in the
U.S. have genital warts at any one time.
 RRP: is very rare, less than 2,000 children get juvenileonset RRP every year in the U.S.
 Cervical cancer: each year, about 12,000 women get
cervical cancer in the U.S. Almost all of these cancers are
HPV-associated.
Source CDC
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 Other cancers that can be caused by HPV are less
common than cervical cancer.
 Each year in the U.S., there are about:
1,500 women who get HPV-associated vulvar cancer
500 women who get HPV-associated vaginal cancer
400 men who get HPV-associated penile cancer
Source CDC
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 Each year in the U.S., there are about:
2,700 women and 1,500 men who get HPV-associated anal
cancer
1,500 women and 5,600 men who get HPV-associated
oropharyngeal cancers.
Source CDC
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 Gay bisexual men, and people with weak immune
systems (including those who have HIV/AIDS) are at higher
risk for some HPV-related health problems.
Source CDC
Human Papillomavirus—Prevalence of High-risk and Low-risk
Types Among Females Aged 14–59 Years, National Health and
Nutrition Examination Survey, 2003–2006
Prevalence, %
60
Low-risk HPV*
High-risk HPV*
50
40
30
20
10
0
14–19
20–24
25–29
30–39
40–49
Age
* HPV = human papillomavirus.
NOTE: Error bars indicate 95% confidence intervals. Both high-risk and low-risk HPV types were detected
in some females.
SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital HPV
among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006.
J Infect Dis. 2011;204(4):566-73
50–59
Genital Warts—Initial Visits to Physicians’ Offices,
United States, 1966–2010
Visits (in thousands)
500
400
300
200
100
0
1966
1969
1972
1975
1978
1981
1984
1987
1990
1993
1996
1999
Year
NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to
30%.
SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.
2002
2005
2008
STD Surveillance Network (SSuN)—Genital Warts—
Prevalence Among Sexually Transmitted Disease (STD)
Clinic Patients by Sex, Sex of Partners, and Site, 2010
Percentage
15
MSM*
MSW*
Women
12
9
6
3
0
San
Francisco
Los
Angeles
Seattle
Denver
Chicago
New Birmingham
Baltimore
New York Hartford/
Orleans
City
New Haven
Richmond
Philadelphia
* MSM = men who have sex with men; MSW = men who have sex with women only.
Genital Herpes—Initial Visits to Physicians’ Offices,
United States, 1966–2010
Visits (in thousands)
400
350
300
250
200
150
100
50
0
1966
1969
1972
1975
1978
1981
1984
1987
1990
1993
1996
1999
Year
NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to
30%.
SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.
2002
2005
2008
Herpes Simplex Virus Type 2—Seroprevalence in Non-Hispanic
Whites and Non-Hispanic Blacks by Age Group, National Health and
Nutrition Examination Survey, 1976–1980, 1988–1994, 1999–2004,
2005–2008
Percentage
Percentage
100
100
Non-Hispanic Whites
80
60
60
40
40
20
20
0
All Ages*
14–19
20–29
Age
30–39
1976–1980
Non-Hispanic Blacks
80
40–49
1988–1994
0
All Ages*
1999–2004
14–19
20–29
Age
2005–2008
* Age-adjusted by using the 2000 U.S. Census civilian, non-institutionalized population aged 14–49
years as the standard.
NOTE: Error bars indicate 95% confidence intervals.
30–39
40–49
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Risk factors
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Transmission
 HPV is passed on through genital contact, most often
during vaginal and anal sex.
 HPV may also be passed on during oral sex and genitalto-genital contact.
 HPV can be passed on between straight and same-sex
partners—even when the infected partner has no signs or
symptoms.
Source CDC
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Transmission
 A person can have HPV even if years have passed since
he or she had sexual contact with an infected person.
 Most infected persons are unaware of their
infectiousness and capacity to infect their sex partner.
 It is also possible to get more than one type of HPV.
Source CDC
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Transmission
 Rarely, a pregnant woman with genital HPV can pass
HPV to her baby during delivery.
 Very rarely, the child can develop symptoms
Source CDC
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Prevention
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 Vaccines can protect males and females against some of
the most common types of HPV that can lead to disease and
cancer.
 These vaccines are given in three shots. It is important to
get all three doses to get the best protection.
 The vaccines are most effective when given at 11 or 12
years of age.
Source CDC
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 Girls and women: Two vaccines (Cervarix and Gardasil)
are available to protect females against the types of HPV
that cause most cervical cancers.
 Either vaccine is recommended for 11 and 12 year-old
girls, and for females 13 through 26 years of age, who did
not get any or all of the shots when they were younger.
 These vaccines can also be given to girls beginning at 9
years of age.
Source CDC
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 Boys and men: One available vaccine (Gardasil) protects
males against most genital warts and anal cancers.
 This vaccine is available for boys and men, 9 through 26
years of age.
Source CDC
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 For sexually active individuals: condoms may lower the
risk of HPV. To be most effective, they should be used with
every sex act, from start to finish.
 Condoms may also lower the risk of developing HPVrelated diseases, such as genital warts and cervical cancer.
 But HPV can infect areas that are not covered by a
condom - so condoms may not fully protect against HPV.
Source CDC
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 People can also lower their chances of getting HPV by
being in a faithful relationship with one partner; limiting
their number of sex partners; and choosing a partner who
has had no or few prior sex partners.
 But even people with only one lifetime sex partner can
get HPV.
 That's why the only sure way to prevent HPV is to avoid
all sexual activity.
Source CDC
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Treatment
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 There is no treatment for the virus itself, but
there are treatments for the diseases that HPV can cause:
 Visible genital warts: can be removed by the patient him
or herself with prescribed medications.
 Cervical cancer: is most treatable when it is diagnosed
and treated early. But women who get routine Pap tests and
follow up as needed can identify problems before cancer
develops.
Source CDC