Makindo Medical Notes

🌐 Introduction

• Human Papillomavirus (HPV) is a family of >100 DNA viruses and is one of the most common sexually transmitted infections (STIs) worldwide.
• Most infections are asymptomatic and self-limiting, but certain high-risk types can persist and cause malignant transformation.
• HPV is a leading cause of cervical cancer and is increasingly linked to anal, penile, vulval, and oropharyngeal cancers.

🔢 Types of HPV

• Low-risk HPV (e.g. types 6 & 11): cause benign lesions such as genital warts and recurrent respiratory papillomatosis.
• High-risk HPV (e.g. types 16 & 18): strongly associated with cervical intraepithelial neoplasia (CIN) and invasive cancers.
• Other oncogenic types: HPV 31, 33, 45, 52, and 58 also contribute to cervical and other anogenital cancers.

📲 Transmission

• Spread occurs via sexual contact (vaginal, anal, oral) or close skin-to-skin genital contact.
• Non-penetrative routes (e.g. digital–genital contact, fomites) are rare but possible.
• Condoms reduce but do not eliminate risk (HPV can infect uncovered areas).

🩺 Clinical Features

• Asymptomatic: Most infections are silent and clear spontaneously within 1–2 years.
• Genital Warts: Soft, fleshy growths on the vulva, penis, perianal region, or cervix. Caused by types 6 & 11.
• Cervical Dysplasia: Persistent high-risk HPV infection can cause CIN (graded CIN1–3).
• Cancer: Cervical carcinoma is most strongly linked (esp. squamous type). Others include vulval, anal, penile, and oropharyngeal cancers.

🔬 Investigations

• 🧪 Cervical Screening (Pap smear): Detects pre-malignant changes such as dyskaryosis.
• HPV DNA Testing: Identifies high-risk viral types, used alongside cytology in many screening programmes.
• Colposcopy + Biopsy: Performed when screening is abnormal to confirm and stage CIN or cancer.

🛡️ Prevention

• 💉 HPV Vaccination:
  • Quadrivalent (Gardasil): covers types 6, 11, 16, 18.
  • Nonavalent: broader coverage including 31, 33, 45, 52, 58.
  • Now offered to both boys and girls in the UK to prevent genital warts and HPV-related cancers.
• 🧍 Safe Sexual Practices: Condom use lowers transmission risk.
• 🧾 Screening: Cervical smear programme in the UK (ages 25–64) significantly reduces cancer incidence.

💊 Management

• Genital Warts: Topical agents (imiquimod, podophyllotoxin), cryotherapy, cautery, or surgical excision.
• Cervical Dysplasia (CIN): Treated with LLETZ/LEEP (loop excision), cryotherapy, or laser ablation depending on severity.
• Cancer: Managed according to stage — surgery, radiotherapy, chemotherapy, or combinations thereof.

💡 Clinical Pearl: - HPV 16 & 18 account for ~70% of cervical cancers. - Vaccination + regular screening are the two most powerful tools in prevention. - Most HPV infections resolve naturally — it is persistence of high-risk types that drives cancer risk.