
Health Dictionary
Reliable, easy-to-read patient information on common medical conditions β written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Human papillomavirus natural history, complications and prognosis
Introduction
Overview
Overview
Most infections with HPV are subclinical, asymptomatic and resolves without any complications in immunocompetent individuals. Time to develop symptoms and signs is not well defined but it may take 3 weeks to 3 months for genital warts, several months to years for cellular abnormalities (metaplasia and dysplasia) and years for development of cancers. 90% of infections resolve within 2 years due to host immune response.[1]Persistent HPV infection is associated with risk factors such as multiple sexual partners, alcohol consumption, immunosuppression, older age, and multiple types of HPV detected previously. Without treatment, persistent infection with low-risk types (low-grade intraepithelial lesions) may resolve spontaneously or persist and proliferate as warty lesions. However, high-risk HPV types (16,18,31,32) may lead to high-grade intraepithelial lesions which ultimately to carcinoma(cervical, anal, vaginal, vulvar, penile and oropharyngeal).[2][3][4][5]Prognosis of HPV infection depends primarily on type of HPV causing infection.[6][7][8][9][10]
Natural history
Natural history
Most infections with HPV are subclinical, asymptomatic and resolves without any complications in immunocompetent individuals. Time to develop symptoms and signs is not well defined but it may take 3 weeks to 3 months for genital warts, several months to years for cellular abnormalities (metaplasia and dysplasia) and years for development of cancers. 90% of infections resolve within 2 years due to host immune response.[1]
Persistent HPV infection is associated with risk factors such as multiple sexual partners, alcohol consumption, immunosuppression, older age, and multiple types of HPV detected previously. Without treatment, persistent infection with low-risk types (low-grade intraepithelial lesions) may resolve spontaneously or persist and proliferate as warty lesions. However, high-risk HPV types (16,18,31,32) may lead to high-grade intraepithelial lesions which ultimately to carcinoma(cervical, anal, vaginal, vulvar, penile and oropharyngeal).[2][3][4][5]Complications associated with the human papillomavirus infection include:[11][12][13][14][15][16][17][18]genital warts, cervical cancer, vaginal cancer, vulvar cancer, anal cancer, penile cancer, head and neck cancer.
Complications
Complications
Complications associated with the human papilloma virus infection include:[11][12][13][14][15][16][17][18]
Prognosis
Prognosis
Prognosis of HPV infection depends primarily on type of HPV causing infection.[6][7][8][9][10][19][20][21][22]
Good prognostic factors
- Low risk HPV type (1, 2, 4, 6, 11)[9]
- Immunocompetent[10]
- Early diagnosis and treatment[9][19]
- Regular follow-up
- Safe sex behavior
Bad prognostic factors
- High risk HPV type(16, 18, 31, 32)[6][7]
- Immunocompromised[10]
- Multiple sexual partners[8][21]
- Repeated infection in past years
- Delay in seeking treatment[23]
- Lack of follow up and screening[23]
- Metastatic carcinoma (cervical, anal, vaginal, oropharyngeal)[8][24]
- Presence of other STDs (HIV, syphilis, chlamydia)[20][21][22]
- Tobacco and alcohol usage[8][25][26]
References
References
- β 1.0 1.1 Ault KA (2006). “Epidemiology and natural history of human papillomavirus infections in the female genital tract”. Infect Dis Obstet Gynecol. 2006 Suppl: 40470. doi:10.1155/IDOG/2006/40470. PMCΒ 1581465. PMIDΒ 16967912.
- β 2.0 2.1 Castle PE, Schiffman M, Herrero R, Hildesheim A, Rodriguez AC, Bratti MC; et al. (2005). “A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica”. J Infect Dis. 191 (11): 1808β16. doi:10.1086/428779. PMIDΒ 15871112.
- β 3.0 3.1 Woodman CB, Collins S, Winter H, Bailey A, Ellis J, Prior P; et al. (2001). “Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study”. Lancet. 357 (9271): 1831β6. doi:10.1016/S0140-6736(00)04956-4. PMIDΒ 11410191.
- β 4.0 4.1 Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD (1998). “Natural history of cervicovaginal papillomavirus infection in young women”. N Engl J Med. 338 (7): 423β8. doi:10.1056/NEJM199802123380703. PMIDΒ 9459645.
- β 5.0 5.1 http://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html Accessed on October 13, 2016
- β 6.0 6.1 6.2 Yang SH, Kong SK, Lee SH, Lim SY, Park CY (2014). “Human papillomavirus 18 as a poor prognostic factor in stage I-IIA cervical cancer following primary surgical treatment”. Obstet Gynecol Sci. 57 (6): 492β500. doi:10.5468/ogs.2014.57.6.492. PMCΒ 4245343. PMIDΒ 25469338.
- β 7.0 7.1 7.2 No JH, Sung MW, Hah JH, Choi SH, Lee MC, Kim HS; et al. (2015). “Prevalence and prognostic value of human papillomavirus genotypes in tonsillar squamous cell carcinoma: a Korean multicenter study”. Cancer. 121 (4): 535β44. doi:10.1002/cncr.29086. PMIDΒ 25283642.
- β 8.0 8.1 8.2 8.3 8.4 Lin BM, Wang H, D’Souza G, Zhang Z, Fakhry C, Joseph AW; et al. (2013). “Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma”. Cancer. 119 (19): 3462β71. doi:10.1002/cncr.28250. PMCΒ 3788050. PMIDΒ 23861037.
- β 9.0 9.1 9.2 9.3 Beutner KR, Wiley DJ, Douglas JM, Tyring SK, Fife K, Trofatter K; et al. (1999). “Genital warts and their treatment”. Clin Infect Dis. 28 Suppl 1: S37β56. doi:10.1086/514722. PMIDΒ 10028109.
- β 10.0 10.1 10.2 10.3 Ferenczy A, CoutlΓ©e F, Franco E, Hankins C (2003). “Human papillomavirus and HIV coinfection and the risk of neoplasias of the lower genital tract: a review of recent developments”. CMAJ. 169 (5): 431β4. PMCΒ 183297. PMIDΒ 12952805.
- β 11.0 11.1 http://www.cdc.gov/hpv/parents/vaccine.html Accessed on October 11, 2016
- β 12.0 12.1 Tilston P (1997). “Anal human papillomavirus and anal cancer”. J Clin Pathol. 50 (8): 625β34. PMCΒ 500098. PMIDΒ 9301544.
- β 13.0 13.1 Palefsky JM, Holly EA, Ralston ML, Jay N (1998). “Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men”. J Infect Dis. 177 (2): 361β7. PMIDΒ 9466522.
- β 14.0 14.1 Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL; et al. (1993). “History of circumcision, medical conditions, and sexual activity and risk of penile cancer”. J Natl Cancer Inst. 85 (1): 19β24. PMIDΒ 8380060.
- β 15.0 15.1 Varma VA, Sanchez-Lanier M, Unger ER, Clark C, Tickman R, Hewan-Lowe K; et al. (1991). “Association of human papillomavirus with penile carcinoma: a study using polymerase chain reaction and in situ hybridization”. Hum Pathol. 22 (9): 908β13. PMIDΒ 1655618.
- β 16.0 16.1 Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L; et al. (2000). “Evidence for a causal association between human papillomavirus and a subset of head and neck cancers”. J Natl Cancer Inst. 92 (9): 709β20. PMIDΒ 10793107.
- β 17.0 17.1 Beachler DC, DΚΌSouza G (2013). “Oral human papillomavirus infection and head and neck cancers in HIV-infected individuals”. Curr Opin Oncol. 25 (5): 503β10. doi:10.1097/CCO.0b013e32836242b4. PMCΒ 3896303. PMIDΒ 23852381.
- β 18.0 18.1 de Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B; et al. (2010). “Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study”. Lancet Oncol. 11 (11): 1048β56. doi:10.1016/S1470-2045(10)70230-8. PMIDΒ 20952254.
- β 19.0 19.1 Zampronha Rde A, Freitas-Junior R, Murta EF, Michelin MA, Barbaresco AA, Adad SJ; et al. (2013). “Human papillomavirus types 16 and 18 and the prognosis of patients with stage I cervical cancer”. Clinics (Sao Paulo). 68 (6): 809β14. doi:10.6061/clinics/2013(06)14. PMCΒ 3674251. PMIDΒ 23778490.
- β 20.0 20.1 Tamim H, Finan RR, Sharida HE, Rashid M, Almawi WY (2002). “Cervicovaginal coinfections with human papillomavirus and Chlamydia trachomatis”. Diagn Microbiol Infect Dis. 43 (4): 277β81. PMIDΒ 12151187.
- β 21.0 21.1 21.2 Martins AE, Lucena-Silva N, Garcia RG, Welkovic S, Barbosa A, Menezes ML; et al. (2014). “Prognostic evaluation of DNA index in HIV-HPV co-infected women cervical samples attending in reference centers for HIV-AIDS in Recife”. PLoS One. 9 (8): e104801. doi:10.1371/journal.pone.0104801. PMCΒ 4140713. PMIDΒ 25144309.
- β 22.0 22.1 Fitzgerald DW, Bezak K, Ocheretina O, Riviere C, Wright TC, Milne GL; et al. (2012). “The effect of HIV and HPV coinfection on cervical COX-2 expression and systemic prostaglandin E2 levels”. Cancer Prev Res (Phila). 5 (1): 34β40. doi:10.1158/1940-6207.CAPR-11-0496. PMCΒ 3252428. PMIDΒ 22135046.
- β 23.0 23.1 Yanofsky VR, Patel RV, Goldenberg G (2012). “Genital warts: a comprehensive review”. J Clin Aesthet Dermatol. 5 (6): 25β36. PMCΒ 3390234. PMIDΒ 22768354.
- β Fuller AF, Elliott N, Kosloff C, Hoskins WJ, Lewis JL (1989). “Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix”. Gynecol Oncol. 33 (1): 34β9. PMIDΒ 2703164.
- β Brennan JA, Boyle JO, Koch WM, Goodman SN, Hruban RH, Eby YJ; et al. (1995). “Association between cigarette smoking and mutation of the p53 gene in squamous-cell carcinoma of the head and neck”. N Engl J Med. 332 (11): 712β7. doi:10.1056/NEJM199503163321104. PMIDΒ 7854378.
- β Maxwell JH, Kumar B, Feng FY, Worden FP, Lee JS, Eisbruch A; et al. (2010). “Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence”. Clin Cancer Res. 16 (4): 1226β35. doi:10.1158/1078-0432.CCR-09-2350. PMCΒ 2822887. PMIDΒ 20145161.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
