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Human papillomavirus 

Human papillomavirus
Chapter:
Human papillomavirus
DOI:
10.1093/med/9780198729228.003.0096
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date: 17 June 2019

Human papillomaviruses (HPV) are small, non-enveloped, double-stranded, epitheliotropic DNA viruses. Sequencing of the capsid gene has identified over 100 different types. HPV are divided into cutaneous and mucosal types, depending on the epithelium they infect. High-risk (oncogenic) HPV are involved in 100% of cervical cancers and 90% of anal cancers (HPV-16 and 18). Cutaneous warts are uncommon in infancy, increase in frequency in childhood, and reach a peak in the teenage years, occurring with equal frequency in both sexes. They are seen worldwide and in all age groups; most people will have had warts at some time. Cell-mediated immune responses are important for host control of wart infections; impaired cell-mediated immunity is associated with markedly increased incidence and extensive spread of viral warts, as well as involvement of multiple HPV types. Genital warts are a very common sexually transmitted infection. For the sexually active population, the overall lifetime risk of acquiring HPV is about 75%. There is no curative treatment for HPV, and many warts disappear spontaneously. Recurrence of warts after treatment is common. Indications for treatment are pain, interference with function, and psychological morbidity. There is a lack of evidence regarding the efficacy of treatments for non-genital warts. Vaccination is the most effective means of prevention. Current vaccines, based on virus-like particles, are extremely effective in providing protection from infection in almost 100% of cases. There are two vaccines: bivalent (HPV-16/18) and quadrivalent (HPV-6/11/16/18). Studies are required to assess their long-term efficacy.

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