Introduction:
It’s a dna virus. It is an epitheliotropic virus which means for completion of its life cycle , it requires an intact squamous cell. Different subtypes of virus
| Low risk subtypes: | HPV 6 and 11 |
| High risk subtypes: | HPV 16,18,31,33,45,52,58. |
- Low risk sub types cause infective conditions like genital warts, laryngeal papilloma.
- High risk sub types have oncogenic potency and can lead to cancer cervix, cancer vulval vaginal cancer, laryngeal cancer, oral cancer, cancer penis ,anal cancer.
- Most common HPV leading to cancer cervix: HPV 16 in 55 % of cases.
- Most specific HPV leading to cancer cervix is HPV 18
- By 2022 there will be approximately 660,000 new cases of cervical cancer worldwide, making it the fourth most common cancer worldwide and the most common cause of this cancer is HPV virus. And cancer cervix can be prevented by screening and HPV vaccination.
What is HPV infection:
It causes various conditions like genital warts, cervical cancer,vulval cancer, Ca vaginal,oral cancer, cancer penis, analysis cancer.
Course of infection:
| Mostly | Spontaneous clearance no treatment required |
| Sometimes | Latent infection cases warts |
| If infection persists | >6 months in E6,E7 genes are expressed causes cancer cervix |
Genes of HPV virus:
Early genes: ‘E’ genes expressed in basal and para basal layers
Late genes:’L’ genes expressed in surface layer
| Early genes | E1,E2,E4,E6,and E7 | E1, E2 for viral replication
E6, E7 for malignant transformation E6 knocks out p53 gene E7 knocks out retinoblastoma gene |
| Late genes | L1 and L2 | L1 major capsid protein: HPV vaccines are made out of this.
L2 minor capsid protein |
Types of warts caused by HPV:
| Common warts | Appearances:Rough, raised, cauliflower like surface
Site: on hands, finger, elbow, knees Caused by HPV type 2,4,27,57. |
| Planter warts | Appearances: Hard painful warts
Site : soles Caused by HPV 1,2,4,63 |
| Filiform warts | Appearances: long,slender,finger like projection
Site: on face Caused by HPV 1,2,4,27,29 |
| Anogenital warts | Appearances:Soft flesh colored cauliflower like.
Site : anal region, genital region Caused by HPV 6 and 11 |
| Flat warts | Appearances:Smooth , flat topped, skin colour or slightly brown
Site: neck,face,hand, wrist,knees. Caused by HPV 3,10,28,49 |
| Epidermodysplasia verruciformis warts | Rare seen in immunodeficiency
Appearances: flat, scaly lesion resembles pityriasis versicolor Caused by HPV 5,8,20,47(associated with higher risk of skin cancer) |
Mode of transmission:
| Sexual transmission | Most common
Vaginal, anal,oral sex with an infected partner Skin to Skin contact in the genital area even without penetrations |
| Non sexual direct contact | Hand to genital or genital to genital contact
Touching warts and then another area of skin |
| Vertical transmission | Mother to child
During vaginal delivery Can cause juvenile onset recurrent respiratory papillomatosis in infants |
| Fomites | Rare
Through contaminated objects |
Causes
Risk factor: Sexual factor: early age at first sexual intercourse, multiple sexual partner, having partner with multiple partner, unprotected sex
Host factor: weak immune system like HIV infection ,on immunosuppressive drugs, poor nutrition,co-existing STDs like chlamydia , herpes , female sex ( cervical transformation zone is highly vulnerable that’s why pap is taken from this zone .
Lifestyle factors like smoking, long term use of ocp, poor genital hygiene
Obstetrics/ gynecological factor like high parity, history of cervical dysplasia or precancerous lesion
Symptoms and when to seek help:
Asymptomatic, genital warts, persistent infection with high risk strain like 16,18, abnormal vaginal discharge, abnormal vaginal bleeding, pelvic pains and pain during intercourse.
Treatment:
There is no specific antiviral drug against HPV
WHO approach for HPV
Screen-and-treat approaches:
1 HPV mRNA as the primary screening test, followed by treatment
Screen, triage and treat approaches:
2 HPV mRNA as the primary screening test, followed by VIA triage, followed by
treatment
3 HPV mRNA as the primary screening test, followed by colposcopy triage,
followed by treatment
4 HPV mRNA as the primary screening test, followed by cytology triage, followed
by colposcopy and treatment
Critical outcomes for the screening and treatment recommendations:
Cervical cancer
Mortality
High-grade cervical intraepithelial neoplasia or worse (CIN2+)
HPV infection
Preterm birth
Pre-cancer treatments
Adverse events (direct consequence of pre-cancer treatment):
– major infections or bleeding
– procedure-associated pain
– cervical stenosis
– infertility
– spontaneous abortion
– perinatal deaths
– premature rupture of membrane
– unnecessary interventions
– increased viral shedding in women living with HIV
Costs
Equity
Acceptability
Feasibility
Treatment options are:
HPV (human papillomavirus) infection itself usually does not require treatment—most infections clear on their own within 1–2 years due to the immune system.
However, treatment is needed for the conditions caused by HPV, such as genital warts, precancerous lesions, or cancers.
- Genital Warts (caused by low-risk HPV types like 6, 11)
Topical treatments :
- Podophyllotoxin / Podophyllin resin
- Imiquimod cream (stimulates immune response)
- Trichloroacetic acid (TCA)
- Procedural treatments:
- Cryotherapy (freezing with liquid nitrogen)
- Electrocautery
- Surgical excision
- Laser therapy
- Cervical Precancerous Lesions (CIN)
- Ablative therapies:
- Cryotherapy
- Laser ablation
- Excisional procedures:
- LEEP (Loop Electrosurgical Excision Procedure)
- Cold knife conization
- HPV-related Cancers (cervical, anal, oropharyngeal, penile, vulvar, vaginal)
- Standard oncology treatments depending on stage:
- Surgery
- Radiation therapy
- Chemotherapy (e.g., cisplatin-based regimens)
- Targeted therapy / immunotherapy in advanced cases
Prevention:
- HPV vaccination is the best prevention .
Dosage schedule:
Age >15 : 3 doses,1-2 months between ist and 2nd , 6 months for 1-3rd.
Age<15 2 doses 1-2 dose 6 months apart.
WHO – SAGE recommendation April 2022
*9-14 yr 1or2 doses,
* 15-20yr 1 or 2 doses,
more than 21yr 2 doses,
HIV positive 2 doses.
- Safe sexually practice (condoms reduce,but don’t fully prevent hpv)
- Regular cervical screening by pap smear , HPV DNA testing.
HPV vaccination guidelines (based on WHO, CDC, and Indian guidelines):
- Age of Vaccination
Routine age: 9–14 years (before sexual debut, best immune response).
Catch-up vaccination:
Females: up to 26 years
Males: up to 21 years (up to 26 years if MSM or immunocompromised, including HIV).
Some guidelines (like ICMR, 2023) recommend vaccination for boys and girls 9–26 years.
- Dose Schedule
9–14 years:
2-dose schedule (0 and 6–12 months).
≥15 years or immunocompromised:
3-dose schedule (0, 1–2 months, 6 months).
- Types of Vaccines
- Bivalent (Cervarix) → HPV 16, 18 (oncogenic types).
- Quadrivalent (Gardasil) → HPV 6, 11, 16, 18 (covers warts + cancer).
- 9-valent (Gardasil 9) → HPV 6, 11, 16, 18, 31, 33, 45, 52, 58 (broadest protection).
- Special Recommendations
Pregnancy → HPV vaccine not recommended. If given accidentally, no need to terminate pregnancy, but further doses deferred.
Breastfeeding → Can be given safely.
Immunocompromised / HIV → Give 3 doses, regardless of age.
Screening: Vaccination does not replace cervical cancer screening (Pap smear / HPV DNA testing must continue).
- Key Points for Exams
Best age: 9–14 years before sexual debut.
<15 yrs = 2 doses, ≥15 yrs or immunocompromised = 3 doses.
Prevents cervical, anal, oropharyngeal cancers, and genital warts.
Still recommended even if sexually active (but less effective if already exposed).
FAQs
- What is HPV?
Human Papillomavirus → DNA virus (Papillomaviridae family).
> 200 types, divided into:
Low-risk → 6, 11 (cause genital warts).
High-risk → 16, 18, 31, 33, 45… (cause cancers).
- How is HPV transmitted?
Primarily through sexual contact (vaginal, anal, oral).
Can also spread via skin-to-skin contact, rarely via fomites.
- What diseases does HPV cause?
Benign: Genital warts, laryngeal papillomatosis.
Precancerous lesions: CIN, VIN, AIN.
Cancers: Cervical, vulvar, vaginal, anal, penile, oropharyngeal.
- Does HPV infection always cause symptoms?
No — most infections are asymptomatic and clear within 1–2 years.
- Can HPV be cured?
The virus itself has no antiviral cure.
But warts, precancerous lesions, or cancers caused by HPV can be treated.
- Who should get the HPV vaccine?
Girls & boys: 9–14 years (best before sexual debut).
Catch-up: Females up to 26 yrs, males up to 21 yrs (26 yrs if MSM / HIV+).
- Does the vaccine help if already sexually active?
Yes, it can still provide protection against types not yet acquired,
but efficacy is highest before exposure.
- Does HPV vaccination eliminate the need for cervical cancer screening?
No. Screening must continue (Pap smear / HPV DNA) as vaccines don’t cover all oncogenic types.
- Is the HPV vaccine safe?
Yes. Well-tolerated. Side effects: pain, redness at injection site, mild fever.
- Can HPV infection be prevented other than vaccination?
Condom use (reduces but doesn’t fully prevent).
Limiting the number of partners.
Smoking cessation (smoking increases persistence).
- Is HPV only a women’s issue?
No. Men can also get HPV → genital warts, anal cancer, penile cancer, oropharyngeal cancer.
- Can HPV be transmitted during pregnancy?
Yes, rarely → may cause juvenile laryngeal papillomatosis in newborn via birth canal.
