Human papillomavirus natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

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

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 associated with the human papilloma virus infection include:[11][12][13][14][15][16][17][18]

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

Bad prognostic factors

References

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  2. 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): 1808–16. doi:10.1086/428779. PMID 15871112.
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  11. 11.0 11.1 http://www.cdc.gov/hpv/parents/vaccine.html Accessed on October 11, 2016
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  16. 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): 709–20. PMID 10793107.
  17. 17.0 17.1 Beachler DC, DʼSouza G (2013). "Oral human papillomavirus infection and head and neck cancers in HIV-infected individuals". Curr Opin Oncol. 25 (5): 503–10. doi:10.1097/CCO.0b013e32836242b4. PMC 3896303. PMID 23852381.
  18. 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): 1048–56. doi:10.1016/S1470-2045(10)70230-8. PMID 20952254.
  19. 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): 809–14. doi:10.6061/clinics/2013(06)14. PMC 3674251. PMID 23778490.
  20. 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): 277–81. PMID 12151187.
  21. 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. PMC 4140713. PMID 25144309.
  22. 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): 34–40. doi:10.1158/1940-6207.CAPR-11-0496. PMC 3252428. PMID 22135046.
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