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Papillomavirus (HPV)

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Key Points

  • Human Papillomavirus (HPV)
    • Characteristics
      • DNA virus
        • Replicates in nucleus
        • Double-stranded
      • No envelope
      • Circular chromosome
    • Transmission
      • Sexually transmitted
        • Most common sexually transmitted disease
        • Barrier contraception (e.g. condoms) is protective
      • May also be spread through direct skin-to-skin contact
    • Pathogenesis and Presentation
      • Warts
        • Serotypes 1, 2
          • Cutaneous warts
        • Serotypes 6,11
          • Condyloma acuminata (anogenital warts) 
            • Soft, tan, cauliflower-like masses on genitals
            • Low oncogenic potential
          • Laryngeal warts
      • CIN/cervical cancer
        • Serotypes 16, 18, 31, 33 (over 16)
          • Also serotypes 35, 51
        • Viral oncogenes are integrated into host cell genomes
          • E6 degrades p53 protein (tumor suppressor)
          • E7 binds to Rb protein (tumor suppressor)
          • Immunosuppression (e.g. HIV) promotes oncogenesis by reducing immune monitoring
        • May cause other cancers (head and neck, anal, penile)
    • Diagnosis
      • PCR is gold-standard
      • Pap smear may detect cervical lesions
    • Treatment
      • Self-resolving
      • Cryotherapy (removal of warts), surgery/chemo for cancer
    • Vaccination
      • Gardasil 9 in US
        • Targets 1,6, 16, 18, 31,33, 45, 52, 58
        • Used in young men/women (ages 9-26)