Minnesota Department of Health Human Papillomavirus (HPV)

Minnesota Department of Health What is HPV Infection? Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection in the United States. There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Source CDC, 2011

Minnesota Department of Health What is HPV Infection? Most people who become infected with HPV do not even know they have it. At least 50% of sexually active people will have genital HPV at some time in their lives. HPV is not the same as herpes or HIV (the virus that causes AIDS) even though it is sexually transmitted. Source CDC, 2011

Minnesota Department of Health HPV

Minnesota Department of Health Symptoms and Pathogenesis Source : CDC

Minnesota Department of Health Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.  The types of HPV that can cause genital warts are not the same as the types that can cause cancers. Source CDC

Minnesota Department of Health There is no way to know which people who get HPV will go on to develop cancer or other health problems. Source CDC

Minnesota Department of Health But, sometimes, HPV infections are not cleared and can cause: Genital warts Rarely, warts in the throat Cervical cancer and other, less common but serious cancers( cancers of the vulva, vagina, penis, anus, and back of throat). Source CDC

Minnesota Department of Health Genital warts usually appear as a small bump or group of bumps in the genital area. Warts can appear within weeks or months after sexual contact with an infected partner (even with asymptomatic infected partner). Untreated genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer. Source CDC

Minnesota Department of Health Cervical cancer usually does not have symptoms until it is quite advanced. It is therefore important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer. Source CDC

Minnesota Department of Health Recurrent Respiratory Papillomatosis (RRP) is a condition in which warts grow in the throat. When this occurs in children it is called juvenile-onset RRP (JORRP). These growths can sometimes block the airway, causing a hoarse voice or troubled breathing. Source CDC

Oral warts

warts

warts

Mouth Cancer from HPV

Minnesota Department of Health Epidemiology

Minnesota Department of Health Approximately 20 million Americans are currently infected with HPV. 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives. Source CDC

Minnesota Department of Health Genital warts: about 1% of sexually active adults in the U.S. have genital warts at any one time. RRP: is very rare, less than 2,000 children get juvenile-onset RRP every year in the U.S. Cervical cancer: each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated. Source CDC

Minnesota Department of Health Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about: 1,500 women who get HPV-associated vulvar cancer 500 women who get HPV-associated vaginal cancer 400 men who get HPV-associated penile cancer Source CDC

Minnesota Department of Health Each year in the U.S., there are about: 2,700 women and 1,500 men who get HPV-associated anal cancer 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers. Source CDC

Minnesota Department of Health Gay bisexual men, and people with weak immune systems (including those who have HIV/AIDS) are at higher risk for some HPV-related health problems. Source CDC

Human Papillomavirus—Prevalence of High-risk and Low-risk Types Among Females Aged 14–59 Years, National Health and Nutrition Examination Survey, 2003–2006 50–59 40–49 30–39 25–29 20–24 14–19 Low-risk HPV* Prevalence, % High-risk HPV* Age 10 20 30 40 50 60 * HPV = human papillomavirus. NOTE: Error bars indicate 95% confidence intervals. Both high-risk and low-risk HPV types were detected in some females. SOURCE: Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital HPV among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. J Infect Dis. 2011;204(4):566-73

Genital Warts—Initial Visits to Physicians’ Offices, United States, 1966–2010 100 200 300 400 500 2008 2005 2002 1999 1996 1993 1990 1987 1984 1981 1978 1975 1972 1969 1966 Visits (in thousands) Year NOTE: The relative standard errors for genital warts estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.

STD Surveillance Network (SSuN)—Genital Warts—Prevalence Among Sexually Transmitted Disease (STD) Clinic Patients by Sex, Sex of Partners, and Site, 2010 Philadelphia Baltimore Richmond New Orleans Chicago Denver Seattle Los Angeles San Francisco MSW* MSM* Percentage Women 3 6 9 12 15 Birmingham New York City Hartford/ New Haven * MSM = men who have sex with men; MSW = men who have sex with women only.

Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2010 50 100 150 200 250 300 350 400 Visits (in thousands) Year 2008 2005 2002 1999 1996 1993 1990 1987 1984 1981 1978 1975 1972 1969 1966 NOTE: The relative standard errors for genital herpes estimates of more than 100,000 range from 18% to 30%. SOURCE: IMS Health, Integrated Promotional Services™. IMS Health Report, 1966–2010.

Herpes Simplex Virus Type 2—Seroprevalence in Non-Hispanic Whites and Non-Hispanic Blacks by Age Group, National Health and Nutrition Examination Survey, 1976–1980, 1988–1994, 1999–2004, 2005–2008 1976–1980 1988–1994 1999–2004 2005–2008 20 40 60 80 100 40–49 30–39 20–29 14–19 All Ages* Percentage Non-Hispanic Whites Age Non-Hispanic Blacks * Age-adjusted by using the 2000 U.S. Census civilian, non-institutionalized population aged 14–49 years as the standard. NOTE: Error bars indicate 95% confidence intervals.

Minnesota Department of Health Risk factors

Transmission HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms. Source CDC

Transmission A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons are unaware of their infectiousness and capacity to infect their sex partner. It is also possible to get more than one type of HPV. Source CDC

Transmission Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop symptoms Source CDC

Minnesota Department of Health Prevention

The vaccines are most effective when given at 11 or 12 years of age. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age. Source CDC

These vaccines can also be given to girls beginning at 9 years of age. Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. Either vaccine is recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls beginning at 9 years of age. Source CDC

This vaccine is available for boys and men, 9 through 26 years of age. Boys and men: One available vaccine (Gardasil) protects males against most genital warts and anal cancers. This vaccine is available for boys and men, 9 through 26 years of age. Source CDC

For sexually active individuals: condoms may lower the risk of HPV For sexually active individuals: condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV. Source CDC

But even people with only one lifetime sex partner can get HPV. People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. That's why the only sure way to prevent HPV is to avoid all sexual activity. Source CDC

Minnesota Department of Health Treatment

Minnesota Department of Health There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause: Visible genital warts:  can be removed by the patient him or herself with prescribed medications. Cervical cancer:  is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Source CDC