Review
English
Laprise C 1,2, Mariano C3, Duarte-Franco E 1,4, Steben M 1,5
1-Institut national de santé publique du Québec (INSPQ), Montreal. 2-PhD Candidate, University of Montreal, Montreal. 3-Resident, Internal Medicine, University of British Columbia. 4-Departments of Family Medicine and Obstetrics & Gynecology, McGill University, Montreal. 5-Vulvar disease clinic, Hôpital Notre- Dame, Centre hospitalier de l’Université de Montréal, Canada.
Libyan J Infect Dis. 2009;3(1):3-12
Abstract
More than 120 different human papillomaviruses (HPV) genotypes or types for short have been identified, of which a group of 40 genotypes can infect the anogenital area. The preferential mode of transmission of these HPVs is through sexual activity. Genital HPVs infections are quite common: 4 out of 5 adults living in industrialized countries are infected at least by one genotype in their lifetime. Data is unknown about this frequency in most of developing countries. Different HPV types are associated with a variety of diseases, from infection without disease to non malignant conditions to premalignant and finally malignant conditions. HPV are considered carcinogenic to humans. Indeed many HPV types of the anogenital area are capable of inducing cell transformation especially where there is a transformation zone. Anogenital types have been classified regarding their risk of being found in cervical cancer as high, moderate or low risk. In fact, when speaking of cervical cancer, HPV infection has been demonstrated to be a necessary cause, albeit not sufficient. Most prominently, cervical cancer is placed in the list of diseases associated with HPV infection because it is the most important cause of years of life lost and the second cause of mortality for women living in developing countries. The HPV types most frequently associated with cervical cancer are the types 16 and 18 therefore, these have been the targets chosen for vaccine development. Although non malignant, external genital warts are usually associated with important psychosexual burden to affected patients and at times to cancer of the larynx, vulva, penis and anus. Also there is major stigma and psychological impairment associated with these conditions. There are no curative treatments and available alternatives are many times mutilating and painful. These are the reasons why some HPV vaccines have also targeted HPV types 6 and 11 the main culprits for these conditions. Cytology has significantly decreased cervical cancer morbidity and mortality over the past 50 years, however, even in developed countries such benefits have leveled off; in addition, it is not used for screening of genital warts. An effective prevention program will need to include HPV vaccination in the armament against anogenital HPV-related disease, in addition to Pap cytology. In this article we briefly review the epidemiology, clinical picture and prevention alternatives for these conditions.
Keywords: Human Papillomaviruses, epidemiology, prevention, vaccines.
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