Human Papillomavirus Management

Prevention

The American College of Physicians and other guideline societies recommend routine HPV vaccination for females and males aged 11-12 years, though it can start as early as age 9, as stated by the Centers for Disease Control and Prevention 1
Catch-up vaccination is recommended for females through age 26 and males through age 21 (through age 26 for MSM and immunocompromised persons), according to the Centers for Disease Control and Prevention 1, 3
The nonavalent vaccine (9vHPV) provides protection against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, potentially preventing approximately 90% of cervical and other HPV-related cancers, as reported by the National Cancer Institute 1
Condom use may reduce the risk for HPV and HPV-associated diseases; studies have demonstrated a 70% reduction in HPV infection when partners used condoms consistently and correctly, as found by the Centers for Disease Control and Prevention 1, 4
Abstaining from sexual activity is the surest way to prevent genital HPV infection, as stated by the Centers for Disease Control and Prevention 4
For sexually active individuals, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections, according to the Centers for Disease Control and Prevention 4

The American College of Obstetricians and Gynecologists recommends that all women should have a Pap test for cervical cancer screening within 3 years of beginning sexual activity or by age 21 years, whichever occurs first, as stated by the American Cancer Society 1, 4
Women aged >30 years with three normal consecutive Pap tests should be screened every 2-3 years, according to the American College of Obstetricians and Gynecologists 1
HPV testing as an adjunct to routine Pap test may be appropriate in certain populations, as reported by the American Society for Clinical Pathology 3
Consideration should be given to increasing the screening interval to 3 years if both Pap and HPV testing results are negative in women aged >30 years, as recommended by the American College of Obstetricians and Gynecologists 3
Data are insufficient to recommend routine anal cancer screening with anal cytology in persons living with HIV/AIDS or HIV-negative MSM, as stated by the Infectious Diseases Society of America 2, 5
An annual digital anorectal examination may be useful for early detection of anal cancer in high-risk populations, according to the American Cancer Society 2

Treatment options for cervical, vaginal, and vulvar cancer precursors include various local approaches that remove the lesion (e.g., cryotherapy, electrocautery, laser therapy, and surgical excision), as reported by the American Society for Colposcopy and Cervical Pathology 4
A new formulation of imiquimod (3.75% cream) is also recommended for AGW treatment, according to the Infectious Diseases Society of America 5

HPV vaccination is recommended for all HIV-infected males and females in a 3-dose series at 11 or 12 years of age, and for those 13-26 years of age if not previously vaccinated, as stated by the Centers for Disease Control and Prevention 3
HIV-infected MSM with HPV infection are at increased risk for anal dysplasia and cancer, according to the Infectious Diseases Society of America 3
If anal cytologic screening (anal Pap smears) is performed and indicates abnormal findings, then high-resolution anoscopy should be performed with biopsy of abnormal areas, as recommended by the American Society for Colposcopy and Cervical Pathology 3
When HPV testing is carried out, it should be accompanied by evidence-driven and patient-centered counseling to minimize negative psychosocial outcomes, as reported by the European Society for Medical Oncology 6, 7
Education should focus on illness, treatment, symptom burden, and sexual behaviors associated with an increased risk of HPV transmission, according to the American Cancer Society 8
Counseling for emotional support can be provided through enhanced coping techniques and delivering resources and information, as stated by the National Comprehensive Cancer Network 8

HPV vaccination does not protect against persistent infection, cervical cancer precursor lesions, or genital warts caused by an HPV type that individuals are infected with at the time of vaccination, as reported by the Centers for Disease Control and Prevention 1
Neither routine surveillance for HPV infection nor partner notification is useful for HPV prevention, according to the American College of Obstetricians and Gynecologists 4
HPV infection is so prevalent that the majority of partners of persons found to have HPV infection are infected already, as stated by the Centers for Disease Control and Prevention 4
Smoking has been linked with an increased prevalence of oral HPV infection and is associated with a worse prognosis, as reported by the American Cancer Society 7