What is Human Papillomavirus (HPV)?

From the Guidelines

HPV vaccination is strongly recommended for all children at age 11-12, but can be given as early as age 9 and up to age 45, with a standard regimen of two doses for those who start before age 15 and three doses for those who start at age 15 or older, as it has been shown to be highly effective in preventing HPV-related cancers and diseases, as demonstrated in studies such as 1 and 1. The HPV vaccine (Gardasil 9) is the recommended vaccine, and it has been shown to provide protection against HPV types 16 and 18, which are responsible for approximately 70% of HPV-related cancers, as well as types 6 and 11, which are responsible for 90% of genital warts, as noted in 1. For those already infected, treatment depends on the manifestation, with genital warts being treatable with topical medications like imiquimod 5% cream or podofilox 0.5% solution/gel, or surgical removal, as discussed in 1. Regular cervical cancer screening is essential for early detection of HPV-related precancerous changes, with Pap tests recommended every 3 years for women 21-65, or Pap plus HPV co-testing every 5 years for women 30-65, as recommended in 1. Some key points to consider when implementing HPV vaccination include:

• The vaccine is most effective when given before sexual debut, as noted in 1 and 1
• The standard regimen is two doses for those who start before age 15 and three doses for those who start at age 15 or older, as recommended in 1 and 1
• HPV infections are often asymptomatic and can clear spontaneously, but persistent high-risk HPV types can lead to cellular changes that may progress to cancer over years or decades, which is why both vaccination and screening are important preventive measures, as discussed in 1, 1, and 1. Healthcare providers play a crucial role in recommending and administering the HPV vaccine, and their strong endorsement is more influential than a weak one, as noted in 1. Overall, HPV vaccination is a critical strategy for cancer prevention, and healthcare providers should prioritize recommending and administering the vaccine to all eligible individuals, as emphasized in 1 and 1.

From the Research

Human Papillomavirus (HPV) Overview

• HPV is a significant cause of cervical cancer in the United States 2
• The HPV vaccine is approved for individuals aged 9-26 years and some individuals up to age 45 years 2

HPV Vaccination Efficacy

• The HPV vaccine is a safe and highly effective way to prevent cervical cancer 2
• HPV vaccination after loop electrosurgical excision procedure (LEEP) reduces the risk of recurrence of cervical dysplasia 3
• Administration of an HPV vaccine after LEEP seems to reduce the risk of recurrence, suggesting that HPV vaccination has a role as an adjuvant treatment after LEEP 3

Treatment of Cervical Intraepithelial Neoplasia (CIN)

• LEEP and cold knife cone (CKC) are often used for the treatment of high-grade cervical intraepithelial lesions 4
• LEEP is an in-office procedure with less discomfort and fewer complications than CKC, but concerns related to LEEP include the interpretability of the resection margins and positive margins 4
• The residual/recurrent rate for cervical dysplasia after LEEP is approximately 2.9% 4

Adjuvant HPV Vaccination

• Adjuvant HPV vaccination in women with CIN who undergo LEEP may reduce the risk of recurrence of CIN 5
• A randomized controlled trial is being conducted to evaluate the efficacy of nonavalent HPV vaccination in preventing recurrent CIN II-III after 24 months 5

Comparison of Treatment Options

• Cryotherapy, cold knife, and thermocoagulation are alternative treatments for CIN, but their efficacy and safety compared to LEEP vary 6
• Cold knife treatment decreases the risk of residual disease compared to LEEP, while cryotherapy increases the risk of disease recurrence and infections 6