Human Papillomaviruses : Disease Burden in the United States

Human Papillomaviruses : Disease Burden in the United States

Anogenital HPV infection is believed to be the most common sexually transmitted infection in the United States. An estimated 79 million persons are infected, and an estimated 14 million new HPV infections occur annually with half of these in persons 15-24 years.

The two most common types of cervical cancer worldwide, squamous cell carcinoma followed by adenocarcinoma, are both caused by HPV. The CDC and National Cancer Institute’s United States Cancer Statistics Working Group reports that from 2005 through 2009 there were annual averages of 12,595 cases and 3,968 deaths due to cervical cancer. HPV is believed to be responsible for nearly all of these cases of cervical cancer. HPV types 16 and 18 are associated with 70% of these cancers.

In addition to cervical cancer, HPV is believed to be responsible for 90% of anal cancers, 71% of vulvar, vaginal, or penile cancers, and 72% of oropharyngeal cancers.

Population-based estimates, primarily from clinics treating persons with sexually transmitted infections, indicate that about 1% of the sexually active adolescent and adult population in the United States have clinically apparent genital warts. More than 90% of cases of anogenital warts are associated with the low-risk HPV types 6 and 11.

About 8 billion dollars are spent annually on management of sequelae of HPV infections, primarily for the management of abnormal cervical cytology and treatment of cervical neoplasia. This exceeds the economic burden of any other sexually transmitted infection except human immunodefi­ciency virus.

Prevention

HPV Infection
HPV transmission can be reduced but not eliminated with the use of physical barriers such as condoms. Recent studies demonstrated a significant reduction in HPV infection among young women after initiation of sexual activity when their partners used condoms consistently and correctly. Abstaining from sexual activity (i.e., refraining from any genital contact with another individual) is the surest way to prevent genital HPV infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections.

Cervical Cancer Screening
Most cases and deaths from cervical cancer can be prevented through detection of precancerous changes within the cervix by cervical cytology using the Pap test. Currently available Pap test screening can be done by a conventional Pap or a liquid-based cytology. CDC does not issue recom­mendations for cervical cancer screening, but various professional groups have published recommendations. Cervical cancer screening recommendations were revised in 2012 after the U.S. Preventive Services Task Force (USPSTF) and a multidisciplinary group, including the American Cancer Society (ASC), American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) reviewed new evidence. Previously, recommendations varied by organization. Since 2012, all organizations have recommended that screening should begin at age 21 years.

While there are slight differences in other aspects of the recommendations, all groups recommend screening in women aged 21 to 65 years with cytology (Pap test) every 3 years. For women aged 30 to 65 years who want to lengthen the screening interval, screening can be done with a combination of cytology and HPV testing (“co-testing”) every 5 years.

The use of HPV vaccine does not eliminate the need for continued Pap test screening, since 30% of cervical cancers are caused by HPV types not included in the vaccine.

Human Papillomaviruses : Disease Burden in the United States 2019-01-08T08:24:00-08:00 Rating: 4.5 Diposkan Oleh: David Maharoni