Human papilloma virus (HPV) refers to a group of more than 150 related viruses that cause warts (papillomas) on different parts of the body including the hands, feet, genitals, or anus. It is one of the most common STDs and although most HPV infections self-resolve, some types can cause cervical cancer in women and anal cancers in both men and women.
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Human Papilloma Virus (HPV)
Up to 75% of sexually active males and females will have an HPV infection at some point in their lifetime and symptoms are generally mild or non-existent. Most HPV infections (about 70%) go away without any treatment within 1–2 years. However, there are over 40 types of HPV and becoming immune to one type does not protect an individual from becoming infected with another type. Persistent infection with high-risk HPV types over many years can cause precancerous changes leading to cervical cancer, which is the second most common cancer in women worldwide, second only to breast cancer.
HPVs are grouped into types based on their degree of causing cancer. Low-risk HPV types such as HPV-6 and HPV-11, are rarely associated with cancer and are the major cause (99%) of genital warts. High-risk HPV types that are known to cause cancer, including HPV-16, HPV-18, HPV-31, HPV-33, HPV-35, HPV-39, HPV-45, HPV-51, HPV-52, HPV-56, HPV-58, HPV-59 and HPV-68. The most common high-risk types are HPV-16 and HPV-18 which cause about 70% of cervical cancers. HPV infection with HPV 16 or 18 can also cause anal, vaginal, vulvar, penile and some oral cavity and oropharyngeal cancers. HPV-33 has also been found in cancer of the anus and vulva.
Traditionally, genital HPV infection is detected by a Pap smear and does not distinguish between high- and low-risk types. There are several DNA HPV tests, some of which are approved for marketing by the FDA, that can detect high-risk types of HPV. However, in developing countries where more than 85% of cervical cancer deaths occur, the resources, infrastructure, and technological expertise and the need for repeated screening at frequent intervals, have made conventional molecular and cytology-based (Pap smear) screening prohibitively difficult. Ideally, screening tests suitable for low resource settings should be simple, rapid, cost effective and provide information regarding the HPV oncogenic activity.
Research has demonstrated that both HPV E6 and E7 oncoproteins mediate the development of cervical cancer. Their overexpression, which can be measured by mRNA transcripts or protein expression, directly correlates with the severity of cervical histopathology and the risk for precancerous progression. Many commercial assays now include the detection of E6 and E7 proteins for HPV-16 and HPV-18, in which positive results suggest an increased risk of cervical cancer.
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