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HPV infection : Treatment &


by Stephanie Chieng Mei Ling

 HPVhuman papillomavirus
 Is a virus that infect skin and mucous membranes of humans
 When someone is infected with HPV, the condition that results
will depend a lot on which type of HPV virus is transmitted and
the location of transmission. Some diseases that HPV can cause
- Warts, including common warts (verrucae vulgaris),
plantar(foot) warts (verrucae plantaris), and flat warts (verrucae
- Genital warts
- Cervical cancer
- Other precancerous lesions or cancer, including on the penis,
anus, vagina, and vulva
Introduction (cont)
- Laryngeal papillomas, which are noncancerous tumors on the
larynx (voice box), vocal cords, or the air passages leading
from the nose into the lungs (respiratory tract).  
 About 30-40 HPV types are typically transmitted through
sexual contact and infect the anogenital region. Some
sexually transmitted HPV types may cause genital warts.
 HPV infection is also the cause of nearly all cases of cervical
HPV Types and Associated 
Disease HPV types
Plantar warts 1, 2, 4
Common warts 1, 2, 4, 26, 27, 29, 41, 57
Flat warts 3, 10, 27, 28, 41, 49
Genital warts 6, 11, 30, 40-45, 51, 54
Cervical cancer 16, 18, 31, 33, 35, 39, 45, 51, 52, 56,
Precancerous changes 16, 18, 34, 39, 42, 55
Laryngeal papillomas 6, 11, 30
High & low risk types
 HPV research scientists have separated HPV types into:
"high-risk" types which are more likely to lead to the
development of cancer, while "low-risk" viruses
rarely develop into cancer.
 Low-risk HPV types can cause no symptoms or may cause
conditions such as genital warts, but do not cause cervical
cancer. Warts can form weeks, months, or even years after
sexual contact with a person who has genital HPV.
 HPV infection occurs when the virus enters the body through a
cut, abrasion or imperceptible tear in the outer layer of the skin.
 Is transferred primarily by skin-to-skin contact.
 HPV infections that associated with genital warts and related
lesions are contracted through sexual intercourse, anal sex and
other skin-to-skin contact in the genital regions.
 Some HPV infections that result in oral or upper respiratory
lesions are contracted through oral sex.
Pictures of Some Warts

Plantar warts Tongue warts filiform wart common warts

flat warts
smaller and smoother than other kinds
of warts and tend to grow in large
Tests available
 The HPV test on the market is only used as part of cervical
cancer screening.
 Genital warts by visual inspection.
 Cervical cell changes (early signs of cervical cancer) identified
by routine Pap tests (pap smear). The HPV test can identify high-
risk HPV types on a woman’s cervix, which can cause cervical
cell changes and cancer.
 In Malaysia, all women who are, or who have been sexually
active, between the ages of 20 and 65 years, are recommended to
undergo Pap smear testing. If the first two consecutive Pap
results are negative, screening every three years is recommended.
 There is no treatment for the virus itself, as a healthy immune
system can usually fight off HPV naturally.
 There are a numbers of OTC products and home remedies
available to remove warts. These treatments appear to reduce
the concentration of HPV, but they don't eliminate the virus.
 OTC treatment for common skin warts are usually based upon
the use of products containing salicylic acid.
OTC products
 Salicylic acid preparations
 These are available as drops, gels, pads, and plasters. They
are designed for application to all kinds of warts, from tiny
ones to great, big lumpy ones.
 Salicylic acid is a keratolytic medication, which means it
dissolves the protein (keratin), which makes up most of both
the wart and the thick layer of dead skin that often tops it.
 Generally, the acid must be placed directly on the wart every
day for weeks or months to soften the warts.
 Duct tape
 A study in 2002 reported findings that showed that duct tape
wiped out more warts than cryotherapy did.
OTC products (cont)
 The "duct tape therapy" used in this study included covering
warts with duct tape for six days and peel off on 7th day, then
soaking the warts in warm water and rubbing them with an
emery board or pumice stone. The process was repeated for as
long as two months.
 However, more recent research has not found duct tape to be
significantly effective for treating warts.
 This treatment maybe hard to use, because in order to work,
the tape must be left in place all the time and removed only on
selected day(s) in the week. Almost always, the tape falls off.
Home Remedies
 Banana peel  Use fresh banana peel pieces & place the
yellow side out each day on the affected areas & covered with
bandage for overnight. Change q 12-24hrs.
 Garlic  Crush a glove of garlic and place on area(s) with
warts & cover with bandage.
 Pineapple  Apply fresh cut pineapple on warts several times
a day will remove warts in 2-3 days.
 Chalk/ raw potato  Rubbing a piece of chalk or raw potato on
the area frequently will remove the wart in few weeks.
Other Treatments
 If OTC products & home remedies isn’t helping, may seek
medical advice. Doctors usually start with the least painful,
least destructive methods, especially in young children.
 Freezing with liquid nitrogen (cryotherapy)
 Freezing works by causing a blister to form under and around
the wart. Then, the dead tissue sloughs off within a week or so.
 Cantharidin- not available in M’sia
 Is a substance extracted from the blister beetle. The extract is
mixed with other chemicals, painted onto the skin and let it
dry. The application is painless, but the resulting skin blister
can be uncomfortable. The blister lifts the wart off the skin so
the doctor can remove the dead part of the wart.
 Immunotherapy
 Topical immunotherapy medications that may be prescribed
for stubborn warts include squaric acid dibutylester (SADBE-
not available here)and topical Imiquimod .
 Topical imiquimod is marketed for the treatment of genital
warts but has also proved effective for treating common warts.
 Imiquimod 5% cream applied 3x/week. Cream is applied at
night and left on the skin for 6-10 hr before washing off.
 Retinoids
 Derived from vitamin A, these medications disrupt the wart's
skin cell growth. Doctor may rarely prescribe a retinoid cream
(0.02% or 0.05%) .
High grade pre-malignant lesions
 The high grade pre-malignant lesions will usually require
removal of the lesions to prevent development into cancerous
 Treatments include surgical removal, or aggressive laser
 Since warts are caused by a virus, they may recur following
attempts at surgical removal.
 Minor surgery
 This involves cutting away the wart tissue or destroying it by
using an electric needle in a process called electrodessication and
curettage. Local anesthetic will be given before this surgery.
 Laser surgery
 Laser surgery can be expensive, and it may leave a scar. It's
usually reserved for tough-to-treat warts.
 Radiation
 Uses high-powered energy to kill cancer cells.
 Hysterectomy (major surgery)
 Involves removal of the cancerous and precancerous areas, the
cervix and the uterus.
Cervical Cancer
 Cervical cancer is a disease in which malignant (cancer) cells
form in the tissues of the cervix.
 Virtually all cases of cervical cancer are caused by HPV
infections. Not all women with HPV infection, however, will
develop cervical cancer.
 Cervical cancer is most treatable when it is diagnosed and
treated early.
 Women who get routine Pap testing and follow up as needed
can identify problems before cancer develops.
 Surgery, radiation and chemotherapy are often needed for this
Radiotherapy (cervical cancer)
 The aim of radiotherapy is to deliver a tumouricidal radiation
dose with optimal cure rates and minimal complications.
 External beam radiotherapy (EBRT)
 Is used to treat the primary tumour and pelvic nodes.
 Radiotherapy to the pelvis only is recommended for cervical
 Brachytherapy (BT)
 Is an integral part of radiotherapy for carcinoma of the cervix,
treating mainly the primary tumour.
 High doses of radiation can be delivered to the tumour while the
surrounding normal tissues (e.g. rectum) are relatively spared.
Gardasil Vaccine
 Gardasil vaccine is an inactivated vaccine which protects
against 4 major types of HPV.
 Include 2 types(16,18) that cause about 70% of cervical cancer
and 2 types(6,11) that cause about 90% of genital warts.
Therefore, can prevent most genital warts & most cases of
cervical cancer.
 Protection from Gardasil is expected last at least 5 yrs. But
vaccinated women still need cervical cancer screening because
the vaccine does not protect against all HPV types that cause
cervical cancer.
 Is recommended for girls 11-12 years of age because it is
important to get the vaccine before 1st sexual contact as they
have not exposed to HPV.
Gardasil Vaccine (cont’)
 However, if a girl or woman is already infected with a type of
HPV, the vaccine will not prevent disease from that type.
 Is also recommended for girls and women 13-26 years of age 
who did not receive it before.
 Gardasil vaccine is given as a 3-dose series:
1st Dose: Now
2nd Dose: 2 months after Dose 1
3rd Dose: 6 months after Dose 1
Cervarix Vaccine
 Is a HPV vaccine against 2 types of HPV which is 16 & 18.
 Both HPV types are the common cause for cervical cancer.
 It is claimed to provide substantial protection against HPV
type 31 and 45 (which can also cause cervical cancer).
 Is recommended for girls & women of 10-45 years old.
 The vaccine is also given as a 3-dose series:
1st Dose: Now
2nd Dose: 1 months after Dose 1
3rd Dose: 6 months after Dose 1
 GSK recently claimed that Cervarix is effective up to 6.4 yrs.
Avoidance/ Side Effects
 Anyone who has ever had a life-threatening allergic reaction
to yeast, to any other component of HPV vaccine, or to a
previous dose of HPV vaccine should not get the vaccine.
 Avoid in pregnant women.
 People who are mildly ill when the shot is scheduled can still
get HPV vaccine. People with moderate or severe illnesses 
should wait until they recover.
 Mild S/E: pain, ithcing/swelling/redness at injection site, mild
fever. These symptoms do not last long and go away on their
 Genital warts & related lesions- reduce risk of developing
genital warts and other HPV-related genital lesions by:
 Being in a mutually monogamous sexual relationship
 Reducing your number of sex partners
 Using a latex condom, which may prevent some but not all
HPV transmission
 Common warts
 Prevent the spread of the infection and formation of new warts
by not picking at a wart and not biting the nails
 Plantar warts
 Reduce the risk of contracting HPV infections that cause
plantar warts by keeping the feet clean and dry, wearing clean
socks, and wearing shoes or sandals in public pools and locker
 Clinical Practice Guidelines- Management of Cancer Cervix
, Central for Disease Control & Prevention
 Cervical Cancer (Treatments & Drugs)
 Wart (common warts)
 Types of HPV
 Gardasil & Cervarix official website