HPV: What is it? What does it do? Natasha Press Division of Infectious Diseases St. Paul’s Hospital
What is HPV <ul><li>Human Papillomaviruses </li></ul><ul><li>Name of a group of viruses </li></ul><ul><li>>100 different s...
What is HPV <ul><li>HPV causes warts </li></ul><ul><li>HPV causes cancer </li></ul>
HPV causes warts on hands/feet <ul><li>Common skin warts </li></ul><ul><li>HPV types 1,2,3,4 </li></ul>University of India...
HPV causes warts in the  anogenital area <ul><li>Anogenital warts </li></ul><ul><li>Condyloma acuminata </li></ul><ul><li>...
Risk factors for anogenital warts <ul><li>Sexual activity (any kind) </li></ul><ul><li>Number of sexual partners </li></ul...
Low-risk HPV types <ul><li>Non-oncogenic = non-cancer causing </li></ul><ul><li>6, 11 , 42, 43, 44 </li></ul><ul><li>1, 2,...
High-risk HPV types <ul><li>Oncogenic = cancer causing </li></ul><ul><li>16 ,  18 , 31, 33, 35 </li></ul><ul><li>39, 45, 5...
HPV causes cancer <ul><li>Anogenital: </li></ul><ul><li>Anal cancer </li></ul><ul><li>Penile cancer </li></ul><ul><li>Gyne...
HPV causes cancer <ul><li>Dysplasia = pre-cancer lesion </li></ul><ul><li>Intraepithelial neoplasia </li></ul><ul><li>Mild...
Anal dysplasia <ul><li>Name depends on where the dysplasia is: </li></ul><ul><li>cervical dysplasia = CIN </li></ul><ul><l...
HPV causes cancer INFECTION CLEARANCE PERSISTENCE REGRESSION INVASION AIN 3 Severe High-grade Cancer AIN 2 AIN 1 Mild Low-...
Anogenital HPV Infection <ul><li>General population:  15% </li></ul><ul><li>MSM:   60% </li></ul><ul><li>HIV+ MSM:   ~100%...
Incidence of anal cancer <ul><li>Cervical cancer: 40/100,000 </li></ul><ul><li>Cervical Pap ↓ rate by 80% </li></ul><ul><l...
Increasing rate of anal cancer 1997-2005 in BC  for men aged 30-60 years Cases per 100 000 Increase in ASCC p <0.02 log li...
Anal dysplasia <ul><li>Could screening in men reduce the rate of anal cancer? </li></ul><ul><li>Progression from dysplasia...
Anal Pap Procedure <ul><li>Moistened Dacron swab </li></ul><ul><li>Rotate/apply pressure to walls of canal </li></ul><ul><...
Anal Pap Results <ul><li>Negative </li></ul><ul><li>Atypical squamous cells </li></ul><ul><ul><li>ASCUS </li></ul></ul><ul...
Overview of HPV <ul><li>Low Risk </li></ul><ul><li>HPV types: 6, 11 </li></ul><ul><li>Genital warts </li></ul><ul><li>Low-...
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HPV: What is it? What does it do?

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HPV–What is it and what does it do? Presented by Natasha Press, St. Paul’s Hospital at the 5th Annual Gay Men's Health Summit held in Vancouver, BC on November 9th and 10th, 2009.

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  • 42, 43, 44 = low-grade lesions in cervix
  • 16 = 50% of cervical cancer, higher proportion in anal cancer 18 = 20% of cervical cancer
  • HIV – poor immunity assoc with increased persistence
  • Low grade squamous intraepithelial lesion
  • HPV: What is it? What does it do?

    1. 1. HPV: What is it? What does it do? Natasha Press Division of Infectious Diseases St. Paul’s Hospital
    2. 2. What is HPV <ul><li>Human Papillomaviruses </li></ul><ul><li>Name of a group of viruses </li></ul><ul><li>>100 different strains </li></ul><ul><li>>30 of them are sexually transmitted </li></ul><ul><li>Only infect humans </li></ul><ul><li>Infect skin or mucosa </li></ul>
    3. 3. What is HPV <ul><li>HPV causes warts </li></ul><ul><li>HPV causes cancer </li></ul>
    4. 4. HPV causes warts on hands/feet <ul><li>Common skin warts </li></ul><ul><li>HPV types 1,2,3,4 </li></ul>University of Indiana Department of Pathology
    5. 5. HPV causes warts in the anogenital area <ul><li>Anogenital warts </li></ul><ul><li>Condyloma acuminata </li></ul><ul><li>HPV strains 6, 11 </li></ul>
    6. 6. Risk factors for anogenital warts <ul><li>Sexual activity (any kind) </li></ul><ul><li>Number of sexual partners </li></ul><ul><li>Not toilet seats! </li></ul><ul><li>(the virus can only be passed from one skin surface to another) </li></ul>
    7. 7. Low-risk HPV types <ul><li>Non-oncogenic = non-cancer causing </li></ul><ul><li>6, 11 , 42, 43, 44 </li></ul><ul><li>1, 2, 4 </li></ul>
    8. 8. High-risk HPV types <ul><li>Oncogenic = cancer causing </li></ul><ul><li>16 , 18 , 31, 33, 35 </li></ul><ul><li>39, 45, 51, 52, 56, 58, 70 </li></ul>
    9. 9. HPV causes cancer <ul><li>Anogenital: </li></ul><ul><li>Anal cancer </li></ul><ul><li>Penile cancer </li></ul><ul><li>Gynecological cancers </li></ul><ul><li>Oral cancer: </li></ul><ul><li>Tongue </li></ul><ul><li>Tonsil </li></ul>
    10. 10. HPV causes cancer <ul><li>Dysplasia = pre-cancer lesion </li></ul><ul><li>Intraepithelial neoplasia </li></ul><ul><li>Mild dysplasia -> Moderate -> severe -> cancer </li></ul><ul><li>Low-grade -> high grade </li></ul>
    11. 11. Anal dysplasia <ul><li>Name depends on where the dysplasia is: </li></ul><ul><li>cervical dysplasia = CIN </li></ul><ul><li>anal dysplasia = AIN </li></ul><ul><li>AIN 1 -> AIN 2 -> AIN 3 </li></ul><ul><li>Dysplasia has no symptoms </li></ul>
    12. 12. HPV causes cancer INFECTION CLEARANCE PERSISTENCE REGRESSION INVASION AIN 3 Severe High-grade Cancer AIN 2 AIN 1 Mild Low-grade Normal anal canal
    13. 13. Anogenital HPV Infection <ul><li>General population: 15% </li></ul><ul><li>MSM: 60% </li></ul><ul><li>HIV+ MSM: ~100% </li></ul><ul><li>75% of sexually active adults have been exposed to HPV </li></ul>
    14. 14. Incidence of anal cancer <ul><li>Cervical cancer: 40/100,000 </li></ul><ul><li>Cervical Pap ↓ rate by 80% </li></ul><ul><li>Anal cancer: </li></ul><ul><ul><li>HIV- MSM: 35/100,000 </li></ul></ul><ul><ul><li>HIV+ MSM: twice as high </li></ul></ul>
    15. 15. Increasing rate of anal cancer 1997-2005 in BC for men aged 30-60 years Cases per 100 000 Increase in ASCC p <0.02 log linear model
    16. 16. Anal dysplasia <ul><li>Could screening in men reduce the rate of anal cancer? </li></ul><ul><li>Progression from dysplasia -> cancer probably takes years </li></ul><ul><li>Anal pap? </li></ul>
    17. 17. Anal Pap Procedure <ul><li>Moistened Dacron swab </li></ul><ul><li>Rotate/apply pressure to walls of canal </li></ul><ul><li>Thin-prep solution </li></ul>
    18. 18. Anal Pap Results <ul><li>Negative </li></ul><ul><li>Atypical squamous cells </li></ul><ul><ul><li>ASCUS </li></ul></ul><ul><ul><li>ASC-H </li></ul></ul><ul><li>Low grade (LSIL) </li></ul><ul><li>High grade (HSIL) </li></ul>
    19. 19. Overview of HPV <ul><li>Low Risk </li></ul><ul><li>HPV types: 6, 11 </li></ul><ul><li>Genital warts </li></ul><ul><li>Low-grade anal changes </li></ul><ul><li>High Risk </li></ul><ul><li>HPV types: 16, 18 </li></ul><ul><li>Dysplasia (genital, anal) </li></ul><ul><li>Cancer (genital, anal) </li></ul><ul><li>Head and neck cancers </li></ul>

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