Fast Five Quiz: Common STDs

Michael Stuart Bronze, MD

Disclosures

January 17, 2019

The FDA approved a supplemental application of Merck's nine-valent HPV vaccine to include women and men aged 27-45 years. Approval for adults aged up to 45 years was based on a study of approximately 3200 women aged 27-45 years monitored for an average of 3.5 years. The nine-valent HPV vaccine was 88% effective in preventing the combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.

HPV infections have not been shown to be cytolytic; rather, viral particles are released as a result of degeneration of desquamating cells. The HPV virus can survive for many months and at low temperatures without a host; therefore, an individual with plantar warts can spread the virus by walking barefoot.

Patients who develop condylomata acuminata have usually been exposed to low-risk HPV types, such as HPV-6 and HPV-11. These HPV infections are associated with mild dysplasia that is often transient in nature. Many patients with mild dysplasia of the vulva, vagina, or cervix experience spontaneous regression of these lesions. Patients who are exposed to high-risk HPV types, such as HPV-16 or HPV-18, usually do not develop condylomata. These patients are at risk for high-grade dysplasia or anogenital carcinoma.

Treatment is not recommended for subclinical anogenital or mucosal HPV infection in the absence of coexistent dysplasia. No evidence demonstrates that treatment eliminates HPV infection or that it decreases infectivity. In fact, warts may recur after treatment because of activation of latent virus present in healthy skin adjacent to the lesion.

For more on HPV, read here.

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