Two HPV vaccines are licensed in the United States: a bivalent vaccine (Cervarix) containing HPV types 16 and 18 and a quadrivalent vaccine (Gardasil) vaccine containing HPV types 6, 11, 16, and 18. Both vaccines offer protection against the HPV types that cause 70% of cervical cancers (i.e., types 16 and 18), and the quadrivalent HPV vaccine also protects against the types that cause 90% of genital warts (i.e., types 6 and 11). Either vaccine can be administered to girls aged 11–12 years and can be administered to those as young as 9 years of age (15,16); girls and women ages 13–26 years who have not started or completed the vaccine series also should receive the vaccine.
Ninety-five percent of patients treated with excisional therapy are cures. In 5% of patients persistence or recurrence of disease can be observed, which is closely associated with the presence of positive margins at the time of conization.
When biopsy confirms the presence of high-grade precancer (CIN II or III), the lesion is either excised or ablated. In ablative techniques, only part of the tissue is examined when biopsies have been given priority. This may occur in up to 1% of patients.
Lifestyle modifications to delay onset of sexual activity until age 21, minimizing number of lifetime sexual partner, the consistent use of condoms, and the avoidance of tobacco use should be stressed to patients. Although a limitation of a condom is that if cannot cover all genital skin, the consistent use of condoms is associated with protection not only from HPV but also from other STDs.
Although removal of the lesions or warts is desirable, it does not eliminate the underlying virus, therefore recurrence is likely to occur.
GARDASIL does not prevent all types of cervical cancer, and it does not treat HPV so it’s important for women to continue routine cervical cancer screenings. The Centers for Disease Control and Prevention (CDC) recommends routine vaccination with GARDASIL for girls ages 11 to 12, and for young women ages 13 through 26 who have not already been vaccinated. The CDC states that GARDASIL can be given to boys and young men ages 9 through 26.
Having regular Pap tests is one of the best ways to help protect against cervical cancer in the future. A Pap test doesn’t diagnose HPV, but it can look for abnormal cells in the lining of the cervix before the cells become precancers or cancer. All HPV types that affect the genital area can cause abnormal Pap tests, if the test is abnormal you can ask your doctor to order an HPV test.
Cervical infection and cellular changes may require a colposcopy, a painless examination during which a lighted magnifying instrument is used to view the internal reproductive organs in women. In some cases, it is necessary to do a biopsy of cervical tissue. Depending on the nature of the cervical lesion, cauterization, freezing (cryosurgery), laser, or surgery may be necessary.
Depending on factors such as their size and location, genital warts are treated in several ways: a doctor may recommend treatment with a chemical such as 25 percent podophyllin solution, which is applied to the affected area and washed off after several hours, small warts can be removed by freezing (with liquid nitrogen) or burning (electrodesiccation). Surgery is occasionally needed to remove large warts that have not responded to other treatment.
Treatment is directed to the macroscopic (i.e., genital warts) or pathologic (i.e, precancerous) lesions caused by infection. Subclinical genital HPV infection typically clears spontaneously, and therefore specific antiviral therapy is not recommended to eradicate HPV infection. In the absence of lesions, treatment is not recommended for subclinical genital HPV infection whether it is diagnosed by colposcopy, acetic acid application, or by laboratory tests for HPV DNA.