Infectious DiseasesTier 2Disease (DEADMAN)

Genito-urinary conditions - human papillomavirus – associated conditions, including anogenital warts

Description

HPV causes anogenital warts (low-risk genotypes, predominantly 6/11) and is the necessary cause of cervical and other anogenital cancers (high-risk genotypes, predominantly 16/18) - these two clinical consequences reflect distinct genotype groups with different implications, though both are addressed by the same vaccination programme

Epidemiology

Extremely common sexually transmitted infection, with most sexually active individuals acquiring at least one genotype at some point; most infections are transient and cleared by the immune system without consequence

Aetiopathogenesis

Low-risk genotypes cause benign epithelial proliferation (warts) through productive viral replication without integration; high-risk genotypes can integrate viral DNA disrupting tumour suppressor gene function (p53, Rb pathway via E6/E7 oncoproteins), driving malignant transformation with persistent infection over years

Diagnosis

Anogenital warts are a clinical diagnosis based on appearance; cervical HPV-related dysplasia is detected through cervical screening (HPV-based primary screening, with cytology as a secondary triage test in most current programmes) rather than by direct wart inspection

Management

Anogenital warts: topical treatments (podophyllotoxin, imiquimod) or ablative/destructive therapy (cryotherapy, excision) - no treatment eradicates the underlying viral infection, only the visible lesion, and recurrence is common
HPV vaccination (prophylactic, covering both low- and high-risk genotypes in current formulations) is the most effective preventive intervention and is most effective when given before sexual debut

Associations

Cervical, anal, and oropharyngeal cancer (high-risk genotype consequence), genital warts (low-risk genotype consequence), HPV vaccination programmes, cervical screening interval and HPV-primary testing

Natural history & complications

Treating visible anogenital warts does not eradicate the underlying HPV infection - recurrence after treatment is common because the virus can persist in surrounding clinically normal epithelium, which is important for setting realistic patient expectations about treatment

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