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Human papillomavirus: Current prevalence and future protection.

LESS THAN 20 YEARS AGO, researchers were still working to establish the etiologic relationship between human papillomaviruses (HPV) and cervical cancer. Now, health and medical communities are on the verge of celebrating a vaccine against HPV that prevents cervical cancer. In this issue of Sexually Transmitted Diseases, Dr. Lisa Manhart and colleagues report the findings of the first population-based estimate of HPV prevalence among young women in the United States, which have clear implications for developing effective vaccination strategies.1 Based on data from 3262 sexually active women aged 18 to 25 years who participated in the National Longitudinal Study of Adolescent Health (Add Health), the weighted prevalence of HPV was 26.9%. Surprisingly, among those with only one lifetime partner, the prevalence was 14.3%. Depending on the true sensitivity of urine tests to detect cervical and lower genital tract HPV infection, actual prevalence may be as high as 33%. Predictors of infection, including certain sexual risk behaviors, were generally consistent with those found in other populations; however, the authors describe intriguing results related to partner characteristics. To further elucidate the prevalence of HPV, population-based surveys (e.g., National Health and Nutrition Examination Survey) should include genital specimens collected from sexually active men and women of all ages. Furthermore, self-collected vaginal swab specimens would provide test sensitivity more comparable to cervical specimens and improve the accuracy of the prevalence estimates in females.2 Approximately one third of the more than 100 HPV types infect genital and oral mucosa.3 Genital HPV is one of the most common sexually transmitted infections.4 Manhart et al provide data in support of current estimates that 20 million people in the United States are infected with HPV. The majority of HPV infections is asymptomatic and transient, and resolve without causing clinical disease; however, persistent infection with high-risk oncogenic types can progress to anogenital and oral cancers. The most common high-risk types include types 16 and 18, which account for approximately 70% of cervical cancers. Infections with low-risk types can cause genital warts, recurrent respiratory papillomatosis, and low-grade cervical abnormalities. Low-risk types 6 and 11 account for approximately 90% of genital warts. Worldwide, cervical cancer is the second leading cause of cancer-related death among women. The American Cancer Society predicts that there will be approximately 9710 new cases of invasive cervical cancer in the United States in 2006, and approximately 3700 women will die from this disease.5 Strategies to prevent cervical cancer in the United States, which have relied on the early diagnosis and treatment of precancerous lesions, have decreased rates of cervical cancer by more than 75% since the peak in 1948. However, the current Pap screening program is expensive and, because of the limited specificity of screening tests, too often leads to invasive diagnostic and treatment procedures that do not ultimately prevent death or disability from cervical disease. Worse yet is the potential for unnecessary medical interventions to lead to adverse reproductive health outcomes and complications. Widespread implementation of an HPV vaccine could make an important contribution to preventing morbidity and mortality related to HPV infection. Several prophylactic HPV vaccines have shown promise in preventing infection and disease.6–10 Two pharmaceutical companies, Merck and Company, Inc. and GlaxoSmithKline (GSK), have developed HPV vaccines, which are composed of DNA-free viruslike particles. Merck developed a quadrivalent vaccine against HPV types 6, 11, 16, and 18, whereas GSK developed a bivalent vaccine against HPV types 16 and 18. Both vaccines prevent over 90% of incident and persistent infections with the specific types included in the vaccine as well as the precancerous cervical lesions associated with those infections. In addition, the quadrivalent vaccine protects against genital warts and other HPV-related diseases of the vulva and vagina.11 The vaccines have been demonstrated to provide protection for at least 4 years and published data indicate only minimal adverse effects from the vaccine. Administration of the vaccine requires 3 doses over a 6-month period. Merck’s application for US Federal Drug Administration (FDA) licensure was approved in June 2006 for females aged 9–26 years; GSK is expected to apply for FDA licensure in 2006.12 Correspondence: Heidi M. Bauer, MD, MPH, Chief, Office of Medical and Scientific Affairs, California Department of Health Services, STD Control Branch, 850 Marina Bay Parkway, P-2, Richmond, CA 94804. E-mail: hbauer@dhs.ca.gov Received for publication April 5, 2006, and accepted April 24, 2006. From the *California Department of Health Services STD Control Branch, Richmond, California; and the †Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia Sexually Transmitted Diseases, August 2006, Vol. 33, No. 8, p.509–511 DOI: 10.1097/01.olq.0000225323.51240.bc Copyright © 2006, American Sexually Transmitted Diseases Association All rights reserved.