ASCCP - Practice Recommendations - Practice Management Materials

PRACTICE RECOMMENDATIONS: Practice Management Materials

• Vulva • Vagina • Cervix • Anus

VULVA: HUMAN PAPILLOMAVIRUS INFECTIONS & VULVAR INTRAEPITHELIAL NEOPLASIA

HPV:	• Introduction	• Definition	• Diagnosis	• Treatment	• References
VIN:	• Introduction	• Definition	• Diagnosis	• Treatment	• References
	• Cases/Examples

HPV DEFINITION
Human Papillomavirus (HPV) is a double stranded DNA virus of the family Papovaviridae. It infects only epithelial cells in humans (skin and mucus membranes of the vulva, vagina, urethra, penis, anal canal and perianal skin).

Member of family Papovaviridae
Double-strand DNA Tumor viruses
Circular genome of 7,800 base pairs
Non-enveloped virion
45 – 55 nm. icosohedral capsid
More than 100 sub-types of HPV

HPV Sub-types
The anogenital types of HPV can be divided into two groups:

Little or no oncogenic potential (low risk)	Significant oncogenic potential (high risk)
HPV 6, 11, 42, 43, 44	HPV 16, 18, 31, 33, 35, 51 and 52
Usually present as raised, acuminate, verrucous lesions but may also be flat non-pigmented papillomas	Almost always flat warts
2/3 of external genital warts	1/3 of external genital warts

Oncogenic viral types integrate the host cells’ DNA. This is accomplished by an alteration in the viral DNA at the site (E1 and E2 gene) that is responsible for regulation of the E6 and E7 viral genes. The loss of regulatory control produced by disturbed function of the viral E1 and E2 genes, allows excess production of HPV E6 and E7 proteins, which inactivate the host cells’ tumor suppressing efforts, allowing uncontrolled proliferation of the permanently mutated host cell.

Cofactors involved in HPV-induced Oncogenesis

Impaired immune response
Epithelial cell type
Cocarcinogens (i.e. cigarette use)
Age of first intercourse

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