Assignment: Cervical Cancer Human Papillomavirus Infection Presentation

Of the many types of human papillomavirus (HPV), more than 30 infect the genital tract. The association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Although HPV is essential to the transformation of cervical epithelial cells, it is not sufficient, and a variety of cofactors and molecular events influence whether cervical cancer will develop. Early detection and treatment of precancerous lesions can prevent progression to cervical cancer. Identification of precancerous lesions has been primarily by cytologic screening of cervical cells. Cellular abnormalities, however, may be missed or may not be sufficiently distinct, and a portion of patients with borderline or mildly dyskaryotic cytomorphology will have higher-grade disease identified by subsequent colposcopy and biopsy. Sensitive and specific molecular techniques that detect HPV DNA and distinguish high-risk HPV types from low-risk HPV types have been introduced as an adjunct to cytology. Earlier detection of high-risk HPV types may improve triage, treatment, and follow-up in infected patients. Currently, the clearest role for HPV DNA testing is to improve diagnostic accuracy and limit unnecessary colposcopy in patients with borderline or mildly abnormal cytologic test results.

INTRODUCTION
Human papillomavirus (HPV) is one of the most common causes of sexually transmitted disease in both men and women worldwide and is thought to be the most common sexually transmitted viral disease in the United States. Genital HPV infection is not a reportable disease, so actual incidence and prevalence figures are not known; however, it is estimated that the incidence of new infections in the United States ranges from 1 million to 5.5 million per year, and the prevalence is estimated to be as high as 20 million (20). HPV continues to be an important topic, as rates of infection appear to continue to be rapidly increasing.

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Papillomaviruses are ubiquitous and have been detected in a wide variety of animals as well as in humans and are specific for their respective hosts. More than 200 types of HPV have been recognized on the basis of DNA sequence data showing genomic differences. Eighty-five HPV genotypes are well characterized. An additional 120 isolates are partially characterized potential new genotypes (133). HPVs can infect basal epithelial cells of the skin or inner lining of tissues and are categorized as cutaneous types or mucosal types. Cutaneous types of HPV are epidermitrophic and target the skin of the hands and feet. Mucosal types infect the lining of the mouth, throat, respiratory tract, or anogenital epithelium. Based on their association with cervical cancer and precursor lesions, HPVs can also be grouped to high-risk and low-risk HPV types. Low-risk HPV types include types 6, 11, 42, 43, and 44. High-risk HPV types include types 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70. Included in the high-risk group are some HPV types that are less frequently found in cancers but are often found in squamous intraepithelial lesions (SILs) (Table (Table1).1). Some authors refer to these HPV types as intermediate-risk. Low-risk subtypes are also occasionally found in cervical carcinomas.

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Assignment: Cervical Cancer Human Papillomavirus Infection Presentation