Morphology: Non-enveloped, double-stranded DNA virus. Family Papillomaviridae. >200 types; **high-risk types 16, 18, 31, 33, 45** drive cancers (cervical, anal, oropharyngeal, penile, vulvar/vaginal); low-risk types 6, 11 cause anogenital warts (condyloma acuminata).
Typical drugs
—
Empiric therapy when resistant
No systemic antiviral. Lesion management: cryotherapy, podophyllotoxin, imiquimod (topical immune modulator), excision, laser. Cervical precancer: colposcopy + LEEP / cone biopsy / cryo. Gardasil 9 vaccine is the prevention story.
Resistance notes
N/A.
Pearls
Most common STI globally. Most infections clear spontaneously within 2 years (~90%); persistent high-risk HPV → precancer → cancer (years to decades). Gardasil 9 (9-valent) prevents 7 high-risk + 2 wart-causing types. ACIP recommendation: ages 9–14 (2-dose series 6–12 months apart); ages 15–26 (3-dose series 0, 1–2, 6 months); ages 27–45 shared decision-making. HPV-associated cancers: cervical (gold standard screening + treatment workflow), anal (rising in MSM esp HIV+), oropharyngeal (rising; throat / tonsil — better prognosis than tobacco-related), vulvar / vaginal / penile (less common). Cervical cancer screening (USPSTF 2018): ages 21–29 Pap q3 years; 30–65 Pap q3 years OR HPV co-test q5 years OR HPV alone q5 years (FDA-approved tests). Anogenital warts: cryo, podophyllotoxin (patient-applied), imiquimod cream (topical immune modulator), excision. Derm-relevant: external genital warts common derm consult; cosmetic + symptomatic excision.
References
- ACIP HPV Vaccine Guidance (2023)
- USPSTF Cervical Cancer Screening (2018)
- CDC HPV