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Managing HPV: A New Era in Patient Care

(Published June 2009)


Despite the fact that cervical cancer is highly preventable with screening and early intervention, about 11,150 new cases of cervical cancer occur annually in the United States. Infection with high-risk types of human papillomavirus (HPV) is a necessary cause of cervical cancer, and evidence also suggests a strong association of high-risk HPV with cancer of the penis, vagina, vulva, anus, and oropharynx. Genital infection with HPV is ubiquitous among people who are sexually active. In fact, it is the most commonly diagnosed sexually transmitted infection in the United States. However, HPV infection, including infection with the high-risk types associated with cervical cancer and the low-risk types associated with external genital warts, is most often cleared by the body’s immune system.

Ideal management of cervical cytology abnormalities and positive HPV DNA testing must balance the need to identify and treat abnormalities likely to progress to invasive cancer with the need to avoid unnecessary treatment of abnormalities related to transient HPV infection unlikely to lead to invasive cancer. Guidelines on screening for and management of HPV-related disease can be challenging to interpret and may shift repeatedly as new research is reported.

Testing for HPV infection, screening for HPV-related disease, and managing HPV-associated conditions are complex topics about which some critical shifts in thinking recently have occurred. This Clinical Proceedings is not meant to provide a comprehensive study of HPV; it was created to highlight management areas for which expert guidelines have recently changed and to cover issues that tend to be perplexing for front-line providers. To close the gap between ideal and delivered care, it is essential that clinicians be familiar with these updates. We hope that this monograph illuminates important areas of concern, facilitates optimal screening for and management of HPV-related disease, and supports clinicians in counseling patients about HPV. To facilitate counseling, we have included “Counseling Points” boxes throughout the Clinical Proceedings.

Our sincere thanks to the members of our expert advisory committee for investing their remarkable insight and valuable time in this project.

Wayne C. Shields
President and CEO
Association of Reproductive Health Professionals

Vanessa E. Cullins, MD, MPH, MBA
Vice President for Medical Affairs
Planned Parenthood Federation of America®