Pathology and epidemiology of HPV infection in females

Margaret Stanley
ttp://www.sciencedirect.com/science/article/pii/S0090825810000879
Human papillomaviruses (HPVs) are a large family of small double-stranded DNA
viruses that infect squamous epithelia. It has been established that infection with
specific HPV types is a contributing factor to different types of anogenital cancer,
including vulval, vaginal, anal, penile, and head and neck cancers. Approximately 4%
of all cancers are associated with HPV. HPV infection is the major cause of cervical
cancer and genital warts. Genital HPV infections are very common, are sexually
transmitted, and have a peak prevalence between ages 18 and 30. Most of these
infections clear spontaneously, but in 1020% of women, these infections remain
persistent and are at risk of progression to grade 2/3 cervical intraepithelial
neoplasm (CIN) and eventually to invasive cancer of the cervix (ICC). CINs are
genetically unstable lesions with a 3040% risk of progression to ICC. If left
untreated, they form a spectrum of increasing cytological atypia, ranging from lowgrade CIN1 to high-grade CIN3; the latter are caused almost exclusively by high-risk
HPVs, HPV 16 and 18. Infection with HPV requires a microabrasion in the genital
epithelium. The oncogenic properties of high-risk HPV reside in the E6 and E7
genes, which if inappropriately expressed in dividing cells deregulate cell division
and differentiation. HPV DNA testing has been shown consistently to be superior to
cytology in terms of sensitivity and positive predictive value and will become a major
tool in cervical cancer screening, at least in the developed countries.

Human papillomavirus (HPV)

Human papillomavirus (HPV) is an extremely common

virus. At some point in our life most of us will catch the virus. The world over, HPV is
the most widespread sexually transmitted virus; 80% (four out of five) of the worlds
population will contract some type of the virus once [1]. If you catch HPV, in the
majority of cases the bodys immune system will clear or get rid of the virus without
the need for further treatment. In fact you may not even know that you had
contracted the virus.
There are over 100 identified types of HPV; each different type has been assigned a
number. HPV infects the skin and mucosa (any moist membranes such as the lining
of the mouth and throat, the cervix and the anus). Different types affect different
parts of the body causing lesions. The majority of HPV types infect the skin on
external areas of the body including the hands and feet. For example, HPV types 1
and 2 cause verrucas on the feet [2].
Around 40 of the HPV types affect the genital areas of men and women, including
the skin of the penis, vulva (area outside the vagina), anus, and the linings of the
vagina, cervix, and rectum [3]. Around 20 of these types are thought to be associated
with the development of cancer. The WHO International Association for Research on
Cancer (IARC) identifies 13 of these types as oncogenic (cancer causing). This
means there is direct evidence that they are associated with the development of
cervical cancer and are considered high-risk [4]. These high risk types of HPV are:
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 [5]. A person infected with highrisk genital HPV will show no symptoms so they may never even know they have it.
Additionally there are nine HPV types that may also be associated with the
development of cervical cancer these are types: 26, 53, 64, 65, 66, 67, 69, 70, 73,
82. However, currently there is not enough evidence to indicate that these types are
high risk for cervical cancer [6].

The remaining genital HPV types have been designated low-risk as they do not
cause cervical cancer but they can cause other problems such as genital warts.
- See more at: http://www.jostrust.org.uk/about-cervicalcancer/hpv#sthash.c1IwLmQY.dpuf
References
Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. The
American Journal of Medicine, 102 (5A), 3-8.
Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPVrelated conditions: HPV-6/11 disease. Vaccine, 24 (3), S3/35-41.
Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men,
cancers other than cervical and benign conditions. Vaccine, 26 (10), K17-28.
Walboomers JMM et al.,1999 Human papillomavirus is a necessary cause of
invasive cancer worldwide. Journal of Pathology, 189 (1), 1219.
Szarewski A. 2012. Cervarix: a bivalent vaccine against HPV types 16 and 18, with
cross-protection against other high-risk HPV types. Expert Review Vaccines 11(6),
645 657.
Bouvard et al., 2009. A review of human carcinogens Part B: biological agents.
Lancet Oncology 10, 321 - 322.
- See more at: http://www.jostrust.org.uk/about-cervicalcancer/hpv#sthash.c1IwLmQY.dpuf

HPV Lesson Plan

Length: 30 - 45 minutes

This lesson provides information on the burden of illness of the human papillomaviru
s (HPV) and the prevention strategies to avoid contracting HPV, including
vaccination.
The purpose
The purpose is to raise the awareness of students on
the burden of illness of HPV and to inform
students on the strategies that could prevent them from contracting HPV, including v
accination. Educational element: Health promotion
Expectations and learning outcomes: (According to provincial curriculum)
To demonstrate the factors tied to healthy growth and healthy sexuality.
To provide information on the consequence on health of HPV (burden of illness).
To provide information on strategies to prevent HPV, including vaccination.
To analyze the effect of decisions with regards to sexual relations. NOTE:
This lesson is recommended for students in grades 7, 8, 9, 10 as well as students in
grades 11 and 12 in order to improve their comprehension on the health consequenc
es of HPV (burden of illness) and factors linked to a healthy sexuality.
Resources for educators Information tool kit for educators (PDF).
Information on HPV, the burden of illness and prevention strategies on the HPV web
site, developed by the Society of Obstetricians and Gynaecologists
www.hpvinfo.ca. The lesson scenario A Introduction Lead a discussion on:
Information on HPV (see appendix A of information tool kit)
Burden of illness (see appendix B of information tool kit)
Screening of HPV (see appendix C of information tool kit)
Prevention of HPV and vaccination (see appendix D of information tool kit) B
Investigation / Exploration / Staging
To ensure students retain the information, encourage students to work in teams for a
brainstorming session. Heterogeneous class
Ask students to form groups of four, two girls, two boys From the
knowledge acquired in previous lessons on HPV, ask student to develop
A list of health consequences of HPV specific to girls and a list of health consequenc
es specific to boys.
A list of prevention strategies for girls and a list of prevention strategies for boys.
Lead a discussion on the responses provided by students and create a table from th

e
responses obtained relative to the health consequences of HPV and the prevention
strategies.
The educator probes the students and with their help develops a comprehensive list
of
health consequences specific to girls and boys, and the consequences that are com
mon to both boys and girls.
The educator probes the students and with their help develops a comprehensive list
of prevention strategies specific to girls and
boys, and a list of prevention strategies that is common to both boys and girls.
The educator shares with the students the information with regards to the burden of i
llness of HPV that is specific to girls, specific to boys, and to both girls and boys. A
class of girls only Ask students to form groups of four girls.
From the knowledge acquired in previous lessons on HPV, ask students to develop
A list of health consequences of HPV specific to girls.
A list of prevention strategies for girls.
Lead a discussion on the responses provided by students and create a table from th
e responses
obtained relative to the health consequences of HPV and the prevention strategies.

The educator probes the students and with their help develops a comprehensive list
of health consequences from HPV.
The educator probes the students and with their help develops a comprehensive list
of prevention strategies for girls, including vaccination.
The educator shares with the students the information with regards to the burden of i
llness of HPV and the prevention strategies, including vaccination.
A class of boys only Ask students to form groups of four boys
From the knowledge acquired in previous lessons on HPV, ask students to develop
A list of health consequences of HPV specific to boys.
A list of prevention strategies for girls and a list of prevention strategies for boys.
Lead a discussion on the responses provided by students and create a table from th
e
responses obtained relative to the health consequences of HPV and the prevention
strategies.

The educator probes the students and with their help develops a comprehensive list
of health consequences specific to boys.
The educator probes the students and with their help develops a comprehensive list
of prevention strategies specific to boys.
The educator shares with the students the information with regards to the burden of i
llness of HPV and the prevention strategies specific to boys. C Conclusion
The educator provides a synthesis on the burden of illness of HPV and the preventio
n strategies, including vaccination. D Additional activities / Followups
Invite students to discuss and share information with their parents on the burden of ill
ness
of HPV and the prevention strategies, including vaccination, using the web site
www.HPVinfo.ca. Invite students to discuss vaccination with the school nurse.
We hope that the activities and teaching tools in this lesson plan are useful in the cla
ssroom. We
welcome your feedback and any ideas you might have for additional teacher resourc
es. Contact us at helpdesk@sogc.com.