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REPORT TO CONGRESS Prevention of Genital Human Papillomavirus Infection

Centers for Disease Control and Prevention Department of Health and Human Services

Julie Louise Gerberding, M.D., M.P.H. Director Centers for Disease Control and Prevention January 2004

Table of Contents
Executive Summary Introduction Epidemiology of Genital HPV Infection Incidence andPrevalence of Genital HPV Infection Prevalence of Sequelae of Genital HPV Infection Natural History of Genital HPV Infection Transmission and Prevention of Genital HPV Infection Transmission Prevention of Genital HPV Infection Reducing Duration of Infectiousness Reducing Efficiency of Transmission Condoms Microbicides Reduction of Sexual Behavior Risk Vaccines Prevention of Cervical Cancer Summaryof Strategies to Prevent Genital HPV Infection References Pages 11-12 Pages 12 Pages 12-13 Page 13 Pages 13-16 Page 16 Pages 16 Pages 16-17 Pages 17-18 Pages 18-19 Pages 20-35 Pages 8-10 Page 10 Pages 10-11 Pages 3-5 Pages 6-7


Prevention of Genital Human Papillomavirus Infection Executive Summary
This report describes key aspects of the epidemiology of genital HPV infection and itstransmission, and summarizes the best strategies to prevent infections with genital HPV as well as the HPV-associated diseases of genital warts and cervical cancer. Genital infection with human papillomavirus (HPV) is very common in sexually active men and women and can sometimes have serious health consequences. About 20 million Americans are currently infected, and about 5.5 million people becomenewly infected each year. The virus can infect the genital skin and the linings of the vagina, cervix, rectum, and urethra. Most infections cause no clinical problems and go away on their own without treatment. Some infections lead to genital warts in men and women, and abnormal Papanicolaou (Pap) tests in women. Treatments are directed to abnormal cells associated with HPV rather than the virusitself; currently there is no curative treatment for HPV infection. Of greatest importance, persistent infection with certain types of HPV is a leading cause of cervical cancer. Progression from cervical cancer precursor lesions to invasive cancer is a slow process, estimated to take 10–15 years. Cervical cancer is an uncommon consequence of HPV infection in women, especially if they are screened forcancer regularly with Pap tests and have appropriate follow-up of abnormalities. The purpose of screening with the Pap test is to detect cervical abnormalities that can be treated, thereby preventing progression to invasive cervical cancer, and also to detect invasive cervical cancer at a very early stage. If detected early and managed promptly, survival rates for cervical cancer are over 90%. Inthe past 40 years, widespread cervical cancer screening using the Pap test and treatment of precancerous cervical abnormalities have resulted in a dramatic decrease in the incidence and mortality due to cervical cancer in the United States. However, each year in the United States, an estimated 12,200 women develop cervical cancer and 4,100 women die from it. Of women in the United States whodevelop cervical cancer, about half have never had a Pap test. Because genital HPV infection is most common in men and women who have had multiple sex partners, abstaining from sexual activity (i.e. refraining from any genital contact with another individual) is the surest way to prevent infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is thestrategy most likely to prevent future genital HPV infections. For those who choose to be sexually active but who are not in a monogamous relationship, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. All published epidemiologic studies of HPV have methodologic limitations that make the effect of condoms in the...
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