the most common sexually transmitted infection in USA

| Disease associations | • Cervical cancer • Vulvar & vaginal cancers • Anal cancer • Penile cancer • Oropharyngeal cancer • Anogenital warts • Recurrent respiratory papillomatosis | | --- | --- | | Vaccine indications | • All female and male patients* age 11-26 (but may be given to those age 9-45) • Catch up vaccination should be offered to those who didn’t complete the series or un-vaccinated • Not indicated in pregnancy |

*Including those with a history of genital warts, abnormal Pap cytology, or positive HPV DNA test.

HPV infection, particularly with high-risk types 16 and 18, is also associated with anogenital (eg, cervical, anal) and oropharyngeal cancers.  The most effective preventive strategy is HPV vaccination, ideally prior to initial sexual contact (ie, first HPV exposure).  Barrier contraceptive use is also protective.  The 9-valent HPV vaccine is available in the United States and is typically administered to males and females age 11-26 but can be given to those age 9-45.

Gardasil-9 (9vHPV) is distributed in the United States. This vaccine protects against nine HPV types (6, 11, 16, 18, 31, 33, 45, 52, and 58).

most young (age <30) women become infected with HPV shortly after the onset of sexual activity, the infection typically clears and does not progress to cervical dysplasia or cancer.

Persistent HPV infection (particularly with types 16 and 18) results in cellular dysplasia because the incorporation of viral DNA increases prooncogenic protein expression and inhibits normal cellular regulation.

Previous or current HPV infection is not a contraindication to HPV vaccination because vaccination provides protection against other HPV types that the patient may encounter with future sexual activity.