Human papillomavirus infections

Though the existence of disease associated with HPV has been documented for centuries, it has been only within the past 2 decades that we have recognized the clinical diversity and significant morbidity and mortality associated with HPV infections. The original lack of interest and nonavailability of in vitro culture systems has hampered research. However, with the advent of molecular diagnostic techniques, strong evidence suggests that HPV plays a major role in the development of specific anogenital cancers, including cervical, vaginal, vulvar, penile, and anal. It is this association between anogenital cancers and HPV that may result in treatment guidelines that eventually will eliminate these cancers. Moreover, to the extent that this association has resulted in overdiagnosis and unnecessarily aggressive treatment, new and ongoing research may create more appropriate treatment options. The principles for diagnosis and treatment should be based on adequate evaluation, including colposcopic examination and histologic confirmation for suspected neoplastic lesions. The majority of HPV-induced disease should be treated conservatively (often best with observation). The role of HPV DNA testing in clinical outcome is yet to be defined, with the exception of high-grade neoplastic disease, which should be treated aggressively.