HPV | Shim Clinic, STD CLINIC SINGAPORE™

HPV | Shim Clinic, STD CLINIC SINGAPORE™: Human papillomavirus (HPV) symptoms in men/women, screening/diagnosis, testing/check, treatment clinic, Singapore. Private and confidential service. Definitions, references, and latest news.

Description

Table of Contents

• HPV (human papillomavirus)
• Genital warts
  • Genital Warts Treatment / Genital Warts Removal
• Cervical Cancer
• HPV vaccine / Cervical Cancer Vaccine
  • Gardasil®
  • Cervarix®
  • V503
• HPV test

• 100% of genital warts
• 100% of cervical cancers in females,
• 90% of anal cancers in males & females
• 40% of external genitalia cancers
  • penile cancers in males,
  • vulvar cancers in females,
  • vaginal cancers in females,
• 12% of oropharyngeal cancers (mouth and throat cancers)
• 3% of oral cancers

• HPV types 1 and 2 cause plantar warts
• HPV types 3 and 10 cause flat warts
• HPV types 6 and 11 (preventable with Gardasil® vaccination) cause 90% of genital warts
• HPV types 16 and 18 (preventable with Gardasil® or Cervarix® vaccination) cause 70% of cervical cancers in females
• HPV types 16, 18, 31, 33, 45, 52, and 58 (preventable with V503 vaccination) cause 90% of cervical cancers in females. It may be available by 2013.

• Human_papillomavirus | 2can Support Portal | EBI

HPV	1 6	1 8	3 1	3 3	3 5	3 9	4 5	5 1	5 2	5 6	5 8	5 9	6 8	7 0	7 3	8 2	2 6	5 3	6 6	6	1 1	4 0	4 2	4 3	4 4	5 4	5 5	6 1	6 2	6 4	6 7	6 9	7 1	7 2	8 1	8 3	8 4	C P 6 1 0 8	I S 0 3 9	7 4
Risk	H	H	H	H	H	H	H	H	H	H	H	H	H	H	H	H	I	I	I	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	L	U
Cervarix	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Gardasil	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
V503	+	+	+	+	-	-	+	-	+	-	+	-	-	-	-	-	-	-	-	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
DigeneHR	+	+	+	+	+	+	+	+	+	+	+	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
CobasHPV	+	+	+	+	+	+	+	+	+	+	+	+	+	-	-	-	-	-	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Digene	+	+	+	+	+	+	+	+	+	+	+	+	+	-	-	-	-	-	-	+	+	-	+	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
HybriBio	+	+	+	+	+	+	+	+	+	+	+	+	+	-	-	-	-	+	+	+	+	-	+	+	+	-	-	-	-	-	-	-	-	-	+	-	-	-	-	-
PapilloCheck	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	-	+	+	+	+	+	+	+	+	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
InnoLiPA	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	-	+	+	+	-	-	-	-	-	+	+	-	-	-	-	-	-	+
LinearArray	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+	-	-	+	+	+	+	+	+	+	+	+	+	+	+	+	+	-

Legend: 71 (CP 8061), 81 (CP 8304), 82/MM4, 82/IS039, 83 (MM7), 84 (MM8)

References

• Human-papilloma

Genital warts appear within 3 months after sexual contact with an infected person.

Genital warts:

• are usually soft, pink cauliflower-like growths or flesh-coloured bumps on the sex organs
• may also be hard and smooth
• occur alone or in groups
• tend to recur after treatment
• increase the risk of cervical cancer in women.

A person with genital warts can infect others through sexual contact.

Genital warts treatment is usually by cryosurgery with liquid nitrogen. Genital warts removal may also be done by curettage.

Prevention is possible with a HPV vaccine like Gardasil®, which covers types 6 and 11, as they cause 90% of genital warts.

Cervical cancer

• 100% of cervical cancers is caused by HPV (human papillomavirus).
• 70% of cervical cancers is caused by HPV types 16 & 18. Which may be prevented by vaccination with Gardasil® or Cervarix®.
• 90% cervical cancers is caused by HPV types 16, 18, 31, 33, 45, 52, and 58. Which may be prevented by vaccination with V503. It may be available by 2013.

• Gardasil® [HPV (Human Papillomavirus) Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant]
• Cervarix® [HPV (Human Papillomavirus) Bivalent (Types 16 and 18) Vaccine, Recombinant]
• V503 [HPV (Human Papillomavirus) Nonavalent (Types 6, 11, 16, 18, 31, 33, 45, 52, and 58) Vaccine, Recombinant]

• 2006 June 8th - US FDA approves use in females aged 9 to 26 years
• 2006 - Singapore HSA approval
• 2008 September 12th - US FDA approves use to prevent vulvar and vaginal cancer
• 2009 October 16th - US FDA approves use to prevent genital warts in males aged 9 to 26 years
• 2010 December 22nd - US FDA approves use to prevent anal cancer in males and females aged 9 to 26 years
• 2010 December 22nd - Singapore HSA approves use to prevent genital warts in males aged 9 to 26 years
• 2011 April 5th - US FDA approves use in women 27 through 45 years of age
• 2011 December 20th Singapore HSA approves use to prevent anal cancer in males and females aged 9 to 26 years

• Gardasil.com
• Gardasil® @ US FDA

• 2007 - Singapore HSA approval
• 2009 October 16th - US FDA approves use in females aged 10 to 25 years
• 2011 July 19th - US FDA approves use in females as young as 9 years of age
• 2011 August 3rd - Singapore HSA approves use for the prevention of persistent infection, premalignant cervical lesions and cervical cancer

• Cervarix.com
• Cervarix® @ US FDA

• 2007 October 12th - Broad Spectrum HPV (Human Papillomavirus) Vaccine Study in 16-to 26-Year-Old Women (V503-001)
• 2009 July 21st - A Study of V503 in Preadolescents and Adolescents (V503-002)
• 2010 May 11th - The Phase III trial is ongoing and Merck anticipates filing a Biologics License Application (BLA) in 2012
• 2010 July - Merck is recruiting for Phase III clinical trials of a nine-valent vaccine

Vaccine	Against	Disease	Age	D o s e s	Dose schedule	Price per dose (SG$)
Havrix™ 1440 Adult Hepatitis A vaccine	Hepatitis A virus	Hepatitis A	≥19y	2	m 0 & 6-12	$90/=
Engerix™-B 20 μg Hepatitis B vaccine	Hepatitis B virus	Hepatitis B	11-15y	2	m 0, & 6	$50/=
			≥20y	3	m 0, 1, & 6
				4	m 0, 1, 2, & 12 or d 0, 7, 21 & m 12
Twinrix®	Hepatitis A virus Hepatitis B virus	Hepatitis A Hepatitis B	1-15y	2	m 0, 6-12	$120/=
			≥16y	3	m 0, 1, 6
				4	d 0, 7, 21 & m 12
Gardasil® - HPV vaccine	HPV types 6, 11, 16 and 18	Genital warts Cervical cancer	9-26y	3	m 0, 2, & 6 or m 0, 1, & 4	$195/=
Cervarix® - HPV vaccine	HPV types 16 and 18 (31, 33, and 45)	Genital warts Cervical cancer	10-25y	3	m 0, 1, & 6 m 0, 1, & 5 m 0, 2½, 12	$195/=
V503 - HPV vaccine	HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58	Genital warts Cervical cancer		3	m 0, 2, & 6 or m 0, 1, & 4	$???/=

HPV test for men/women.

• Digene® High-Risk HPV DNA Test
  • QIAGEN - digene HC2 High-Risk HPV DNA Test - For detection of human papillomavirus infections using hybrid capture 2 technology
  • Detects 13 high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68.
  • Unable to differentiate which types are positive.
  • Cost is SG$200/=
• Digene® HPV DNA Test
  • QIAGEN - digene HC2 HPV DNA Test - For detection of human papillomavirus infections
  • Detects 13 high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. And 5 low-risk types: 6, 11, 42, 43, and 44.
  • Unable to differentiate which types are positive.
  • Not available in Singapore. Unlikely to be available in future.
• Hybribio®
  • HPV GenoArray Test Kit
  • Detects 15 high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68. And 6 low-risk HPV types: 6, 11, 42, 43, 44, CP8304
  • Able to differentiate which types are positive.
  • May be available in Singapore soon.
• Cobas® HPV Test
  • Cobas® HPV Test
  • Detects 14 high-risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68
  • The test specifically identifies (types) HPV 16 and HPV 18, while concurrently detecting the rest of the high risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68)
  • Cost is SG$200/=
• LINEAR ARRAY® HPV Genotyping Test
  • LINEAR ARRAY® HPV Genotyping Test
  • Identifies 37 high-risk HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73 (MM9), 82 (MM4) low-risk HPV genotypes 6, 11, 26, 40, 42, 53, 54, 55, 61, 62, 64, 67, 69, 70, 71, 72, 81, 83 (MM7), 84 (MM8), IS39, and CP6108
• INNO-LiPA HPV Genotyping Extra
  • INNO-LiPA HPV Genotyping Extra
  • Identifies 15 high-risk HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82) 3 probable high-risk HPV genotypes (26, 53, 66) 7 low-risk HPV genotypes (6, 11, 40, 43, 44, 54, 70) and some additional types (69, 71, 74).
• PapilloCheck®
  • PapilloCheck®
  • Identifies 24 hiv-risk HPV types 16 18 31 33 35 39 45 51 52 53 56 58 59 66 68 70 73 82 and low-risk HPV types 6 11 40 42 43 44

References

• HPV - Wikipedia, the free encyclopedia
• HPV: Definition from Answers.com
• HPV - definition of HPV in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.
• WHO | Human papillomavirus (HPV)
• WHO | Human papillomavirus and HPV vaccines
• CDC - Human Papillomavirus (HPV)

Human papillomavirus–related genital disease in the immunocompromised host: Part I
Wed, 16 May 2012 08:07:34 +0100 | Journal of the American Academy of Dermatology
Human papillomavirus (HPV) is responsible for common condyloma acuminata and a number of premalignant and malignant anogenital lesions. These conditions are of particular concern in immunocompromised individuals who have higher risk of malignant transformation and are more difficult to treat. This is part I of a two-part review that will highlight the cutaneous features of condyloma acuminata and vaginal, vulvar, penile, and anal intraepithelial neoplasias, with an emphasis on presentation of these HPV-mediated diseases in the immunocompromised host. Counseling patients about these conditions requires a thorough understanding of the epidemiology, natural history of HPV, transmission and infectivity, risk of malignancy, and the role of the host immune response in clearing HPV lesions. Part ...

Human papillomavirus–related genital disease in the immunocompromised host: Part II
Wed, 16 May 2012 08:07:34 +0100 | Journal of the American Academy of Dermatology
This article will provide an updated review of available treatments, with a focus on recent advances and the challenges faced in successfully treating human papillomavirus lesions in the immunocompromised host. (Source: Journal of the American Academy of Dermatology)

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India
Wed, 16 May 2012 06:41:39 +0100 | International Journal of Cancer
We describe the performance of VIA, VILI and cytology, carried out in a multinational project called “Screening Technologies to Advance Rapid Testing” in 5,519 women aged 30‐49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 over‐expression and high‐risk HPV infection, indicating a high validity of histological diagnosis. The sensitivity of VIA, VILI and cytology to detect high‐grade CIN were 64.5%, 64.5% and 67.7%, respectively; specificities were 84.2%, 85.5% and 95.4%. A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared...

Gender Differences Among Low Income Women in Their Intent to Vaccinate Their Sons and Daughters Against Human Papillomavirus Infection
Tue, 15 May 2012 21:43:57 +0100 | Journal of Pediatric and Adolescent Gynecology
Conclusion: Educational interventions are needed to address the importance to mothers of vaccinating both their sons and daughters against HPV. (Source: Journal of Pediatric and Adolescent Gynecology)

Recurrent Respiratory Papillomatosis
Tue, 15 May 2012 18:55:47 +0100 | Otolaryngologic clinics of North America
Recurrent respiratory papillomatosis (RRP) is a rare, benign disease with no known cure. RRP is caused by infection of the upper aerodigestive tract with the human papillomavirus (HPV). Passage through the birth canal is thought to be the initial transmission event, but infection may occur in utero. HPV vaccines have helped to provide protection from cervical cancer; however, their role in the prevention of RRP is undetermined. Clinical presentation of initial symptoms of RRP may be subtle. RRP course varies, and current management focuses on surgical debulking of papillomatous lesions with or without concurrent adjuvant therapy. (Source: Otolaryngologic clinics of North America)

The Consumer: The Consumer: A TV Show Adds to the Muddle on HPV Testing
Tue, 15 May 2012 17:24:43 +0100 | NYT
The girls of "Girls" are asking, and so is everyone else: What does it mean to be infected with HPV? (Source: NYT)

Perspectives on Decision Making About Human Papillomavirus Vaccination Among 11- to 12-Year-Old Girls and Their Mothers
Tue, 15 May 2012 04:00:00 +0100 | Clinical Pediatrics
Conclusions. This study provides novel insights into perspectives on decision making about HPV vaccination among mothers and 11- to12-year-old daughters, which can be used in interventions to improve vaccination rates. (Source: Clinical Pediatrics)

Circumcision and penile HPV prevalence in HIV‐infected men: Heterosexual and Men who have Sex with Men
Mon, 14 May 2012 04:00:00 +0100 | Clinical Microbiology and Infection
AbstractMale circumcision is associated with a lower risk of penile Human Papillomavirus (HPV)‐infection in HIV‐uninfected men. Few studies have evaluated the role of male circumcision on penile HPV‐infection in HIV‐infected men. The aim of this cross‐sectional study was to examine the association between male circumcision and the prevalence of penile HPV‐infection among HIV‐infected men (men who have sex with men (MSM) and heterosexuals). Samples from 706 consecutive men included in the CARH·MEN cohort (24% circumcised: 26% MSM, 18% heterosexuals) were examined by Multiplex‐PCR. In the overall group (all HIV‐infected men included), the prevalence of any penile HPV‐infection was 22% in the circumcised and 27% in uncircumcised men (OR=1.0, 95%CI: 0.6‐1.6, adjusted ana...

Prevalence of human papillomavirus types in cervical lesions from women in rural Western India
Mon, 14 May 2012 04:00:00 +0100 | Journal of Medical Virology
In this study, the HPV type distribution and the frequency of p16INK4a immunoexpression have been determined in 125 cases of inflammatory lesions or grade 1 cervical intraepithelial neoplasia, 74 cases of grade 2, 72 cases of grade 3, and 113 cervical cancer cases diagnosed among women from rural Solapur and Osmanabad districts, Maharashtra. The overall prevalence of high‐risk HPV was 37.6% in inflammatory lesions or grade 1 cervical intraepithelial neoplasia, 63.5% in grade 2, 97.2% in grade 3 and 92% in cervical cancer cases. HPV 16 and HPV 18 were detected in 80.6% of grade 3 cervical intraepithelial neoplasia and 86.5% of cervical cancer cases. 94.7% of the cervical cancer and 84.4% of the high grade lesions with a strong and full thickness staining for p16INK4a were positive for HPV...

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