Human papillomavirus (HPV) and trichomonas: common, concerning, and challenging sexually transmitted infections.

humAn pApIllomAVIrus (hpV) InfeCtIon HPV is the major cause of cervical and anal cancers, as well as oral and anogenital condylomas. HPV is a DNA virus of which over 90 types have been identified. Approximately 30 types are sexually transmitted and infect the anogenital area of both men and women. Data from the National Health and Nutrition Examination Survey have provided the first national estimate of the prevalence of HPV infection among women in the United States aged 14 to 59. Overall, 26.8 percent of women tested positive for one or more strains of HPV. Prevalence of HPV was highest in women ages 20-24. Among all participating women, the prevalence of high-risk types of HPV was 15.2 percent. The prevalence of HPV types 6, 11, 16, and 18—the types targeted by Quadrivalent HPV vaccine was 3.4 percent overall. Persistence of high-risk types of HPV (16, 18, 31, 33, 35, 45) causes cervical dysplasia and cancer. Worldwide, types 16 and 18 account for the majority of cervical cancers, and one or more of these types can be found in 90% of high grade intraepithelial precursor lesions. Non-oncogenic types 6 and 11 are the etiologic agents for the majority of genital warts. Currently, cytology is used to screen for HPV related diseases. However, cytology as a cervical cancer screening method has a number of limitations, including the sensitivity to detect histologically significant disease. The sensitivity and specificity of cervical cytology ranges from 57% to 90% and from 65% to 97%, respectively. These limitations have led to a considerable intypes 6, 11, 16, or 18. The bivalent vaccine is directed against HPV types 16 and 18 to prevent cervical cancer and precancerous lesions. Recommendations from the ACIP and the ACS are shown in Table 1. Studies with the HPV vaccine have demonstrated safety with relatively few adverse events reported. The protective element of the vaccine is the high concentration of HPV type-specific neutralizing antibody. In the Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE I/II) study, almost all women who received the quadrivalent HPV vaccine became anti-HPV 6, 11, 16, and 18 seropositive one month after the third vaccine dose (99.8%, 99.8%, 99.8%, and 99.5% seropositive, respectively). The study also showed that the vaccine prevented 98-100% of CIN grades 1 to 3 or adenocarcinoma in situ, and vaginal, vulvar, perineal, and perianal intraepithelial lesions associated with vaccine-type HPV when administered to subjects who had not been previously exposed to HPV. The vaccine also reduced the rate of vulvar, vaginal, and perianal lesions by 34% and cervical lesions by 20% regardless of the type of HPV infection. The FUTURE II study showed that the efficacy of the vaccine in preventing HPV-16 and -18-related CIN 2 and 3 and adenocarcinoma in situ was lower (44%) for those women with previous exposure to the vaccine types. In Rhode Island, state-supplied vaccine is available for routine vaccination at 11-12 years of age and catch-up vaccination for females 13-18 years of age. As of July 2010, the state also began supplying the vaccine for permissive use in males nine through 18 years of through the universal state-supplied vaccine program. Vaccine recommendations from both the ACIP and the American Cancer Society are shown in Table 1.