Ask a Librarian: Human Papilloma Virus (HPV)

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October 1-7 marked Canada’s third annual HPV prevention week. Human Papilloma Virus (HPV) is very common―it’s estimated more than 75% of sexually active men and women will be affected in their lifetime. HPV is known to cause genital warts, but persistent disease can also cause several types of cancer:  cervical, oropharyngeal, penile, anal, vaginal and vulvar.

Here are some resources on HPV screening, vaccination and treatment selected by Joule’s Ask a Librarian team using a variety of clinical tools included with CMA membership.

 

Clinical summary from DynaMed

Access DynaMed online or through the mobile app to get concise overviews and detailed recommendations, medical graphics and images, drug information from Micromedex and more.

Human Papillomavirus (HPV) Vaccine

  • Prophylactic HPV vaccine appears effective for reducing cervical intraepithelial neoplasia 2 or worse (2018 May)
  • HPV vaccination programs implemented in high-income countries associated with population-level reductions in prevalence of HPV infections, anogenital warts, and cervical intraepithelial neoplasia 2 or worse (2019 Jun)
  • hrHPV testing may detect more cervical intraepithelial neoplasia lesions than liquid- based cytology (2019 Feb)

Recent updates:

15 Jul 2019

HPV vaccination programs implemented in high-income countries associated with population-level reductions in prevalence of HPV infections, anogenital warts, and cervical intraepithelial neoplasia 2 or worse (Lancet 2019 Jun 26 early online)

17 Jun 2019

Text message reminder to parents may increase HPV vaccination rates in adolescents enrolled in school-based vaccination program (J Adolesc Health 2019 Mar 14 early online)

6 May 2019

2vHPV vaccination may reduce risk of preinvasive cervical disease at age 20 years with vaccination at younger age associated with greater reduction in risk (BMJ 2019 Apr 3)

12 Jul 2018

Prophylactic HPV vaccine may not increase risk of spontaneous abortion/miscarriage, stillbirth, or congenital malformation (Cochrane Database Syst Rev 2018 May 9)

Preview (CMA members can access all summaries via this link)

 

Clinical summary from Essential Evidence Plus

Essential Evidence Plus is an evidence-based point of care tool with access to over 13,000 topics, guidelines, abstracts and summaries. For a synopsis of new evidence reviewed by the Essential Evidence Plus editorial team, subscribe to the POEMs daily newsletter.

Human papillomavirus infection

Bottom line

  • The primary role of HPV infection screening is for cervical cancer screening to detect oncogenic genotypes and prevent progression to neoplasia.
  • Anogenital warts caused by human papilloma virus (HPV) are flesh-colored, exophytic lesions. They may be flat, verrucous, or pedunculated, and appear as reddish papules or dome-shaped lesions on keratinized skin. (C level evidence)
  • Behavioral interventions that reduce HPV infection or promote HPV clearance include condom use (B level evidence),  male circumcision (A level evidence),  and vaccination. (A level evidence) HPV vaccine significantly reduces the incidence of anogenital cancer and genital warts. 
  • HPV infection is suspected based on clinical evaluation of lesions, cytology, histology and colposcopy results. Biopsy is indicated if atypical features are noted, a cervical lesion is identified, when the diagnosis is uncertain, or when the lesion does not respond to therapy as expected. (C level evidence)
  • No individual treatment has been shown to be consistently better than another—treatment selection is based on physician and patient preferences, resources, and experience.  (B level evidence)
  • Most patients require multiple treatments to treat genital warts rather than a single treatment. (B level evidence)

Read more via Essential Evidence Plus (CMA members only)

 

Synopsis of clinical studies in POEMs by Essential Evidence Plus:

POEM: What is the effect of human papillomavirus vaccination on the prevalence of cervical disease by age 20 years?

Bottom line

During the initial years of human papillomavirus (HPV) vaccination during which only half of eligible female adolescents in Scotland received all 3 doses, vaccination decreased the likelihood of an histological diagnosis of cervical intraepithelial neoplasia (CIN) grade 3 or worse by 89% at the time of first screening. With the current uptake of vaccination of 90% or greater, the vaccination of boys, and coverage of 7 additional strains of virus, the benefit is likely even higher. 2b

Reference : Palmer T, Wallace L, Pollock KG, et al. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. BMJ 2019;365:l1161

 

Further reading

Book chapters via ClinicalKey (CMA members only):

ClinicalKey drives better care by delivering fast, concise answers, and deep access to evidence whenever, wherever you need it. ClinicalKey includes access to 1,000+ textbooks, 600 full-text journals, images, videos and customizable patient handouts across 30+ medical specialties

 

Articles via CMAJ:

Starting cervical cancer screening at 25 years of age: the time has come

Cathy Popadiuk, Kathleen Decker and Cindy Gauvreau

CMAJ January 07, 2019 191 (1) E1-E2; DOI: https://doi.org/10.1503/cmaj.181312

 

Population-level sexual behaviours in adolescent girls before and after introduction of the human papillomavirus vaccine (2003–2013)

Gina S. Ogilvie, Felicia Phan, Heather N. Pedersen, Simon R. Dobson, Monika Naus and Elizabeth M. Saewyc

CMAJ October 15, 2018 190 (41) E1221-E1226; DOI: https://doi.org/10.1503/cmaj.180628

 

Quadrivalent human papillomavirus vaccination in girls and the risk of autoimmune disorders: the Ontario Grade 8 HPV Vaccine Cohort Study

Erin Y. Liu, Leah M. Smith, Anne K. Ellis, Heather Whitaker, Barbara Law, Jeffrey C. Kwong, Paddy Farrington and Linda E. Lévesque

CMAJ May 28, 2018 190 (21) E648-E655; DOI: https://doi.org/10.1503/cmaj.170871

 

Clinical Practice Guidelines via CPG Infobase:

CPG Infobase contains approximately 1,200 evidence-based Canadian clinical practice guidelines (CPGs) developed or endorsed by authoritative medical or health organizations in Canada.

Canadian Clinical practice guidelines on HPV Infection in CPG Infobase.

 

Drug Information via CPS online and on the RxTx app (CMA members only):

CPS offers 2000+Canadian product monographs for drugs, vaccines and natural health products that are developed by manufacturers, approved by Health Canada and optimized by CPhA editors

Search “HPV or Human Papillomavirus” in the CPS on the RxTx app to find related monographs and the Drug Choices table which provides dosage, adverse effects, drug interactions and relative cost of treatment for medications.

The CPS Online includes patient handouts. Search “HPV” and select “Information for patients” to access handouts on Cervarix, Gardasil and and Gardasil 9.

 

Free information sources

All about HPV vaccines – Canadian Cancer Society

Human papillomavirus (HPV) and cervical cancer – World Health Organization

Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors - Cochrane Systematic Review (summary)

HPV – MedlinePlus – US National Library of Medicine

 

Need more information or have a more focused clinical question on HPV or HPV vaccines (or any other clinical topic of interest)? Contact the Ask a Librarian team to request a literature search.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Joule’s medical librarians are the professionals behind “Ask a Librarian”, a service for all CMA members looking for clinical search expertise. This experienced team of librarians can support you by searching on your behalf, teaching you effective search strategies or training you to use our clinical resources.

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