Talk:Human papillomavirus infection/Archive 1

=2003-5=

Identical
The text on this page is identical to. I'm guessing that's a US gov source, so we can use it. Could someone confirm? (same applied to Genital wart, I cut some text and moved it there -- Tarquin 11:19 Feb 26, 2003 (UTC))
 * It doesn't matter at all, since works of the U.S. federal government are public domain. Of course, that source isn't really an encyclopedic entry. The page is completely different now, though it also seems to be lacking adequate detail, considering how widespread a disease it is..   &mdash;User:Mulad (talk) 16:30, May 6, 2005 (UTC)

From the American Cancer Society Website: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_cervical_cancer_8.asp?rnav=cri
 * "...condoms do not protect against HPV..."
 * "...certain types of sexual behavior increase a woman's risk of getting HPV: sex at an early age, having many sexual partners, having sex with uncircumcised males..."
 * "...it is necessary to have had HPV for cervical cancer to develop..."
 * I know circumcision is the norm in the US, but it bothers me rather a lot that I'm effectively accused of putting women at risk of cancer by not mutilating myself. What's the science behind that? There's no actual explanation on that page. Chris 11:03, 27 August 2005 (UTC)

There is a statistically insignificant increase in HPV transmission from uncircumsized men to females and other men (and vise-versa in both cases). This doesnt mean that the same will hold true through more study. ITs rather doubtful should a firm and significant link be found that it would be related to the actual pysical functioning of the genitallia, but rahter realted to lifestyle. More firmly religious people are cicumsized per capita than religiously liberal and non-religious peoples; which makes it probable that they are havign more sex with more partners. In any case, a condom pretty much solves the problem aside from rare cases where HPV is spread even with the use of a condom in which case circumsision has nothing to do with it anyway. --LouieS 03:26, 29 August 2005 (UTC)
 * I have a good friend who had cervical cancer 2 years ago and it was not from HPV. She told me that there were, I think, 6 other women who had the cervical cancer she had and none were from an STI and that they were all being written up in medical journals.  She was the youngest of the 6 or 7 and she is the only one who lived.  So, for what it's worth, I take issue with the statement that 100% of cervical cancer is caused by HPV.  I'm sorry I don't have any medical references for this, maybe someone with better access to medical journals could find something.
 * Also I'm confused that the beginning of the article states, "HPV infection is a necessary factor in the development of nearly all cases of cervical cancer," which would support my statement above; but then under "HPV-induced diseases:Cancer" it says, "...women with no history of the virus do not develop this type of cancer." Which is it - it causes NEARLY ALL cases or it's impossible to get cervical cancer without history of HPV?  Or am I reading this incorrectly?  I understand it's two different sources, but perhaps this article could choose one over the other or be more specific.  67.170.222.207 09:21, 10 February 2007 (UTC)
 * I brought this up as well, this improper use of the term all. Apparently my comment was deleted, but this really is an issue for me and others.  99% is the bare minimum percentage acheived before you should use the term all (medically it is 99%, scientifically it is 99.9%).  The best estimates I have seen put the cancer/HPV link at 90%, well below the threshold for such rigid language. -Unsigned

Expand
This needs more info: How is it transmitted? Other sites say by "skin to skin contact", but you can't get it from holding hands. What do they mean exactly? Does the virus stay in your body and contagious after the symptoms have cleared up? Can you still give it to others? Does it ever fully disappear? (I believe the virus stays in one's body and contagious forever). Does it create symptoms in both men and women? (I believe symptoms in men are rare). A google search shows several different vaccine studies. Can we get more details about them? User:70.18.40.48 14:56, 28 May 2005
 * You CAN get HPV from holding hands and kissing, HPV is simply a virus that causes warts of any kind, not only genital warts; though genital warts can be spread even without sexual activity. The virus staying in your body depends upon they type, many types a killed through an immune respose within eight months (sourced from NIAID), HPV can be sprad to others without and symptoms present. Symptoms in women are more frequent but less often noticed. There is a vaccine in the works effective agains 16, 18, and 31 i believe which are the main HPV contributors to cancer. Though HPV is NOT the only way for cervical cancer to develop though it is the most common cause, I don't know where ACS gets their facts from, but those are bad ones. http://www.ashastd.org/hpvccrc/patientfaq.html --LouieS 18:38, 22 Jun 2005 (UTC)
 * This sounds like herpes... Tyciol (talk) 04:22, 27 February 2009 (UTC)

General discussion
I know a number of women who have HPV, and think it really sucks, and feel like sex ed failed to warn them of the dangers. I think this article very significantly downplays some of the dangers. First, I'm not sure if it's fair to imply HPV goes away within 1 year. It doesn't -- some forms will cause irregular pap smears and will contribute to cancer for the rest of your life.

Second, while HPV is endemic, the "bad" forms of HPV aren't yet (the kinds that cause cancer, warts, or other problems) -- lots of people have them, but nowhere near 80% (this figure should be supported more strongly -- it seemed weaker in the source), so it's not fair to imply that "HPV is an almost unavoidable, and invisible consequence of sexual activity." It's really not. With one partner over a lifetime (or a very small number), you probably won't get a bad type. With many partners, you'll almost certainly have to go in for pap smears every few months. It's not as bad as AIDS in symptoms, but it sucks. With future partners, you'll either need to be dishonest about it (not mention you got it, or lie about having it), or you'll have a much harder time getting laid. If you do get laid, you'll spread it more. It's a very bad thing.

One other note: there's research that implies a connection between HPV and reoccurent urinary tract infections. It might be good to confirm how good this research is, and put up something about it. I saw it on a pretty sketchy web site, but it linked to a real medical article (http://www.health-science-report.com/cgi-bin/alotek.cgi?topics=1&article=111). I don't have access to the original article, so I can't confirm if it is being misquoted. User:18.85.18.76 00:29, 20 June 2005
 * Read the JAMA study on HPV prevalence among women aged 14-59 . It contradicts a good deal of what you're saying. The high risk, or "bad" forms as you put it, are prevalent in 15.2% of women. This refers only to current infection, detected by an HPV DNA test, not to history of infection, which is indicated by a antibody test. Furthermore, young women aged 20-29 have an infection prevalence of about 30% for high-risk types, according to figure 1 . So, yes, infection with high risk HPV types is almost as common as infection with the low-risk types.
 * Also interesting, a study on the seroprevalence of HPV 16 antibodies (which indicates a history of infection, not necessarily a current infection) indicates that, among women aged 12-59, 17.8% have or have had an infection with HPV type 16 . Furthermore, among women aged 20-29, this number spikes to 24.7%. Among women of any age with 2-4 lifetime sexual partners, the HPV 16 antibody seroprevalence is 20.7%. Keep in mind, these numbers reflect only 1 of the high-risk types, which accounts for about 50% of cervical cancers in the US.
 * So, yes, HPV (even the high-risk) forms are very common among sexually active women. The estimate that 80% of sexually active women will contract at least one form in their lifetimes seems on the mark. Yet still, cervical cancer rates in the United States are very low, about 12,000 new cases each year. The fact is that in the vast majority of people who acquire HPV will show no symptoms, even if their infection is with the high-risk types. Very few infections progress to cervical cancer. The most important thing to stress is that condom use does effectively reduce the rate of transmission, by about 70% and regular Pap tests should detect most persistent infections, which can be treated and, usually, cleared.
 * I don't mean to downplay the potential danger of persistent high-risk HPV infections, but there is a good deal of fear-mongering going on here. Play it safe, use a condom, but losing sleep over the potential of an HPV infection is not a good use of your time. —The preceding unsigned comment was added by 216.165.61.75 (talk) 05:09, 10 May 2007 (UTC).
 * Why, the article doesn't downplay the dangers. It clearly says that although HPV can infect unprotected skin areas, other studies indicate that condoms can be up to 70% effective in preventing infection if used every time, AND, if used every time, they can effectively limit ongoing persistence and spread of HPV to additional genital sites in already infected individuals. In other words, it's important not to get infected twice. I would also add that since estimated half of population have some kind of HPV, and we now have a vaccine against HPV-induced cancer, HPV spread should be encouraged because with 9 out of 10 people having it, it will become a non-issue. "Oh, you have HPV? That's ok, today everyone does".69.107.71.8 04:35, 29 April 2007 (UTC)

Taxonomy of HPV
The taxonomy of HPV has changed. E-M De Villiers et al publication in 2004 indicateds that: Within HPV type 16 are the variants of HPV 16 that make it slightly different the world round. User:130.189.38.197 00:05, 6 September 2005
 * Papillomavirus is the Family.
 * alpha is the genus
 * species 9 is one of the oncogenic species
 * within species 9 are
 * the oncogenic types: including type 16.

NPOV sources
The article seems to the lack the former and needs the latter. Andre ( talk ) 19:55, 19 October 2005 (UTC)
 * I can work on it some, what in particular strikes you as needing work? Delldot 18:06, 6 November 2005 (UTC)

"student"?
"HPV is a student"? I assume this a typo for "virus"? -Unsigned
 * Yeah, that was vandalism. The person's been warned. Thanks for noticing! Delldot 18:06, 6 November 2005 (UTC)

NPOV and quotes in controversy section
I tried to NPOV the Controversy section of the article by representing the other side as well, though if you think I've gone too far in that direction you might tweak it some or add more info. Also, I was concerned because there was a quotation in there that wasn't cited. There were three sets of quotes. Here's how it looked: "Because the vaccine protects against a sexually transmitted virus, many conservatives oppose making it mandatory, citing fears that it could send a subtle message condoning sexual activity before marriage...'I've talked to some who have said, "This is going to sabotage our abstinence message,' " said Gene Rudd, associate executive director of the Christian Medical and Dental Associations. So I removed the outer set of quotes.  Does anyone know who we're qoting with the outside quotes?  I was worried this text might be cut and pasted from somewhere.  Thanks, delldot | talk 18:11, 18 November 2005 (UTC)

=2006=

Oncogenic HPV
The reference below disputes that HPV 16 & HPV 18 are the most common. I wonder whether this is due to geographical variation (like HIV-1, the primary strain in North America, vs. HIV-2, the primary strain in Africa). Anyone have an idea about the geographic variance of HPV strains? Andersson S, Mints M, Sallstrom J, Wilander E. The relative distribution of oncogenic types of human papillomavirus in benign, pre-malignant and malignant cervical biopsies. A study with human papillomavirus deoxyribonucleic acid sequence analysis. Cancer Detect Prev. 2005;29(1):37-41. Epub 2005 Jan 26. Nephron 00:16, 6 February 2006 (UTC)

Missing out on treatments
It could be helpful if there was information regarding how the infection can be treated - what treatment can be offered to a victim. As it says there has been found no cure then we know that, but options of treatments are an important part. Correct me if I am wrong - I might not be seeing it. -Unsigned
 * ''Since the treatments for common warts, genital warts, cervical pre-cancer and cervical cancer are very different, I think detailed discussion of treatment options belongs in those separate articles. Retroid 22:06, 10 June 2006 (UTC)

Treatments
Treatments: medications, freeze warts, laser treatment, cutting and radiation (cancer). -Unsigned

What are these magical words?
...whose mission is to generate a cornified layer that seals the body and prevents dessecation. In this upper layer the late viral proteins L1 and L2 are expressed. They bind the viral DNA and autoassemble, giving rise to the complete virions, ready for a new infection, that are released as the dead keratinocytes descamate...

The first word dessecation? Is this passage really talking about dehydration? Secondly, descamate??? Is not a word that I can find at all, but is apparently a googlewhack. Was this just vandalism, or a misspelling of a real word? I am not studying biology, so I really haven't a clue. -Redwraith9
 * First time at site; these look like dessicate and desquamate. Sfahey 20:56, 18 August 2006 (UTC)

Rearrangement
This discussion page leads me to believe that most people who arrive at this article are primarily interested in HPV-related diseases. I therefore moved the general discussion of papillomavirus biology to the main article Papillomavirus. I also attempted to re-focus the intro and put the various HPV-related diseases in perspective. I think the Effects section could be organized a little better, but I wanted to give people a chance to object to the current changes first. I'm compiling a list of HPV-related articles on my Talk page - feel free to modify. Retroid 13:27, 28 May 2006 (UTC)
 * I certainly agree the articles (still) have too much overlap, and with (I expect) many more visitors here than to "papillomavirus" it's strange to refer to the latter in the lead paragraph as the "main" article. It seems to me that the best option for divvying up info between "P" and "HPV" should be 1) "HPV" having a brief "Biology of ..." section, with a header saying "See "P""; and 2) "P" having a brief "HPV and human disease" section, with a header saying "Main article: "HPV"". On a different note I am going to move those annoying top of the page comments down "below the box." Sfahey 21:34, 18 August 2006 (UTC)

HPV 6-11
Can a person contract the virus from merely touching the virgina with a hand, no prenetration? -Unsigned
 * Probably yes. Some epidemiological studies have found that adolescents begin to acquire genital HPV infections prior to engaging in penetrative sexual contact.  It's therefore thought that mutual genital "petting" can result in transmission of genital HPV infections. Retroid 22:03, 10 June 2006 (UTC)

Prevention
There are problems in the passage about prevention: "Sexually-transmitted HPV infections may be distributed widely over genital skin and mucosal surfaces, and transmission can occur even when there are no visible symptoms. Thus, the only sure way to prevent genital HPV infection is to abstain from any contact with the genitals of another."

There is a logical flaw in this statement. Assuming all else is true the second sentence could be reworded as: "Thus, the only sure way to prevent sexually-transmitted HPV infections is to abstain from any contact with the genitals of another"

This may still be incorrect, eg. if another person could touch their infected genitals and then touch yours and infect you.

If the only way (other than childbirth) that HPV can only be spread is through "sexual" contact, then "Sexually-transmitted HPV" would be better worded as "All post-natal transmission of HPV is through sexual activity", or more acurately: "All post-natal transmission of HPV occurs through direct genital to genital contact."

I don't know what the situation is, but the current wording needs to be changed. -Unsigned
 * You could say, "The only sure way to avoid genital HPV infection would be lifelong sexual abstinence." That's technically accurate since it's thought that occasional infection of infants during birth is generally oral/respiratory (not genital). Anyway, even the reformulated sentence bugs me because it doesn't seem like especially useful advice for most folks. How about "People with greater numbers of sexual partners are at increased risk of developing HPV-related diseases."? The Prevention section could cover A) Pap smear and new HPV DNA tests, B) the new HPV vaccine, C) limiting # of sexual partners, D) condoms, E) topical microbicides. Retroid 22:11, 13 June 2006 (UTC)
 * Oops, wasn't signed in when I implemented the above changes. User:69.140.22.184 is me. Retroid 18:15, 24 June 2006 (UTC)

Good
I probably shouldn't nominated since I once upon a time edited this article, but this is rapidly approaching good/featured article status. Maybe a pass through peer review? Anyway, congrats to Retroid, et al. jengod 08:03, 15 July 2006 (UTC)
 * Maybe after the introduction is sorted a bit more. It's huge. 72.48.26.130 07:35, 29 July 2006 (UTC)
 * Some material from Papillomavirus sneaked into the Intro section - in my opinion it resulted in some redundancy and a few bits of relatively arcane biology. I consolidated the redundancies and stripped out the arcane factoids.  My theory is that the great majority of people arriving at this article are investigating A) Merck's "a virus causes cancer?!" vaccine ads, B) an abnormal pap smear, C) warts of some kind.  So I'm with User 72.48.26.130 - the Intro should be terse and focus on HPV diseases. See also Talk page for main article Papillomavirus.   Retroid 14:30, 5 August 2006 (UTC)

On another note
The article would benefit from an actual cosmetic image of the HPV symptoms (warts etc) on a living human subject. -Unsigned
 * Image of Pap smear cells does the job nicely - good one, Euthman! Retroid 14:30, 4 August 2006 (UTC)
 * This is about the virus; pictures of genital warts belong in genital warts. — Omegatron 23:16, 4 August 2006 (UTC)

Some additions
I found the articles about Apoptosis and Necrosis linking to this page, I was checking for a place to insert a link about 'Apoptosis' in this article which may reveal informative on the subject, but I wasn't sure if it would apply to warts in general or common/plantar warts, or where I could insert it, a new text, in the current text or references. --TiCPU 18:52, 31 July 2006 (UTC)
 * One function of the papillomavirus oncogenes E6 and E7 is prevention of apoptosis. I added a link to Apoptosis in an appropriate spot in the main article Papillomavirus (and vice versa).     Retroid 14:17, 4 August 2006 (UTC)
 * I wonder about the word "ASCUS" in the section labeled Prevention. This word isn't linked to anything. It's thrown around by my doc regularly, but yet I do not know what it means. When I look it up in the dictionary, it just talks about fungus. When I look in wiki it says the same thing. Can someone with some medical knowledge give a definition for this word and place it in this article. (Or write a little wiki page and link to there???) This user would be very appreciative. -New User

Western disease?
Is this disease prevalent outside the West? I'm pretty sure it isn't. -Unsigned
 * So, if you haven't read: the answer is yes, in fact more so outside of the "west". —Preceding unsigned comment added by 129.176.151.7 (talk) 14:14, 21 March 2008 (UTC)
 * Because only people in the west fuck? -- Lincoln F. Stern 19:37, 21 February 2007 (UTC)
 * In my personal experience it's prevalent (as in an issue that is big enough to attract goverment and media attention) in Singapore. --PeterMarkSmith 03:40, 22 February 2007 (UTC)
 * HPV-associated cervical neoplasia is leading cause of dead from cancer in women in developing countries. in developed countries its second just behind breast cancer. thanks to early detection, pap smear etc. Xmort 14:24, 22 February 2007 (UTC)


 * It's classically a disease of poverty, presumably something to do with early and frequent sexual partners. I've had a very quick look on Medline for recent reviews: "Child marriage is driven by poverty and has many effects on girls' health: increased risk for sexually transmitted diseases, cervical cancer, malaria, death during childbirth, and obstetric fistulas." Nour, Nawal M. Health consequences of child marriage in Africa. [Review] [40 refs]

Emerging Infectious Diseases. 12(11):1644-9, 2006 Nov.

"incidence rates ranging from 3.8 per 100,000 women per year in Israel to 48.2 per 100,000 per year in Colombia." Haverkos, H. Rohrer, M. Pickworth, W. The cause of invasive cervical cancer could be multifactorial. [Review] [47 refs] Biomedicine & Pharmacotherapy. 54(1):54-9, 2000 Feb.

However, greater sexual freedom and more cigarettes in many developed countries also contribute: "In Finland, there has between 1991 and 1995 been a 60% increase in the incidence of cervical cancer among women <55 years of age. Trends in detection rates of cervical cancer precursor lesions are consistent with an increase in the background cervical cancer risk. From the 1960s to 1980s, there has been a major increase in HPV seroprevalences over time in the Nordic countries. Increasing trends are also seen for other sexually transmitted diseases and smoking." Dillner, J. Trends over time in the incidence of cervical neoplasia in comparison to trends over time in human papillomavirus infection. [Review] [76 refs] Journal of Clinical Virology. 19(1-2):7-23, 2000 Oct. -Richard Keatinge 10:35, 24 April 2007 (UTC)

External link
A well written article has been written that summarized treatment of HPV in "college-age" patients. Any thoughts? —Preceding unsigned comment added by 71.127.172.67 (talk • contribs) 03:36, 9 October 2006
 * This user was adding www.collegehealth-e.com links to multiple medical articles. And has now engaged in dialogue - thank you. The articles are well written and, more importantly, well sourced. The problem is more of whether content should be added to wikipedia articles or external links. Ideally no external link should be made if it fails to add greater information than the finished article should have once it reaches featured-article status. In this case I think the collegehealth-e.com is generally more detailed. Secondly wikipedia is not here to act as a link to other sources - we don't have one-to-one links to the equivalent article at Encyclopaedia Britannica or Encarta - yet I appreciate that collegehealth-e.com is not trying to be an encyclopaedia on all topics. I am more uncertain the more collegehealth-e.com articles I look at, perhaps this is a useful resource? But if so, should it be a standard external link resource provided by Template:Disease infobox?


 * Certainly populating multiple wikipedia articles without discussion strikes me as probably spamming... I'm going to raise the issue of the general appropriateness/usefulness of collegehealth-e.com links at the Clinical Medicine wikiproject – so please join discussion at  Wikipedia talk:WikiProject Clinical medicine. David Ruben Talk 03:01, 9 October 2006 (UTC)

Incidence vs. Age Graph
Shouldn't the incidence vs. age graph have some sort of metric on the y-axis? Ahhwhereami 01:26, 15 November 2006 (UTC)
 * Yes, absolutely it should. As it stands, the graph is at best uninformative, and at worst misleading. I propose that the graph be removed in a timely manner if a more detailed and accurate replacement cannot be found.

68.46.236.223 (talk) 17:58, 21 November 2007 (UTC)
 * Actually, I just removed it, myself. If someone has a better graph with a source, feel free to replace it.  No sense in leaving the old graph up, bad as it was.

68.46.236.223 (talk) 18:03, 21 November 2007 (UTC)

Risk for anal cancer, administer to men?
Why is the vaccine only approved for women? I guess cervical cancer in heterosexual women of child-bearing age is more important than anal cancer in young gay/bisexual men. -Unsigned
 * Maybe they think vaccinating males will encourage them to have buttsex? -- Lincoln F. Stern 19:39, 21 February 2007 (UTC)
 * They can't test men for the virus, thus they would have no way of knowing whether or not the vaccine worked. Pelargonium 09:15, 27 March 2007 (UTC)
 * If I remember right, it can be detected in semen, though I don't have a source and I don't remember the sensitivity. (D.c.camero (talk) 21:39, 18 September 2008 (UTC))

The HPV Test
I see information about prevention and about the vaccine, but I don't see any information about The HPV Test that can help detect whether or not a person has the virus. Some valuable information can be found at The HPV TEST and might be a valuable addition to this wikipedia page. --TrisDG 16:33, 5 December 2006 (UTC)TrisDG
 * Pap test information: I just found out from my doctor that vaginal lubricants can invalidate the test. Here is a link which also says that. I have been getting this test for many many years and no one has said this before and NO ONE has ever said, do not use a lubricant for X number of days prior to coming in to the office. If this is accurate information, and it seems to be, it should be included in a discussion of the test and in the doctors office too. Thanks -Unsigned

Cited sources - reference list
I noticed that recent edits cite a source (Richman) but do not include the full citation for the book or article in the reference list. I've requested this from the (new) editor HEYNURSIE on their talk page. Keesiewonder 11:04, 16 December 2006 (UTC)

=2007=

Suggestions
The [|"HPV-induced cancers" figure] and the text ("Sexually transmitted HPVs also cause [...] approximately 25% of cancers of the mouth and upper throat") seem to radically disagree. The figure doesn't show anywhere near 25% attributed to mouth and throat.

I'd like to see some specific statements about the impact of HPV on males, both heterosexual and homosexual. An FAQ I wish were answered, for example, are the risks to a male whose partner has been diagnosed with HPV.

In the interest of public service and reducing the spread of disease through easy access to information, it may be worth refocusing the initial paragraphs to address the key basics about risks (e.g. cancer), transmission (more specifics here would help, as "environmentally", "casual skin-to-skin contact", and "sexually" are all listed), and prevention.

Wikipedia becomes a more mainstream reference every day. I'm certainly not suggesting that the entire article be "dumbed down". But not everyone who comes to this page is a scientist, doctor, or even has an average IQ or better. Those who need more information will read further down. But many may not get past the top-most page. Just a thought. -- MKC 14:15, 8 February 2007 (UTC)
 * I just wanted to add the following recent news item about research from Hopkins to the HPV-induced disease section 2.3 Cancer. I'm a new member and have no axe to grind. In an article on Newswise Johns Hopkins researchers conclude that human papillomavirus (HPV) causes some throat cancers in both men and women. Reporting in the May 10 issue of the New England Journal of Medicine, the researchers find that oral HPV infection is the strongest risk factor for the disease, regardless of tobacco and alcohol use, and having multiple oral sex partners tops the list of sex practices that boost risk for the HPV-linked cancer. Cville roger 16:28, 15 May 2007 (UTC) [User:cville roger] 12:30, 15 May 2007

75% figure?
Baseman and Koutksy, 2005 does NOT have any reference to the quote that "with estimates suggesting that up to 75% of women will become infected with one or more of the sexually transmitted HPV types at some point during adulthood (Baseman and Koutsky, 2005)" Matter of fact, the number "75" is not in the text.

In the paper, it does say that >50% of women will contract one of the HPVs at some point. In the reference section of this Wikipedia article, someone states that "Note: the abstract of this paper states that 60% of initially HPV-negative women became infected over the course of five years of follow-up. 20% of the women in the study population were already infected at the onset of the study. This supports the conservative 75% figure given in the introduction section."

This may indeed be true for the Woodman study of English girls (ages 15-19), but may not be sufficient for generalization. At the very least, the 75% number needs a confirmatory reference, as Baseman and Koutsky's 2005 paper cannot be used as justification. jKay 19:50, 9 February 2007 (UTC)

Questionable Sentence
A recently approved HPV vaccine that blocks initial infection with several of the most common sexually transmitted HPV types may lead to further decreases in the incidence of HPV-induced cancer (Lowy and Schiller 2006). This sentence seems a bit misleading and may even be contradicted by the CDC in a recent CNN article on HPV. Please take a look and judge for yourselves but in order to be completely fact based this sentence perhaps should be removed. ''(this unsigned contribution was by 206.209.15.42 on 28 February 2007)
 * The CNN link to that AP article no longer works, but I found the article here and here.


 * The article is not well-written, though. The sensationalist lead sentence is, "One in four U.S. women ages 14 to 59 is infected with the sexually transmitted virus that in some forms can cause cervical cancer, according to the first broad national estimate."  Unfortunately, it is left unclear in the article whether that is a reference to high-risk HPV strains, or to any type of HPV. (It turns out to be a reference to all sexually-transmitted types of HPV, both high-risk and low-risk.)


 * The AMA does not permit free access to the JAMA article upon which that AP article is based. However, I found many related articles about the same study, including articles here, here, and here.  The last of those (a Wall Street Journal article reproduced on the web site of Sen. Tom Coburn, M.D.) is better written.  It reports that the study found 26.8% prevalence of 'all' HPV strains, 3.4% prevalence of the four strains which Gardasil protects against, of which ~2% were types 16 & 18 (the two high-risk strains that Gardasil protects against).  Reading between the lines, it appears that the study might not have tested for the other 17 HPV types which are currently known or thought to be high-risk strains.


 * That brings me to a question, which I first asked on the Talk:HPV vaccine page. I would be most grateful for any comments or answer to that question.  It seems that a U. Wash. study found that only 18% of fresh high-risk HPV infections in female university students were with types 16 or 18, the two high-risk types which Gardasil protects against.  The other 82% of the infections with high-risk HPV types were with 16 other high-risk strains.  18% is far short of the 70%, which is the approximate percentage of cervical cancer cases which are said to be caused by types 16 & 18.  I can think of two obvious possible explanations for the disparity:
 * 1. The "mix" of HPV strains in circulation is changing. 70% of high-risk infections 30-40(?) years ago (when most current cervical cancer victims presumably became infected) were types 16 & 18, but now other high-risk strains predominate.  And/or,
 * 2. The carcinogenicity of types 16 & 18 is higher than most of the other high-risk strains of HPV.
 * So the question that I asked is: which is the correct explanation? Or is there another explanation that I've not thought of?


 * The answer to that question has important health and public policy implications. If the the mix of HPV strains in general circulation has changed, such that the prevalence of high-risk strains other than 16 & 18 has increased, then the advertised 70% effectiveness against cervical cancer of the HPV vaccines is overstated, and perhaps very greatly overstated.


 * If you have an answer to this question, please post it here. NCdave 08:46, 1 July 2007 (UTC)

Oropharyngeal in NEJoM
How do I add "et al" to a citation? I only listed the first three authors. Darkfrog24 21:21, 11 May 2007 (UTC)
 * Rather than breaking the author list into author1/2/3, I find it more useful to stick with the Pubmed-style
 *  et al | title = ...
 * When using the  templates, which also gets around the problem you've noted. -- MarcoTolo 21:31, 11 May 2007 (UTC)
 * I don't know if there is any need but there is a BCC discussion of the paper here . Nil Einne 13:57, 12 May 2007 (UTC)
 * Hmm... It's probably best to put the real source as the footnote, but this is much easier to read.  NEJoM is practically Sanskrit to many readers.  Maybe we should add the BCC discussion as an external link.Darkfrog24 13:53, 14 May 2007 (UTC)

Smoking section
I modified this a bit in light of newer studies which have shown that smoking increases risk by at least 2x (and possibly over 4x), as well as questioning whether folic acid does significant good. See, for example, Folate, vitamin B12, and homocysteine status, findings of no relation between human papillomavirus persistence and cervical dysplasia. (Sedjo RL, Fowler BM, Schneider A, Henning SM, Hatch K, Giuliano AR; Nutrition, 2003 Jun;19(6):497-502; ) Fnordius 19:35, 13 May 2007 (UTC)
 * While this is certainly applicable to cervical cancer in general, smoking seems a bit extraneous to an article about HPV. What do you guys think? Darkfrog24 13:51, 14 May 2007 (UTC)

New graph
What do people think of the new HPV incidence graph? I think it illustrates useful concepts, but the y-axis ('incidence') is unitless. I'm of two minds about it. 70.95.251.152 05:13, 2 June 2007 (UTC) jKay
 * I agree it would be nice to have units for the incidence axis. —PHaze 22:18, 2 June 2007 (UTC)

I am worried of having HPV
Dear Sirs, I am ---, an MA student in Counseling Psycology. I am a young girl of 25. I am afraid i have HPV, as i have noticed now enlarging genital warts. I am worried. Please advise. Sincerely yours -Unsigned
 * See a doctor. Your university clinic can probably offer you relative anonymity and decent fees.  If not, look up "free clinic" or "anonymous clinic" with your zip code.  For the record, wikipedia talk pages are not the place to discuss things other than the articles at hand. Darkfrog24 13:37, 14 June 2007 (UTC)
 * I removed the name from the MA student's post above, since it was non-essential, and the post looks like a possible defamation attempt.

68.46.236.223 (talk) 17:57, 21 November 2007 (UTC)

Restored citation
This edit was made with the summary "Removed, irrelevant, citation did not mention statement". The citation in question has the following statement on the second page: "Based on the high prevalence of cancer of the cervix in prostitutes and its virtual absence in nuns, he postulated that a sexually transmitted agent causes this cancer." Thus, I have restored the paragraph. -- MarcoTolo 19:20, 21 June 2007 (UTC)

Might want to add a few details
Although it says that HPV can be transmitted without sex, and that hand warts do not "usually" cause genital warts, is that possible? How likely is that occurrence? Have any studies been done on the matter? Is there any way of getting genital warts without having sex with an infected person, or touching the genitals of an infected person? I read that "Only certain types of HPV cause genital warts. Other types, not related to genital warts, can cause abnormal cell changes on the genital skin, usually on a female's cervix." on http://www.ashastd.org/learn/learn_hpv_warts.cfm. How can one tell if a wart is simply a wart on the genital skin, or a genital wart, which would indicate a different virus? In what ways would this affect treatment? Also,do genital warts look the same as skin warts? Are we allowed to have a picture of genital warts on wikipedia? Because it might be helpful to be able to see a picture, even if somebody just included a link (thus making viewing optional). 75.26.189.55 09:04, 28 June 2007 (UTC)Rebecca

Diindolylmethane
I removed the following new content from the main page:
 * Respiratory Papillomatosis Patients are currently recommended to take Diindolylmethane (DIM) as a treatment. This compound, native to Brassica vegetables, is also currently in Phase III clinical trials for Cervical Dysplasia and may soon become recognized as a therapeutic for this condition caused by HPV. DIM is currently also undergoing clinical investigations as a natural therapeutic candidate for other HPV infections.


 * The Diindolylmethane Information Resource Center at the University of California, Berkeley provides regularly updated information on recent scientific discoveries regarding this phytochemical from Brassica vegetables and its clinical use as a therpeutic for HPV.

I have two concerns. First, this page seems to be set up to direct users to specific disease pages for discussions of treatment, so unless we decide to change this, the appropriate locations for this content are on the pages Respiratory papillomatosis (actually a redirect to laryngeal papillomatosis) and cervical intraepithelial neoplasia. Second, I was unable to confirm that DIM or related compounds are an established treatment for any human disease (i.e. RRP). This January 2007 review article - (PMID 17317210) - refers to promising results in "small preliminary trials" for both CIN and RRP, and states that definitive randomized trails have not been completed to date. It does not seem that RRP patients "are currently reccomended to take Diindolylmethane" outside of a research trial.-RustavoTalk/Contribs 01:42, 23 June 2007 (UTC)


 * Rustavo, it looks like you forgot to actually remove the info from the main page, so I just took care of it. If anyone can verify that diindolylmethane is now a currently recommended treatment for any HPV induced disease, please add this information (with citation hopefully) to the relevant disease page. An anonymous user re-added diindolylmethane information to the article.  I have been unable to verify any of the claims made therein, so I reverted the additions. —PHaze 01:41, 10 July 2007 (UTC)
 * It has been added again, still without the citation called for by PHaze and without addressing Rustavo's point that material relating to treatment of HPV-related diseases is inappropriate here. Therefore, I've removed it again. JamesMLane t c 05:21, 8 October 2007 (UTC)

HPV tree graphic
This graphic includes a measure of scale ("0.05") but does not indicate the units, whether physical dimensions or otherwise. What does the length of the lines represent? Spazquest 05:07, 30 June 2007 (UTC)

Discrepancies
In the section Public Health and Genital HPVs a sentence states "the Food and Drug Administration FDA and CDC recommend that girls and women between the ages of 12 and 26 be vaccinated." but in section Vaccine a sentence similarly states "The Food and Drug Administration FDA and CDC recommend that girls and women between the ages of 9 and 26 be vaccinated." Can this be rectified??

Also, I think this article is missing some really important information. What is the effectiveness of the vaccine versus age? I ask because on NPR they were discussing why it is more important for young girls to be vaccinated for maximum effectiveness. I don't remember all of it but to paraphrase they said that the effectiveness decreases exponentially once a girl reaches sixteen, or something like that. I would just like to get this information clarified or maybe cited. thanks Joelotz 06:11, 17 August 2007 (UTC)
 * I've updated and cited the recommendations (girls and women 11-26 per the CDC). Technically, the FDA has approved Gardasil for "girls and women age 9-26", but it is the CDC which makes the public health recommendation. The "maximum effectiveness" issue is typically a function of getting girls vaccinated before the onset of sexual activity. I wasn't able to find the NPR story you're referring to - could you point me to it so I can see if this is a different topic? -- MarcoTolo 19:44, 17 August 2007 (UTC)
 * Hang on for a sec - there are safety concerns regarding Gardasil. The claim that "no side effects" exist is certainly wrong; the de:Paul-Ehrlich-Institut has recorded 189 cases of adverse reactions after Gardasil vaccination in Germany in less than a year. There have been at least 2 cases of SADS in close temporal vicinity with Gardasil vaccination. If you know German, see the news article here. —Preceding unsigned comment added by Dysmorodrepanis (talk • contribs) 12:35, 4 February 2008 (UTC)


 * Update (German text) - the wording is a bit fishy. Confidence in vaccine safety is publicly restored, and the deaths are "tragic" but bear no connection to Gardasil vaccination, and so on. Something seems to be going on behind the scenes, if you can read German check out the weasel wording. We know for a fact that 2 cases of SADS ocurred in close temporal proximity to Gardasil vaccination. Everything else is speculation at this point. But to German native speakers, the way they phrased it suggests that we're far from hearing the last of it. It's a bit too much "regrettable collateral damage" in there:
 * "'Dabei wurde von Prof. Löwer festgehalten, dass die beiden tragischen Todesfällen im deutschsprachigen Raum, auch bei intensiver Untersuchung, einschließlich gerichtsmedizinischer Obduktion und biochemische Diagnostik in keiner Weise in Zusammenhang mit der erfolgten HPV-Impfung stehen. [...] Die Verunsicherung der Bevölkerung durch die Medien wird von den drei herausragenden Instituten abgelehnt und insbesondere wird vor unbegründeter Panik gewarnt.'"
 * ("Prof. Löwer noted that the two tragic deaths in German-speaking countries after intense study, including forensic autopsy and biochemical diagnostics, are not causally connected in any way with the HPV vaccination. [...] FUDing the population at large by the [mass] media is denounced by the [PEI, EMEA, and CDC] and it was especially warned of groundless panic." [my italics])
 * The text goes on to state:
 * "Obwohl die gesammelten Untersuchungsergebnisse der Obduktion keinerlei Hinweise auf die Ursache des Todes der jungen Frau ergaben, hat das Paul Ehrlich Institut ebenfalls eigene zusätzliche Untersuchungen veranlasst, die bis zum heutigen Tag keinen Hinweis auf einen Zusammenhang des Todesfalls mit dem Impfstoff ergeben haben."
 * "In Österreich verstarb es eine 19-jährige Frau drei Wochen nach der ersten Impfung. Auch hier konnte in der Obduktion keinen Zusammenhang mit der Impfung, aber auch keine sonstige Todesursache, nachgewiesen werden."
 * ("Although the accumulated study results of the autopsy gave no indication at all concerning the cause of death of the young woman [from Germany], the PEI ordered additional investigations on its own, which til today gave no indication of a connection between the vaccine and the death.
 * In Austria a young woman died three weeks after the first vaccination shot. Here too no connection to the vaccination, but neither with any other cause of death could be found in an autopsy." [my italics])
 * My scientific ethos riles at the suggestion that "no cause determinable" = "cause xyz has been falsified". And maybe I read too few tabloids, or I underestimate the anti-vaccination movement in Germany; I always thought it was a tiny lunatic fringe. But from where I am I can see no indcation for a mass media FUD or a "panic" of any sorts.
 * The PEI is a respected and professional institution. They could have said: "we don't have an explanation at this point but this is normal in SADS cases; the matter remains under investigation but it certainly is not so that Gardasil vaccination can be considered generally risky." Instead they chose to say: "we have no idea why these deaths occurred but we know that Gardasil is safe and don't trust the media, they're trying to BS you."
 * I am at a total loss here. Dysmorodrepanis (talk) 17:35, 19 February 2008 (UTC)

Another discrepancy: the following sentences, taken together: "15.2% were infected with one or more of the high-risk types that can cause cancer. However only 3.4% were infected with one or more of the four types prevented by the Gardasil vaccine, which was lower than previous estimates. [7][9]" conflict factually with this from the Guardasil page: "Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 cause about 70% of cervical cancer cases." More succinctly, Human papillomavirus says (3.4% / 15.2%) = 22% of cancer cases are caused by a Guardasil-matched strain; but the Guardasil page says this number is at least 70% (plus a small percentage for types 6 and 11). Sorry if my logic isn't clear; it's late. Lucius230909 (talk) 05:27, 5 July 2008 (UTC)
 * The 15.2% is an estimate of percent of women infected with high-risk HPV at a given time, but most of those people will not develop CIN or cancer. So one can't use the fraction of women infected with high-risk HPV at a time as a surrogate for the prevalence of cervical cancer.  Furthermore, the above assumes that all high-risk types carry the same risk.  Even among "high-risk" types, the cervical cancer risk varies from virus type to virus type.  HPV types 16 and 18 are among the highest risk types.  (e.g., in the Epidemiology section it says that type 16 alone causes about half of cervical cancers)  So there is no reason to expect that the proportion of women infected with types 16 and 18 to those infected by any high risk (which you calculated as 22%) would be the same as the fraction of cervical cancer cases caused by those those types.  Hope that helps. Zodon (talk) 07:38, 5 July 2008 (UTC)

History of discovering link between virus and cancer
There's a lot of lifestyle differences between female prostitutes and nuns. Surely sex is just the obvious one to the male mindset. The given reference says nothing about prostitutes or nuns. —Preceding unsigned comment added by 86.146.225.44 (talk) 20:51, 25 November 2007 (UTC)
 * The history section in Cervical Cancer might help to improve this. It offers a little more detail, and a reference (albeit not a very complete one).  "(Rigoni in 1841)"  Zodon (talk) 08:12, 29 February 2008 (UTC)

=2008=

Vaccination
I removed the sentence "To eradicate the disease, men and boys will eventually need to be vaccinated." as seems to be an expression of an opinion or a misquote. The opinion may make good sense, however, the given reference to WebMD did not link to any article. The closest I could find looking in WebMD was at link titled "HPV Virus in Men", within the section 'HPV Vaccine for Men?' stating: "The HPV vaccine Gardasil, approved for use in women in 2006, is not yet approved for men. Studies are still being done to determine if the vaccine works in males. Eventually, public health experts say, boys and men may be vaccinated."

The remaining statement which I left under the Vaccination section was "HPV can infect both men and women", and I linked that to a currently existing WebMD article.

There appear to be quite a few WebMD links within the vaccination section and scattered around. WebMD may be overused in this section as a link, as this website appears to serve as a summary of findings made and published by others, therefore, may be more likely to contain opinions, rather than only researched based factual information.

In researching the statement at the bottom of the Vaccination section, which pertains to HPV vaccination in England, a citation is missing. I didn't know how to indicate the need for that, but as it appears likely to be true, though totally uncited, I left it. (I do wonder about the need for a reference specific to the United Kingdom vaccination policy in this section though. Per Merck, something like 48 countries have approved the vaccine and perhaps a more general note to that effect would be appropriate instead.)  Anyway, in trying to find confirmation of the UK info cited, I did find at: , an article of meeting minutes relating to HPV findings by the United Kingdom's Department of Health. Section 18, approximately paragraph 18, appears to contradict the statement that elimination of the HPV virus would require vaccination of men and infers that study findings did not indicate a significant improvement in HPV prevalence in a highly vaccinated population of women, due to 'herd immunity'. I would add that, in my opinion, this may also contain some assumptions and may overlook the possibility of continued HPV spread via gay males.

If another source exists which pertains to the benefit of vaccinating males, feel free to add this information back, along with a working citation to an authoritative source. However, the Vaccination section seems to be pretty well done, so perhaps any significant new information on that subject would be better added to the main article "HPV Vaccination".

Personally, as the US has a high prostate cancer incidence, I would be quite interested to know if any studies have been performed to examine whether any prostate cancers are related to HPV. Some other information about HPV clearance in women (such as intake of lykopene and other nutrients), appears to link up with reduced prostate cancer in men, and I find myself wondering if these might be linked. This seems worthwhile exploring and if information relating to this exists, this would be a good addition to this section. I also wonder if the failure in clearance of HPV in some women is related to carriage of HPV by her partner and, if so, I wonder where the HPV reservoir in her male partner might be. To me, the prostate would seem to be a good candidate to look at for that. Why are many prostate cancers slow growing and a smaller number of others aggressive and fast growing? Would infection with specific HPV types account for that as in women? The vaccine manufacturors seem not to have considered or explored this at all that I can find.

Once another HPV vaccine becomes available, this section will need further clean-up, and perhaps trimmed down, with more information moved onto the HPV vaccination page. The focus in this section is now focused primarily on the currently approved and available Merck HPV vaccine. Lcph88 (talk) 06:31, 28 February 2008 (UTC)
 * I thought that sentence about eradicating cervical ca. was questionable also. I didn't check the ref, but removal seems reasonable. You can indicate that a reference is needed with the  tag.  There are others for debatable (which can link to a discussion) too. On the prostate cancer question, a quick Google turned up this from Fred Hutchinson CRC "No evidence of HPV connection to prostate cancer" http://www.fhcrc.org/about/pubs/center_news/2003/aug21/sart3.html  One reason it is harder to study HPV in men is it is more difficult to get reliable samples.  (Sampling involves sand paper and the male sex organ.) Zodon (talk) 09:21, 28 February 2008 (UTC)
 * Thanks, both for the info and the link. Lcph88 (talk) 03:35, 29 February 2008 (UTC)
 * While I don't have a reference at this time, I believe the vaccination of men and boys both because they are part of the HPV puzzle and because it may help allay concerns in conservative countries and amongst conservative people about the vaccine somehow promoting promisciuty (at least one partner would be protected). However this is probably a long way off since the vaccine hasn't yet been tested in men Nil Einne (talk) 12:39, 3 April 2008 (UTC)

Lead: remove HPV type numbers
The lead is cumbersome with all the HPV type numbers. They would be better left to the main article. Just thought I'd check before making changes. Pgr94 (talk) 15:34, 28 February 2008 (UTC)
 * If you remove them, please be sure to move them down to the main article (and/or confirm them). That list does not occur elsewhere in the article that I could find.  There are other lists, but they aren't the same as that one.  Zodon (talk) 08:15, 29 February 2008 (UTC)
 * Moved, but the section is admittedly weak. It would good to have an explanation of the numbering system, what does it represent (genotypes), who maintains the numbers, etc. Pgr94 (talk) 12:37, 29 February 2008 (UTC)

Common skin warts
Added references and links to the National Institutes for Health, but couldn't find links using all descriptive language used in this section. If someone can find more, please add reference citations as appropriate. Lcph88 (talk) 04:12, 7 March 2008 (UTC)

Treatment
The link to "other HPV related diseases" in the Treatment section doesn't lead anywhere. 8 March 2008 —Preceding unsigned comment added by 76.103.129.3 (talk) 23:47, 8 March 2008 (UTC) <!--Autosigned by SineBot--:Fixed - it was an internal link to the section on diseases, but the section was renamed. Zodon (talk) 02:09, 9 March 2008 (UTC)

Incorrect information
I am a medical doctor specializing in internal medicine with 25 years of experience. I found the following information in this article to be incorrect and I’d like to update it to include the correct information. If no one protests the updates below within 48 hours, I’d like to go ahead and make these edits to ensure that Wikipedians receive the correct information as soon as possible. All references are included below.
 * Existing Text: "The last Pap test method is mainly used on women over 30. It is a combination Pap-HPV DNA test."
 * Updated Text: "Another method of cervical cancer screening is the HPV DNA test. The U.S. Food and Drug Administration has to date approved one test for high-risk types of HPV, called the Digene® HPV Test. The FDA has approved it, and a number of medical societies have recognized it, for follow-up evaluation of women with inconclusive Paps, as well as for routine screening of all women over 30, along with a Pap.''"   It can often be done on the same sample of cells collected for the Pap. In addition, some researchers have suggested that the most cost-effective method of cervical cancer screening might be to test women for HPV first, giving the Pap only to those found to have the virus.
 * Drsavard (talk) 14:20, 10 March 2008 (UTC)

Suggested improvements to proposed modification: it needs NPOV improvements and citation for major uncited claim. -Unsigned=
 * Suggest much of the specifics about the HPV test (sentence #2) would be more appropriate in the HPV testing section (e.g. trade name, etc.)
 * Uncited claim - Need citation to show that HPV DNA testing is a method of cervical cancer screening. It was FDA approved as an adjunct to (not replacement for) Pap smear screening.  It was shown to be useful for triage in the presence of an abnormal Pap result by the ALTS trial.  There has been speculation that it might be used as a screening test.  However none of that shows that it has clinical value as a screening test for cervical cancer.  So before can call it a cervical cancer screening test, need a quality citation that says that it is.
 * Its use for follow-up should be separated from screening, and appropriate sources linked. (Way it is makes it hard to tell which source covers which).
 * NPOV - Using it for primary screening is speculative, and without balancing material shows distinct POV. Additional material showing other views on this would be necessary for balance.  While some may recommend the HPV test, others recommend against it.  So could use NPOV improvements.
 * Hope this helps to improve the addition. Zodon (talk) 08:01, 11 March 2008 (UTC)


 * I could certainly separate the citations as you suggest, but I have found it less confusing to women and other healthcare professionals if HPV testing is discussed in a holistic fashion.

Regarding your opinion that the use of HPV testing for primary screening is “speculative,” I must strongly disagree. There is a wealth of clinical data supporting the use of routine HPV testing of women age 30+, in conjunction with cytology. Below is just a sampling of these studies, beginning with the most recent: Janet G. Baseman, Ph.D., Department of Epidemiology, University of Washington (American Journal of Obstetrics & Gynecology, March 2008) Sue J. Goldie MD, MPH, Department of Health Policy and Management, Harvard School of Public Health (Journal of the National Cancer Institute, Feb. 26, 2008) Franco, E. et al. Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer. New England Journal of Medicine 2007; 357: 1579-1588. Meijer, C. et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomized controlled implementation trial. The Lancet 2007; DOI:10.1016/S0140-6736(07)61450-0. Castellsague, X. et al. Worldwide Human Papillomavirus Etiology of Cervical Adenocarcinoma and Its Cofactors: Implications for Screening and Prevention. Journal of the National Cancer Institute 2006; 98: 303-315. Cuzick, J. et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. International Journal of Cancer 2006; 119: 000-000. Ronco, G. et al. Human Papillomavirus Testing and Liquid-Based Cytology: Results at Recruitment From the New Technologies for Cervical Cancer Randomized Controlled Trial. Journal of the National Cancer Institute 2006; 98: 765 – 74. ACOG Practice Bulletin No. 61, "Human Papillomavirus. Clinical Management Guidelines for Obstetrician-Gynecologists." April 2005. Sherman M.E., et al. Human Papillomavirus Testing, and Risk for Cervical Neoplasia: A 10-Year Cohort Analysis. Journal of the National Cancer Institute, 2003;95:46-52. Cuzick, J. et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. The Lancet 2003;362:1871-76. Lorincz, A., Richart, R. Human Papillomavirus DNA Testing As An Adjunct To Cytology In Cervical Screening Programs. APLM 2003;127:959-968. Petry K., et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8,466 patients, British Journal of Cancer,2003;88:1570-1577. Bory J., et al. Recurrent Human Papillomavirus Infection Detected with the Hybrid Capture 2 Assay Selects Women with Normal Cervical Smears at Risk for Developing High Grade Cervical Lesions: A Longitudinal Study of 3,091 Women. Int. J. Cancer, 2002;102:519-525. Solomon D., et al. Comparison of Three Management Strategies for Patients with Atypical Squamous Cells of Undetermined Significance: Baseline Results from a Randomized Trial, J. Nat Cancer Inst, 2001; 93:293-299. Clavel C., et al. Human Papillomavirus Testing in Primary Screening for the Detection of High-Grade Cervical Lesions: A Study of 7,932 Women. Brit J Cancer, 2001; 89 (12):1616-1623. Walboomers J.M.M., et al. Human Papillomavirus is a Necessary Cause of Invasive Cervical Cancer Worldwide. Journal of Pathology 1999;189:12-19. 71.224.215.219 (talk) 19:58, 28 April 2008 (UTC)
 * Study results suggest that, in women aged 30 + years, co-testing with a Pap smear and HPV DNA test was more sensitive than reflex HPV testing for the detection of high-grade cervical lesions (91% vs. 54%), provided women with a positive hc2 test and negative Pap were referred to colposcopy and biopsy.
 * For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations.
 * Compared with cytology, HPV testing has greater sensitivity for the detection of cervical intraepithelial neoplasia. The sensitivity of HPV testing for CIN grade 2 or 3 was 94.6%, whereas the sensitivity of cytology alone was 55.4%. The sensitivity of both tests used together was 100%, and the specificity was 92.5%.
 * Implementation of HPV DNA testing in cervical screening led to a substantial increase in the number of CIN 2/3+ lesions detected at the baseline screening round. At the subsequent round, combined HPV DNA and cytological testing was used in both study groups and significantly fewer CIN 2/3+ lesions were seen in the women who received both tests at the baseline round than in the control group. Therefore, the results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions.
 * HPV testing in primary screening and HPV vaccination against the most common types have the potential to reduce the incidence of invasive adenocarcinoma.
 * HPV testing is substantially more sensitive in detecting CIN 2+ than cytology (96.1% vs. 53%) but is less specific (90.7% vs.96.3%). In this analysis, the sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV-positive.
 * HPV testing alone was more sensitive than conventional cytology among women 35- 60 years old. Adding liquid-based cytology improved sensitivity only marginally, while increasing false-positives. HPV testing using Hybrid Capture 2 with a 2 pg/mL cutoff may be more appropriate than a 1 pg/mL cutoff for primary cervical cancer screening.
 * Because HPV DNA testing is more sensitive than cervical cytology in detecting CIN 2 and CIN 3, women with negative concurrent test results can be reassured that their risk of unidentified CIN 2 and CIN 3 or cervical cancer is approximately 1 in 1,000.
 * The negative predictive value of combined HPV/Pap testing is 99.21% for CIN 3.
 * In another study of more than 11,000 women, the digene HPV Test was shown to be 97% sensitive for CIN 2+, compared to 77% for conventional Paps resulting in ASC-US or abnormal results. The study also documented that women infected with high-risk HPV and who have normal or borderline cytology can be managed as effectively with repeat testing after 12 months with immediate colposcopy.
 * Still another study demonstrated that HPV testing is a more sensitive indicator of high-grade CIN than either conventional or liquid cytology alone. Screening with both an HPV and Pap test offered a sensitivity and negative predictive value of almost 100%. Twenty-one percent of women who were persistently positive for high-risk HPV DNA types when tested with hc2 were diagnosed with CIN 2/3 within 36 months, compared to only 0.08% of women who were initially HPV-negative.
 * A study of 8,466 women undergoing routine cervical cancer screening showed that when used in conjunction with a Pap, the sensitivity of the digene HPV Test test was 100% for detection of CIN 2+, while that of the Pap alone was 43.5%.
 * Women with persistent HPV infection are more than 300 times more likely than HPV-negative women to develop high-grade cervical disease.
 * In an ASC-US population, the sensitivity of the digene HPV Test for detecting high-grade precursors and cervical cancer is 96%, compared to 85% for a repeat liquid-based Pap test.
 * A cohort analysis of 5,671 women older than 30 (conducted within a larger study of 7,932 women) showed that conventional cytology was 57% sensitive for HSIL; liquid cytology was 84% sensitive, and the digene HPV Test was 100% sensitive.
 * High-risk HPV types have been detected in 99.7% of cases of cervical cancer, confirming that the virus must be present for cervical cancer to develop.

youngandhealty.ca external link
WhatamIdoing, what is the issue with that link, that led you to delete it, with the provocative comment, "I wonder how many times I'll get to delete this link?" (Just wondering.)  NCdave (talk) 16:23, 13 March 2008 (UTC)
 * The website has relatively little content and is posted by a single-posted account. Actually, by at least two single-purpose accounts, one of which is named after the organization that owns the link, and the occasional anon editor, who "strangely enough" is editing from the same part of the world as the organization.  The links are a violation of both WP:EL's provisions (external links should provide more information than the article) and (at least with user User:Caah-Acsa) also WP:COI.
 * I (and other editors) have deleted the links repeatedly, I've left comments on talk pages, I even thought about finding an e-mail address for them in case they haven't figured out the talk pages, and they still try to use Wikipedia to promote their website. I am a little frustrated with their continuous choice to spam us. I have not, however, asked to have the website blacklisted, because it's in the Wikipedia article that the org wrote about itself, and regular blacklisting would result in it being removed from the org article.  WhatamIdoing (talk) 16:42, 13 March 2008 (UTC)
 * Okay, thanks! I was just wondering.  NCdave (talk) 18:59, 13 March 2008 (UTC)

Picture
I know it's quite gross, but perhaps a picture of a HPV infection should be put somewhere in the article. Persoanally I hate such pictures, and believe that wikipedia should allow to see them somehow, but well, it would be informative. Agameofchess (talk) 19:39, 30 March 2008 (UTC)

Proposed category merge
The related Category:Sexually transmitted infections has been nominated for deletion, merging, or renaming. You are encouraged to join the discussion on the Categories for Discussion page.

External link genitalwartsadvisor does not meet EL criteria
The website genitalwartsadvisor.com/human-papillomavirus-hpv which has been repeatedly added to the external links section does not appear to meet WP:EL criteria. Among the problems are WP:LINKSTOAVOID: #1 (not a unique resource beyond what a good Wikipedia article could be) and #11 (it is a personal web page not by a recognized authority on the subject). If you think the site is worth linking to, please explain/discuss here, rather than continually adding it after it has been removed by several editors. Thank you. Zodon (talk) 21:03, 9 May 2008 (UTC)

Women only
Why is the section about america relevant only to women? —Preceding unsigned comment added by 86.151.175.184 (talk) 18:04, 15 May 2008 (UTC)
 * Most of the data on HPV prevalence (whether US or elsewhere) is in women partly because it is harder to detect HPV infection in men. (e.g. Sampling involves sand paper and the male sex organ.) Zodon (talk) 04:14, 16 May 2008 (UTC)

Prevalence
User:Zodon, I'd like to know your source for that figure of 80% of the population having HPV. The highest reliable figure I could find was from Journal Watch, and that was 45% in the highest prevalence group, as detected by PCR. I don't think PCR-detected prevalence is the same as disease. You have commensal bacteria colonizing your skin and your gut without having skin or gut disease. In order to have a STD, you need an infectous organism and a permissive immune system. Just having HPV present isn't enough. Nbauman (talk) 06:55, 21 June 2008 (UTC)
 * I am fairly certain I ran across a source for the statement about HPV being the most common STI recently (i.e. don't think it is WP:OR). Until a citation is found, (or a reasonable amount of time passes) a fact tag is definitely appropriate (I added a couple).
 * Here are a couple of references that, although they don't say that, lend support that it is not an unreasonable assertion.
 * Weinstock et al. (see references in article) estimate HPV prevalence in 15-24 year olds at 9.2 million, over twice the estimated prevalence of genital herpes (though the evidence is not as good).
 * The ASHA STD factsheet says that "HPV is the most common sexually transmitted virus."
 * Out of curiosity, do you have a citation for HSV being most common STI?
 * The other items I restored from your deletion are also within reason, although sources should of course be found. (But the fact tags were only recently added to them.)
 * For the 80% figure - check the prevalence section - under lifetime subsection, the CDC reference at the bottom of the section, the ASHA estimate above it says 75%. It is unclear whether HPV remains dormant in most people, or only some, so it is less clear how many have transmissable infections.  (i.e. not clear what is a directly comparable figure to the seropositivity for HSV).
 * Note that the statement in the article is that HPV is the most common STI, not STD. (Sorry if I mis-typed in edit summary, STI and STD are often used synonymously.) Zodon (talk) 08:59, 21 June 2008 (UTC)

The senior author of the Weinstock article is Willard Cates, who is one of the top experts on STDs in the country. I've read his articles. This one is well written, and probably the most reliable, because he explains a lot of points that non-specialists might not appreciate, so people are less likely to misunderstand it. This is a good article to start with. Pay special attention to Table 1, where he explains how he ranks the quality of evidence from I (good) to III (poor).

Let's see -- Table 2 gives 4.2 million for prevalence of genital herpes (fair evidence), and 9.2 million for prevalence of HPV (poor evidence). He also says that HSV-2 prevalence was 45 million. The article doesn't give any good prevalence figures for HPV -- 33% at one university health service, etc., with poor evidence. I can't figure this out without drilling down to the source material and doing WP:OR. Everything I read says HPV prevalence and incidence are difficult to get and unreliable -- although those sources were before 2007.

It looks like the most reliable figure is from the NHNES as cited in Journal Watch, of overall prevalence by PCR of 26.8% age 14-59, and highest prevalence 44.8% ages 20-24. That's the source of those newspaper articles in [5], and Journal Watch is more reliable because it's written and reviewed by doctors, not reporters and editors, and I would use that. I didn't read the JAMA article yet.

The prevalence estimate of 90% is an outlier, twice as high as the highest 20-24 group in NHNES. That's not reliable. That article by Revzina [3] isn't available free on the Internet, so I can't check it. Have you read it?

The ASHA says, "It has been estimated that 75% or more of sexually active Americans will contract HPV sometime in their lives." But they don't give a source. Who estimated? They don't give a date. They seem to have made that estimate before the more accurate NHNES study.

Saying the estimates are 14-90% is ridiculous. Where did they get 90% from? Commercial sex workers? If somebody reviewed the literature and found one report where the results were 0% (because their reagents were bad), and 100% (because the technician did the tests at the wrong temperature), would you report that the estimates are 0-100%? That's essentially what this entry is doing.

I thought that HSV-2 had the highest prevalence of any STD, but now I don't know. According to Harrison's Principles of Internal Medicine (p. 1037) the seroprevalence is 20%; and according to the review article on HSV-2 in the New England Journal of Medicine, it's 25%. Journal Watch says the PCR-reported prevalence of HPV is 26.8%.

But you can't just compare 25% to 26.8%, because (1) the difference isn't statistically significant and (2) (a) PCR is more sensitive and usually gives higher numbers than seropositivity. (b) OTOH if a virus is cleared from the body by the immune system, and no longer present, it will still be seropositive, even though there is no prevalence of virus or disease.

You can't pick and choose the age groups, especially from different studies that use different ways of arriving at their estimates, because that's data dredging.

If you're going to give statistics for infections then you have to clarify the difference between infections and disease. I read good article about that in the NEJM a couple of years ago, but I can't easily find it. Good luck in finding a WP:RS.

So I would say that, using the best current evidence, the prevalence of HPV and HSV-2 in the general population are about the same, and not statistically different. Of course my opinion is WP:OR and you can't use it in the entry. But you can't use that "14% to 90%" estimate in the entry either, especially since it's old and we now have better data.

I feel very strongly that we should not include information that is not supported by WP:RS because of the importance of medical subjects generally and the anxiety this particular subject gives people. I'll leave it in for a while to give people a chance to find citations, but if it doesn't have a good citation on point, it has to go. Right? Nbauman (talk)
 * I haven't read Revzina [3].
 * As far as I can see the point of the 14 to 90 is to give range and points out that
 * wide variety of estimates
 * sometimes people are comparing apples and oranges (infected at one time vs lifetime).
 * I don't see why the 14 to 90% estimate can't be used, as long as the source checks out. (Which doesn't mean that can't lead with a more specific estimate if there is something better, and then introduce the subject of variability of estimates.)  But not having read the source, I couldn't say about the merit of keeping the range.


 * Wasn't meaning to pick and chose age group. I just mentioned Weinstock to indicate that the claim about HPV wasn't totally absurd.  Clearly can't keep the claim about prominence of HPV among STIs in the article unless have a reasonable source that makes that specific assertion.


 * I am certainly for improving estimate of prevalence, or at least better coverage of the major views on it. I asked about ref on HSV being most prevalent hoping that such reference might have better data on prevalence of HPV.  (Or even just a different view that should be documented.) This section was a bit lacking in sources and they were rather jumbled when I started looking at the article, I have been chipping away at getting the material sourced.


 * By the way, was there a special reason for deleting the rest of the paragraph?  The edit summary seemed to touch only on the first sentence.  Though the data on cervical cancer lacks specific sources at the moment the fact tags were only recently added, and the numbers don't seem unreasonable. Zodon (talk) 01:40, 22 June 2008 (UTC)
 * I don't think we can use the 14% to 90% unless it comes from a verifiable source. If it's subscription-only, we can't verify it. And if nobody has even read the full article, we're just guessing about what it said. We don't know whether they meant 90% prevalence among the population as a whole, or 90% prevalence among unusual subgroups, like patients at an STD clinic. Furthermore, 14% to 90% is so broad that it's like saying we don't know. Actually, we do know.


 * Revzina is a 2005 article, and now we have later, more reliable estimates from the 2007 NHNES study. If we finally have reliable estimates, it's inaccurate and misleading to say that we don't have reliable estimates, or that our best estimate is that it's between 14% and 90%.


 * The reason I deleted the stuff about the "male body" is mainly that it was unsourced; furthermore it seemed to be generic, original research and personal opinion. I deleted the stuff about cervical cancer because it was unsourced, off the subject of prevalence, and a generic discussion of cervical cancer that didn't relate specifically to HPV. There's also a discussion of cervical cancer elsewhere in the article. Nbauman (talk) 04:53, 22 June 2008 (UTC)


 * I found a source for HPV as most common STI, added footnote for it in place. (Turns out it was already in the prevalence section - just had gotten separated.) Please provide citation to the Wikipedia documents that documents the claim that references that are not available for free are not verifiable. It seems to conflict with WP:Verifiability and WP:RS, which say peer reviewed journals, university level text books, etc. are good sources, no requirement of free access is listed.  Since the material is given with a citation, and the editor even thoughtfully provided a quotation, it seems eminently verifiable. The existence of multiple sources with different views doesn't mean we have to, or even should chose only one view to present.  WP:NPOV Zodon (talk) 07:21, 22 June 2008 (UTC)
 * There's no rule that says that documents that aren't available for free are not verifiable. But in this case, nobody on Talk who is editing the article has read it or can read Revzina, which I think makes it non-verifiable. It contradicts available free peer-reviewed sources. It's based on 10-year-old studies. And it contradicts later studies with better technology (PCR) than they were using earlier.
 * From reading the abstract, it seems that the 90% incidence was in STD clinics. It's wrong to mention 90% without that qualification. Conversely, the 14% figure of "women in the general population" we now know is too low, because the 2007 NHNES study with PCR reported 26.8%. Nbauman (talk) 12:32, 22 June 2008 (UTC)

I searched all of CDC's website and their links, and was not able to verify the claim that 80% of American women will by the age of 50 have contracted at least one strain of the HPV. I therefore deleted this statement because unless there is a source with these exact facts, they should not be stated. —Preceding unsigned comment added by 76.175.254.167 (talk) 03:01, 12 February 2009 (UTC)
 * Thanks for the heads up. Restored the information - CDC rearranged the site again?  Since the reference was used elsewhere, deleting it was not appropriate.  (I moved it to another place where it was used, and added a couple of references from the HPV vaccine article.) Zodon (talk) 04:52, 12 February 2009 (UTC)

Growth in culture
Does anyone know which cell cultures HPV will grow in, and why it won't grow in normal cultures? (D.c.camero (talk) 21:42, 18 September 2008 (UTC))
 * Viruses reproduce by hijacking cellular (i.e. multicellular tissue cells, or microbe cells), or, in some recently discovered cases, macroviral (large virus) RNA or DNA in order to facsimilise their own RNA. Normal growth cultures only include nutrients that microbial cells can feed on.  In order for a culture to allow the growth of a virus it must include raw Nucleic Acid, probably of an exact chemistry, perhaps even contained in the exact cellular nuclei that it would normally be found in (since, as I understand it, many viruses don't shed their shell from their RNA without penetrating nucleic organelle membranes, which would be essential for their reproduction).


 * Also viruses are amongst the most fragile forms of life on earth. They are only so dominant by their ability to rapidly reproduce in great numbers.  A great challenge for laboratory technicians is just not accidentally killing the viruses they have.  It is in many ways too easy.  For example exposure to almost any levels of ultraviolet (or other) light can sterilize a sample, meaning just briefly having sunlight fall on a sample can entirely kill it. 76.111.80.228 (talk) 05:40, 21 September 2008 (UTC)

Anal pap smear
Coverage of anal pap smear here should be kept brief. At best it is peripheral to Human papillomavirus, so while it warrants brief mention, the details belong in the article on that topic. The material about HPV testing, HPV vaccines, etc. certainly does not belong in a section on anal cancer or anal Pap smears. (As some recent edits have made them.) Zodon (talk) 21:52, 11 December 2008 (UTC)

Recent move of nutrition information to cervical cancer
In this edit, User:Zodon moved all the nutrition information to cervical cancer. Yet most (all?) of these sources were not about cervical cancer. They were about HPV. The types of HPV which cause cervical cancer are only a subset of HPV. I think the information should be consolidated under one heading, but it should remain on this page. II | (t - c) 21:51, 15 December 2008 (UTC)
 * The overall section is titled Cervical cancer prevention, much of the text in the nutrition section refers to cervical cancer, cervical dysplasia or CIN. It was on that basis that I made the move, if the organization and content did not adequately reflect the sources, my apologies.  However, just a quick check of the titles of the references shows that many of them (Yeo, Goodman, Kwaśniewska 1997, Kwaśniewska 2002) are about cervical cancer.  Since it is much easier to detect cervical HPV infections I would expect that many of the other references may also be using cervical HPV infection, even though it isn't mentioned in the title.  (i.e. one would need to check the article to see what HPV were they actually studying.)
 * I made the move because the cervical cancer prevention section here has grown quite large, the material in question was largely not covered in the cervical cancer article, the comment above about smoking not directly relating to HPV.
 * I suspect a brief summary of nutrition and cervical cancer/HPV would be more appropriate here, or else the material needs extensive re-writing based on the sources. I will look at the sources in more detail later.  Zodon (talk) 23:54, 15 December 2008 (UTC)
 * Eh, sorry, looks like you're right. The information needs to be consolidated, though, and should be mentioned on this page. It would be interesting to see if anyone had extended this to non-oncogenic HPV, but I suppose you're right that it may not be feasible. II  | (t - c) 00:09, 16 December 2008 (UTC)