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Human papilloma virus infection — Clinical Guidelines

Overview

Human papillomavirus (HPV) is a common viral infection that causes significant morbidity and mortality, leading to anogenital cancers, genital warts, and oropharyngeal cancers 12. HPV vaccines are highly effective in preventing HPV infection and associated diseases 12.

Diagnosis

The prevalence of HPV infection varies globally, with pooled estimates of 8.31% in Nepalese women 1, 10.4% for single-type and 4.7% for multiple-type infections in healthy Chinese women 3, and 25% for high-risk HPV (hrHPV) genotypes among Nigerian women 7.

In oropharyngeal cancer (OPC) patients, the pooled prevalence of HPV and hrHPV infection is 44.22% and 43.94%, respectively, with HPV16 being the most common genotype 4.

HPV prevalence in oral potentially malignant disorders (OPMD) is estimated at 22.5%, with HPV16 being the predominant genotype 11.

Risk factors for hrHPV infection include age at coitarche and multiple sex partners 7. In Nepal, HPV infection was associated with husbands having multiple sexual exposures 1.

In Nigeria, hrHPV prevalence was higher among HIV-positive women (71%) 7.

Management

HPV vaccines have demonstrated good efficacy and immunogenicity in the Chinese population, with significantly higher seroconversion rates for HPV-16 and HPV-18 in vaccinated individuals compared to placebo 6.

HPV vaccination is associated with a significant reduction in the incidence of cervical intraepithelial neoplasia grade 1 (CIN1+) and CIN2+ 6.

The 2vHPV vaccine was associated with more systemic adverse events than the 4vHPV and 9vHPV vaccines, and placebo. No significant differences in serious adverse events were observed between vaccinated and placebo groups 9.

HPV vaccines have been shown to be cost-effective compared to no vaccination in China 2.

Special Populations

HPV vaccination is recommended for girls aged 9-16 years in China, with domestic 2vHPV being more affordable and cost-effective 2.

In European women and adolescents, knowledge about HPV infection positively influences vaccination rates 5. Fear of side effects and insufficient knowledge also affect uptake 5.

HPV vaccination is recommended for adolescents aged 11 or 12 years, with vaccination starting at age 9 years 13.

Catch-up vaccination is recommended for females through age 26 years and for males through age 21 years, and certain special populations through age 26 years 13.

For unvaccinated women aged 27-45 years, shared clinical decision-making is recommended regarding HPV vaccination, considering individual risk for new HPV infection 12 13.

Key Recommendations

HPV vaccination should be strongly recommended to eligible patients, emphasizing the benefits and safety of the vaccine 12.

Vaccination is most effective before exposure to HPV through sexual activity, ideally administered in early adolescence 12.

Catch-up HPV vaccination is recommended for all persons through age 26 years 13.

For adults aged 27-45 years who are not adequately vaccinated, shared clinical decision-making should be used to consider potential HPV vaccination benefits 13.

Targeted public health interventions, including vaccination and screening programs, are recommended to combat HPV infection and related diseases 1.

Rapid screening for hrHPV genotypes and consideration of multivalent HPV vaccines are recommended for women in Nigeria 7.

References

1 Paudel P, Sah A. A meta-analysis of the prevalence, genotype distribution and risk factors for human papillomavirus infection in Nepal. PloS one 2025. link 2 Fu X, Xia Y, Zhou W, Lu Y. Cost-effectiveness of human papillomavirus vaccination among girls aged 9-16 years in China: a meta-analysis. Expert review of vaccines 2025. link 3 Yu Y, Hao J, Mohamed SB, Fu S, Zhao F, Qiao Y. The prevalence of multiple or single HPV infection and genotype distribution in healthy Chinese women: A systemic review. Journal of cancer research and therapeutics 2024. link 4 Cui M, Cheng J, Cheng H, Zhao M, Zhou D, Zhang M et al.. Characteristics of human papillomavirus infection among oropharyngeal cancer patients: A systematic review and meta-analysis. Archives of oral biology 2024. link 5 Jiboc NM, Paşca A, Tăut D, Băban AS. Factors influencing human papillomavirus vaccination uptake in European women and adolescents: A systematic review and meta-analysis. Psycho-oncology 2024. link 6 Guo J, Guo S, Dong S. Efficacy, immunogenicity and safety of HPV vaccination in Chinese population: A meta-analysis. Frontiers in public health 2023. link 7 Ezechi O, Akinsolu F, Salako A, Abodunrin O, Adewole I, Olagunju M et al.. High-risk human papillomavirus infection among Nigerian women: A systematic review and meta-analysis. The Journal of international medical research 2023. link 8 Davies C, Marshall HS, Brotherton JML, McCaffery K, Kang M, Macartney K et al.. Complex intervention to promote human papillomavirus (HPV) vaccine uptake in school settings: A cluster-randomized trial. Preventive medicine 2023. link 9 Huang R, Gan R, Zhang D, Xiao J. The comparative safety of human papillomavirus vaccines: A Bayesian network meta-analysis. Journal of medical virology 2022. link 10 Kechagias KS, Kalliala I, Bowden SJ, Athanasiou A, Paraskevaidi M, Paraskevaidis E et al.. Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis. BMJ (Clinical research ed.) 2022. link 11 de la Cour CD, Sperling CD, Belmonte F, Syrjänen S, Kjaer SK. Human papillomavirus prevalence in oral potentially malignant disorders: Systematic review and meta-analysis. Oral diseases 2021. link 12 . Human Papillomavirus Vaccination: ACOG Committee Opinion, Number 809. Obstetrics and gynecology 2020. link 13 Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and mortality weekly report 2019. link 14 Jones M. RBRVS is still evolving: seven issues of interest to physicians and health information professionals. Journal of AHIMA 1992. link

Human papilloma virus infection