respectively (Hung, et al., 2021). It is to be hoped that as more young women become vaccinated, the number of women infected will decrease. The National Cancer Institute estimates that in 2022 there will be 14,100 new cases of cervical cancer and 4,280 deaths caused by cervical cancer (National Cancer Institute, n.d.a.). In the U.S., Hispanic women are at highest risk for developing cervical cancer, followed by African American women; Native Americans and Alaska Natives are at lowest risk (O’Hara, 2022; U.S. Department of Health and Human Services Office of Minority Health, 2021). Based on data obtained from a national probability sample of U.S. adults ages 18 to 59 years, researchers estimated between 2010-2016 that the prevalence of anogenital warts among females decreased from 7.3% to 4.4% (Nelson, 2019). The availability of the HPV vaccination and safe sex practices may contribute to this decrease. The American Cancer Society estimated that in 2022 , the number of new cases of anal cancer among women in the United States would be 6,290 with 930 deaths (American Cancer Society, 2022b). Women who have been infected with HPV have a much greater risk of developing vulvar cancer as well. Depending on the geographical area, it is estimated that between 18% to 75% of vulvar squamous cell carcinoma (VSCC) cases are HPV-positive (Rakislova, et al., 2017). Vulvar cancer is a rare type of cancer that forms in a woman’s vulva or external genitals. Initially, precancerous cells grow on the skin of the vulva. This growth is called vulvar intraepithelial neoplasia (VIN) or dysplasia . At first there are no symptoms associated with vulvar cancer. Later symptoms can include a lump in the vulvar area, vulvar itching or tenderness, or changes in skin color or growths that look like warts or ulcers. The median age of the diagnosis of vulvar cancers is 67 years of age with the occurrence of HPV (+) tumors afflicting women in their 70’s and 80’s (Khadraoui, 2020). Vaginal cancer refers to any type of cancer that starts in the vagina, and can include squamous cell carcinoma, adenocarcinoma, melanoma, and sarcoma. Approximately 75% of vaginal cancers are caused by HPV (National Cancer Institute, 2022). Vaginal cancer can occur at any age but with an average age of diagnosis of 67 it mainly occurs in older women (ACS, 2021a). For the year 2020 it was estimated that there were 8,870 cases of vaginal cancer which caused 1,630 deaths (Cancer.net, 2022). As is the case with the male population, consistent predictors of HPV infection relate to measures of sexual activity and include multiple partners, a partner who has had multiple partners, younger age at sexual debut, and lack of condom use (Wagner and Villa, 2017; Rodriguez-Alvarez, et al., 2018; Aghakhani, et al., 2017; Mayo Clinic 2022; HHS, n.d.). Cervical cancer screening (Pap test) is recommended every 3 years for women ages 21 through 29 and every 5 years for women ages 30-65. Concurrent HPV testing is also recommended with the (PAP Test) for women in this age range (American Cancer Society, 2018). The CDC recommends that females receive the HPV vaccine starting at age 11, but no later than age 26 (CDC, 2021a; CDC, 2019a). Types of HPV and their association with cancer Human papilloma viruses are a large and diverse group of related viruses (Tumban, 2019). HPV has a pronounced tropism for epithelial cells, infecting layers of cells that line hollow organs and glands, and those that make up the outer surface of the body. As scientific techniques for HPV typing improve, the number of identified HPV types continues to increase. A recently published systematic review of HPV
the virus persists in the body all play a role in whether high-risk types of HPV will lead to cancer (Wagner & Villa 2017). Furthermore, the role that these factors play is also influenced by gender. Men: Transmission, symptoms, and detection HPV is passed to men through direct genital contact, most commonly via vaginal, anal, or oral sex. HPV transmission is also believed to occur through genital contact without intercourse and through hand-genital contact and contact with objects such as sex toys. However, the risk of transmission via these routes is lower than through direct genital contact. The use of condoms and dental dams during vaginal or anal intercourse reduces but does eliminate the risk of HPV transmission (National Cancer Institute, October 2019). A person uninfected with HPV who has sex with a partner infected with HPV has a 70% chance of acquiring an HPV infection (Leslie, et al., 2022). The most common symptom of HPV infection in men is genital warts. HPV types 6 and 11 are associated with genital warts, and it is estimated that 1% of sexually active men in the U.S. have genital warts at any given time (CDC, n.d.). Currently, 30 high-risk HPV types associated with cancer of the anus or penis in men have been identified (WebMD, n.d.a). The American Cancer Society (2022a) estimated that, in the year 2022, there will be 2,070 men who would be newly diagnosed with cancer of the penis and that 470 deaths would occur. Current estimates for anal cancer in 2022 point to 3,150 new cases in men and 440 deaths among men (American Cancer Society, 2022b). It is important to note that anal cancer and colorectal cancer are distinctly different forms of cancer. Colorectal cancer is not caused by HPV and is a more common cancer (CDC, n.d.). Gay and bisexual men are about 17 times more likely to develop anal cancer than men who have sex exclusively with women. Men with weakened immune systems, including HIV-positive men, are also more likely to develop anal cancer and severe cases of treatment-resistant genital warts (CDC, n.d.). Consistent predictors of HPV infection are measures of sexual activity, including multiple partners, a partner who has had multiple partners, younger age at sexual debut, and lack of condom or protective barrier use during intercourse or sexual activities (Wagner & Villa, 2017; Rodriguez-Alvarez, et al., 2018; Aghakhani, et al., 2017; Mayo Clinic, 2022). U.S. Department of Health and Human Services [HHS], n.d.). Most men who get HPV never develop symptoms, except for those who develop genital warts. Limiting the continued spread of HPV requires sexually active adults who are not in a mutually monogamous relationship to use condoms during every act of vaginal, anal, and oral sex. However, since HPV is transmitted via skin-to-skin contact, use of a condom may not provide full protection against HPV infection. Careful washing of hands following sexual activities and disinfecting any fomites such as sex toys before and after use is also important. Both the CDC and the American Academy of Pediatrics recommend that males receive the HPV vaccine by age 11, but not after age 21 (CDC, 2021c; O’Leary & Nyquist, 2019; CDC, 2017a). Women: Transmission, symptoms, and detection HPV transmission routes are the same for men and women. The virus’s impact on women stems from its presence in 99.7% of all cervical cancers (National Cancer Institute, 2022). WebMD, n.d.). Women are also susceptible to HPV- related vaginal, anal, and vulvar cancers, but these cancers are far less common than cervical cancer (Cancer.net, 2019). Among U.S. women aged 18 to 59 years, the prevalence of low and high-risk genital HPV was about 40% and 20%
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