Talk:Human papillomavirus infection

Clarification

Under the cancer section the following sentence is listed:

"E6 – This protein has a close relationship with a cellular protein called E6-AP (E6-Associated Protein). E6-AP is involved in the ubiquitin ligase pathway. A system which acts to degrade proteins. E6-AP binds ubiquitin to the p53 protein, thereby flagging it for proteosomal degradation."

This is indeed true for the "high risk" types of HPV, but from what I understand, the low risk versions do not activate the ubiquitin ligase pathway to degrade p53 and instead just reversibly inhibit it (leading to less mutagenic activity, hence the "low risk"). I realize that the cervical carcinomas are caused mainly by the high risk strains, but it would be helpful to note why some HPVs are not associated with malignant transformation.

Why is this image included?

Papilloma

It isn't referenced in the text, isn't placed in context, or explained. It is also not explained or used on another page. Not I have refrained from using a rhetorical question mark in my above interrogative title, because it isn't really adopted in common use. —Preceding unsigned comment added by Obviousmistake (talk • contribs) 03:23, 3 June 2009 (UTC)

First Paragraph

The link between cervical cancer and HPV is well reported, but mention should be made of HPV's link to anal and oral cancers - it accounts for about 70% of cases for both. —Preceding unsigned comment added by 69.127.84.174 (talk) 03:21, 22 May 2009 (UTC) Agreed - the referenced link (http://www.cdc.gov/std/hpv/stdfact-hpv.htm) now mentions potential cancers of the head and neck but the wikipedia article doesn't - this should be corrected, but I'm not familiar enough with referencing notation to do it myself. —Preceding unsigned comment added by 82.46.93.194 (talk) 23:59, 19 January 2011 (UTC)

External links

• HPV classification, life cycle, malignancy potential and more at MetaPathogen.

This external link has been repeatedly added by one contributor, and removed by others. I am moving it here for discussion. The site does not appear to meet WP:EL, specifically: WP:LINKSTOAVOID

• 1 (not a unique resource beyond what this article could be)
• 11 (personal web pages, not by recognized authority in the field) Zodon (talk) 01:14, 26 January 2009 (UTC)

Hi Zodon, I disagree:

• 1 - topic covered in the review are far away from those that already started in the article; the article emphasizes statistics and other aspects of HPV that will be outdated rapidly, whereas the review is about viral life cycle, genome, proteins and cancer progression presented in the manner that will be true for some time and does not contradict to ANY of the reviews listed; also, if you read any review (all reviews presumed to be authorities, right?) that is listed and accessible, you will never find information about HPV that is packaged in clear and concise manner
• 11 - all websites belong to somebody; also the review is not based on personal views, NLM definitions were used whenever possible, including cancer progression stages; also, please look into appendix and find lots of citations which you can insert in this article (wher it marked "citation needed")

I won't add this link any longer unless somebody votes for it. Thanks. XEAA —Preceding unsigned comment added by Xeaa (talk • contribs) 15:13, 27 January 2009 (UTC)

• Note that #1 says "beyond what the article would contain if it became a Featured article." This article is not up to that standard yet. Certainly this article would benefit from additional coverage of some of the areas mentioned. (If somebody wants to expand this article in those areas - great.) But as the article in the link appears to be something like a review or encyclopedia article it doesn't appear to offer anything beyond what a good encyclopedia article on the topic could offer.
• Not all reviews are presumed to be authorities/authoritative (see WP:RS and WP:MEDRS).
• 11 - The distinction is websites published by a recognized authority in a field (e.g. the CDC or Harald zur Hausen), anybody could put up a web site.

No disparagement of the web site intended, as you observe the bibliography could be helpful here. Zodon (talk) 22:26, 27 January 2009 (UTC)

OK, for the sake of the privacy I would go with "anybody" and "inappropriate" :-) Thanks Xeaa (talk) 22:48, 27 January 2009 (UTC)XEAA

Prevalence 20-24 100%?

Is this even accurate, I find it hard to believe not to mention this can't be statistically true. Please cite the correct source! —Preceding unsigned comment added by 72.194.79.82 (talk) 05:57, 21 March 2009 (UTC)

That was vandalism, been reverted. If see something like that it often pays to check recent revisions for vandalism. Zodon (talk) 06:48, 21 March 2009 (UTC)

Article class and Archive

After reading the article, I feel that it is extremely well-written, and if we can get sources and clear away all those fact tags, it could probably be an A-class article.

Does someone with technical know-how want to archive the old threads? It looks like we literally have years of inactive threads.--Pstanton (talk) 08:22, 29 April 2009 (UTC)

Done. Graham Colm ^Talk 08:36, 29 April 2009 (UTC)

History, Origins, First recorded Occurrences?

I noticed that there isnt really a paragraph about it's history and its 'origins', when it had become prevalent. It reads like that it all came up in the past 5+ years or so, which i find hard to believe, considering the sheer volume of prevalence of different strain-types. anyone who can put some enlightenment into this ? Archangel Michael (talk) 17:25, 2 May 2009 (UTC)

The Papillomavirus article has something on the discovery of the viruses. Skin papillomas, (benign tumours) have been a recognised lesion since the fifth century BC. The cancer link is a relatively recent discovery. Graham Colm ^Talk 17:37, 2 May 2009 (UTC)

Stealth ad link

I removed a link to "hpvanswers.com", which is designed to look like a question/answer site, with a big fat link to a "homeopathic HPV remedy" on the side of the page. The timing of the posts is curious, however: the site apparently didn't exist before a couple of days ago, yet they already have a number of questions from people confused about HPV, all with well-informed answers written in perfect English, quite unlike the response style you see throughout the rest of the Internet. Further, a few refer to the "natural, homepathic" product (which apparently cures genital warts if you spray it under your tongue). The best part is that some of the responses are from the future: it's 10:35 pm EST (GMT-5) now, so at GMT+13 (the "forwardmost" time zone) it is now 4:35pm on August 4th, yet quite impressively they managed to get a number of responses from the evening of the 4th and 5th. That's one well-informed site. I wonder if they know tomorrow's lottery numbers? Anyway, keep an eye out for these sneaky snake oil pushers. – ClockworkSoul 02:42, 4 August 2009 (UTC)

Treatment

"An Ob/Gyn can remove some vaginal HPV types that are viewable during a colposcopy."

This statement is not entirely true. During a colposcopy, an OB/GYN uses a high powered microscope to view the cervix. Acetic acid (vinegar) is applied to the cervix which causes abnormal cells to appear white. These abnormal cells are then biopsied. The colposcopy does not address HPV. However, the colposcopy is performed most often following an abnormal pap smear, and most cervical changes are caused by HPV. Once dysplasia is confirmed through biopsy, the appropriate treatment is prescribed. Depending on the severity of the dysplasia, the patient may undergo cryotherapy, a freezing of the cervix, or a LEEP, loop electrosurgical excision procedure. In most cases, by removing the dysplastic tissue, the HPV virus is irradicated as well. In some women, the virus is persistent. In all cases, close follow up is recommended. 98.179.0.209 (talk) 02:44, 11 August 2009 (UTC)

Drug company promotion alert

This entry has some confusing quotes about the Qiagen test that make it sound as if the test is a good thing, but that's not necessarily true.

There's no doubt that the Qiagen test is more sensitive, but the big question is whether it is clinically appropriate right now. One of the concerns is that it will lead to unnecessary biopsies, and substantial cost, without any improvement in cancer outcomes.

this gynecologist's blog is not a WP:RS, but it warns about some surprisingly heavy-handed marketing for the Qiagen test. I wonder if anyone has written anything like this in a WP:RS.

Are there any guidelines from independent organizations that clearly state whether and when the Qiagen test is appropriate? --Nbauman (talk) 02:13, 18 August 2009 (UTC)

There's a common confusion that the difference between the pap and Qiagen's digene test is a simple matter of sensitivity, but that's not the case: while a pap smear uses direct cytological observation of cells to detect the presence of abnormal cells that may be indicative of cancer, Qiagen's assay uses molecular probes to detect HPV more directly. The problem there, however, is that while HPV is effectively a prerequisite for the development of cervical cancer, the vast majority of HPV infections will clear up without any kind of intervention. As for whether the tests are interchangeable, there is some push in that direction. While I can see some value in using this case as diagnostic of HPV infection and therefore indicating increased observation, patients (and sometimes physicians) need to understand that it's far from a prognostic indicator of cancer.

That being said, I've been meaning to rewrite much of this article for some time... let me see what I can do. – ClockworkSoul 04:42, 18 August 2009 (UTC)

ClockworkSoul, I got the bit about sensitivity from Runowicz's NEJM article. She understands it a lot better than we do, so read what she says and see if I paraphrased her accurately.

There are many people who know more about DNA testing for HPV than I do, and you are welcome to revert my edits WP:BRD if you are one of them. It's a lot of work, but I'm glad you're willing to do it. (I've done a lot of medical editing IRL and one of the most difficult things to do, in my experience, is to compare and reconcile two different drafts of a manuscript, which I'm not doing now.)

I often work on the interface of molecular biology and medicine, and I found out that they are different cultures. If you're a biologist, interesting mechanisms are very important (and I agree). If you're a doctor, the only thing that counts is whether the patient gets better at the end. Doctors respect biologists, just as aircraft pilots respect engineers. But their cultures are different.

Doctors have a different standard of evidence. They want ideally a clinical guideline based on a meta-analysis of several consistent, large, well-designed, randomized controlled trials that demonstrate improvement in a clinically significant endpoint. For example (NEJM 361:712), it doesn't do any good if a drug lowers LDL cholesterol (a surrogate endpoint) if it also kills more people (a primary endpoint) in a randomized controlled trial.

That's why I asked if there were any clinical guidelines.

HPV is a surrogate endpoint. Death from cervical cancer is a primary endpoint. It's very interesting to know that a patient is infected with certain strains of HPV. The next thing a doctor wants to know is, how will this affect my management? And, how will the patient be better off at the end? A lot of doctors (for example Jeffrey Avorn) criticize the FDA for approving interventions based on surrogate endpoints rather than primary endpoints. It's not enough to prove that a drug lowers blood pressure, if you don't also prove that it reduces the primary endpoints of heart failure, kidney failure, etc.

It's not enough to demonstrate that a DNA test will identify more HPV than a Pap test. You also have to demonstrate that using the DNA test will prevent more cervical cancer at the end of the day. The testing companies, understandably, are touting every secondary endpoint that will be improved. It's their job to advocate their test. It's the outside scientist's job to winnow back their advocacy.

As that gynecologist says, the Qiagen page comes up with a meaningless "secondary outcome" of "reassuring" women. As she says, it's more likely to create greater anxiety. Qiagen lists all kinds of secondary outcomes that are clinically irrelevant. This is a confusing collection of technical jargon that a normal person can't possibly understand. Yes, they cite peer-reviewed sources. If you examine that Qiagen page carefully, you'll see that they are using a NEJM article which says that DNA testing would be acceptable in limited resource countries (if they can get a cheaper test instead). That seems to be deceptive.

To quote secondary outcomes is deceptive. To say that the FDA approved the Qiagen test as the "primary screening tool for detecting HPV" is wrong, as I understand it. I can't find it in any of the sources. Where does a source say that the FDA approved Qiagen as a primary screening tool? (I can't find the approval letter on the FDA's web site.)

There's a link to a NEJM article by Mayrand. But that article was also published with an editorial by Runowicz which gave WP:NPOV reasons about the limitations of the Qiagen test. It is Wikipedia policy WP:MOS WP:MEDMOS to use secondary sources rather than just primary research, since secondary sources can evaluate the resarch. I don't understand why you removed my reference to Runowicz.

You can go ahead and edit this. But I checked the sources to make sure they supported the claims, and I expect you to do the same. This is a potentially useful test. The literature says it would be useful in resource-poor environments if the price can come down. The literature says it would be useful in the U.S. and European countries if it can meet our standards of evidence-based medicine (which is not the same as regulatory approval.) If somebody is looking to Wikipedia for help in evaluating that Qiagen promotion, that's what this page should say.

Give my regards to your rats. --Nbauman (talk) 21:17, 18 August 2009 (UTC) 17:02, 18 August 2009 (UTC)

ClockworkSoul,, here it is from your own link: HPV DNA Test - English (PDF)]:

"The hc2 HPV DNA Test is not intended for use as a screening device in the general population."

The article as it stands now is wrong. The hc2 [sic] HPV DNA test is not a "primary screening tool." Nor do I see any source that says it's a gold standard.

Am I wrong? --Nbauman (talk) 21:27, 18 August 2009 (UTC)

Here's the FDA approval notice: Digene Hybrid Capture 2 High-Risk HPV DNA Test - P890064 S009 A004 "The HPV-DNA Test is used only in conjunction with Pap Testing." This is absolutely not a primary screening tool. --Nbauman (talk) 21:49, 18 August 2009 (UTC)

Strain 68 - "high risk" or "probably high risk"?

The chart in the "HPV types and associated diseases" section lists strain 68 as "probably high risk" but the text above the chart lists it as "high risk." Which is correct? If debatable, the text and chart should at least be made consistent one way or the other... IMKatgrrl (talk) 19:55, 21 August 2009 (UTC)

Cervical cancer prevention section

A recent edit [1] changed the name of the section "Cervical cancer prevention" to "HPV prevention". Although the article is about HPV, the section in question is about prevention of cervical cancer, not HPV. Pap smears, HPV testing and smoking avoidance all apply to prevention of cervical cancer, and for the most part do not prevent HPV infection. Condom use operates in two fashions - it can protect against transmission of HPV, but it also is protective against cervical cancer, even if HPV or dysplasia already present (possibly by reducing exposure to immune suppressive agents in semen).

So the title HPV prevention does not make sense for the section. Zodon (talk) 05:32, 8 September 2009 (UTC)

The article is about HPV so it deserves a prevention section, cervical cancer is not HPV, further prevention of associated diseases should be discussed in their own article and early diagnosis in the appropriate section.--Nutriveg (talk) 17:00, 8 September 2009 (UTC)

While most of the coverage of diseases should be in article on the disease, it is usual to cover the diseases that a pathogen causes in the article on the pathogen. (The diseases are the main reason people are interested in HPV.) See, for instance HIV.

While the coverage of most of the diseases here is confined to the section specifically on that disease, Cervical cancer is the most significant disease associated with HPV, so it has received more attention - both in terms of medical interventions, and in coverage here. (I believe the article used to say something about prevention or treatment being covered under individual disease sections.)

Until recently (with development of HPV vaccine), most of the prevention techniques have dealt with specific diseases, rather than with preventing infection by the virus. (I am not saying the current arrangement is wonderful, just observing how it has evolved and why it makes some sense.)

I am not sure how it would work to have a section specifically on HPV prevention -

• presumably prevention section would contain the sections on HPV vaccine, contact with shared objects, and microbicides.
• Pap smears and HPV testing clearly warrant coverage in this article, but don't make sense in an HPV prevention section. Presumably they would remain under Cervical cancer prevention.
• Some sections are unclear where they would go. The condom section becomes a bit dicey, since there are at least two possible mechanisms there, and it may not be clear whether one or the other or both are responsible for the effects. (Is it reduced exposure to HPV, reduced exposure to immune-suppressive components of semen, both, ...?) Smoking avoidance - again not so clear, I don't know the mechanism, whether applies to HPV prevention or just to developing cancer, or both.

Having an HPV prevention section would put the HPV vaccines section in a clearer place, since some vaccines protect against genital warts as well as cervical cancer.

However would also need to consider what information about protection from warts would be apropos of such a section. Since protecting against several different diseases, methods for protecting against some might be irrelevant to others.

It isn't clear how to split things up to make an HPV prevention section, as compared to the current arrangement of covering prevention by disease. Could you suggest how to handle some of the difficulties with making an HPV prevention section. Zodon (talk) 19:41, 8 September 2009 (UTC)

Even HIV being the directly causes of a single disease I don't see the same problem in that article. If it's specific about Cervical Cancer it belongs mainly to that article which section should be shortly referenced here. HPV vaccines are about HPV types, not diseases, since some types are associated with various diseases.

Pap smears and HPV testing belong to detection. Details could be added to contamination of specific parts of the body, and factors increasing contamination (cuts, sperm, ...). Smoking doesn't belong here and vaccines are about HPV types which can cause one or more diseases. I don't see much problem at all and feel that you're just delaying change by making too much noise for a simple change in the section title.--Nutriveg (talk) 21:12, 8 September 2009 (UTC)

Why doesn't smoking belong here?

So how do you deal with condoms, where the mechanism is unknown, and may be multiple?

As already pointed out, just changing the section title would make it incorrect. There is no a-priori reason that can't have a section titled as it currently is in this article. Since I see some merit in the general approach suggested, I am trying to see how to make it work. Zodon (talk) 06:24, 9 September 2009 (UTC)

Smoking is about cervical cancer. Condoms should be cited as conclusions in the literature, they offer some protection. The title of section fits the article title, if the section content does not, fix that content not the title.--Nutriveg (talk) 12:36, 9 September 2009 (UTC)

(Outdent) I came up with an alternative title (Disease prevention) that might address your concern. If there is wikipedia policy that indicates what sections titles may or may not be in an article, or why a section title must fit the article title, or what the criteria are for such fit, please indicate where/what the policy is. Zodon (talk) 17:36, 9 September 2009 (UTC)

It's a better title than the previous but infection don't imply disease, "Infection prevention" or "Prevention" are better titles if the use of the "HPV" word blows your mind.--Nutriveg (talk) 18:00, 9 September 2009 (UTC)

As noted above, most of the material in the section does not deal with infection prevention. Infection seemed implicit in the "HPV prevention" title (since preventing HPV in general is not an option).

I think that the disease prevention title is clearer than just prevention, since probably the reader would infer that Prevention means HPV infection prevention. (Just as treatment would be inferred to be "treatment of HPV infection".) So clearer to indicate the more general coverage of preventing diseases (implicitly those caused by HPV), rather than the more limited preventing infection.

Suggest we leave it at disease prevention for now. Zodon (talk) 20:33, 10 September 2009 (UTC)

Current Research

I removed the following section today:

A 2009 study published in Cancer Prevention Research, a journal of the American Association for Cancer Research, suggests that having the human papillomavirus (HPV) improves survival in Squamous cell carcinoma of the head and neck. Furthermore, African Americans had far less HPV infection than whites, which led to worse survival.

This seemed a little hinky to me, so I read the cited source and found that its conclusion is very different from what's written above. What the authors did write was interesting, but not earth-shattering: as a group, head and neck tumors in blacks had less HPV than those in whites, and were also more resistant to treatment. Also, the authors presented data that showed that head and neck cancer caused by HPV is considerably more responsive to chemotherapy than cancer that arises spontaneously. The authors didn't speculate on the reason for this relationship, or for the reasons behind the differences in HPV status in the head and neck tumors of the two ethnic groups. To say that the study suggests that "having the human papillomavirus improves survival", however, is way off. – ClockworkSoul 12:41, 10 September 2009 (UTC)

I thought the item looked suspicious, but hadn't gotten around to checking it. Thanks.

I restored the current research section title, since the Microbicides subsection was also in that section. Zodon (talk) 18:48, 10 September 2009 (UTC)

Doh. Thanks for fixing that. – ClockworkSoul 19:43, 10 September 2009 (UTC)

Prevention - Oral sexual behaviors

Odds of oral HPV infection increases with increases in the number of recent oral sex partners or open-mouthed kissing partners.

The sentence above added to the disease prevention section, under the title Oral sexual behaviors. So far it appears to just indicate a possible risk factor, not a recommended prevention. It seems okay as a risk factor in the head and neck cancer coverage (I moved it there, but it was moved back), or could be reworked to include coverage of recommended prevention and put back in prevention section. But doesn't make sense to have in prevention section when it doesn't document a widely recognized prevention strategy. Zodon (talk) 19:36, 17 September 2009 (UTC)

Prevention is about preventing from risk factors (in this case increased number of partners). The cited research is about HPV infection, not about specific types, not about head and neck cancer. HPV can cause other (or no) diseases and cross contamination is possible. Please don't make original research.--Nutriveg (talk) 20:23, 17 September 2009 (UTC)

The study is about oral HPV infection, which is one of the causes of orophyrengeal cancer (a subset of head and neck cancers). So it is related to head and neck cancer - just a different name.

Since they did not study transmission from oral to other sites, it has no clear relation to other diseases. (Various studies have indicated routes of acquiring oral infection, but what studies indicate transmission from oral to other sites, e.g. oral to genital?)

The text in question says nothing about prevention. The section is about prevention of disease. A risk factor is not the same as a preventive measure. Sometimes there is nothing that can be done about a risk factor. Sometimes the prevention would be worse than the disease, or so costly, unpleasent, etc. that people would not do it. The article says so little about prevention it is difficult to see what it could support by way of prevention. If you think it belongs in prevention - what preventive measure do you think the article or the text you are proposing suggest?

The study has several limitations. The study notes that the results can not be applied to the general population (so the statement above is over-general).

Since you were proposing the addition, no idea what you mean by original research by others.

As far as original research, the only prevention method that I found mention of in the article is the timing of HPV immunization, and the article says nothing specific about that. So putting this in a new section in prevention certainly qualifies as original research as far as this reference goes, as would asserting this transmission mode links to diseases other than orophyrengeal/head and neck cancer. Zodon (talk) 07:06, 18 September 2009 (UTC)

Exactly, it's about oral HPV infection and you first tried to make that study particular about "oral cancer" and now about "oropharyngeal cancer", later you'll say it's about "oral warts". This is original research! We should cite study results exactly as it was done by their authors, and that was merely what I did, I only failed to mention "Among college-aged men" which should be added instead of deleting the rest. Even considering study limitations the authors didn't change their conclusion: "Oral sex and open-mouthed kissing are associated with the development of oral HPV infection."

That article conclusions were additionally cited by other articles: "HPV infection in the oral cavity and pharynx has been linked to the lifetime number of oral sex partners and number of openmouth kissing partners", "infection were associated with recent number of oral sexual partners, including number of oral sexual partners and number of oral-to-oral (kissing) partners". You are just changing excuses to remove content you don't like. The text belongs to the HPV article as a whole, not to a specific disease.--Nutriveg (talk) 08:26, 18 September 2009 (UTC)

The first sentence of the article says "Oral human papillomavirus (HPV) infection is a cause of oropharyngeal cancer." So, since the same article that has the result in question also says it is (causally) related to oropharyngeal cancer, in what way is saying that this result is related to oropharyngeal cancer original research?

My first response (as you just noted) was to move the content. Now you claim I am trying to remove it with any excuse???

You still haven't addressed the main point - you are asserting that this is prevention of HPV infection or disease. Where in the article does it say that, and what about this is prevention? Zodon (talk) 22:19, 18 September 2009 (UTC)

The phrase you cited is the article motivation. The article conclusion talks about HPV infection, it doesn't restrict its results to specific diseases or HPV types associated with particular diseases, you created that restriction yourself, that's original research.

First, you tried to remove it to the cancer section, more specifically to "next to rest dealing with oral ca(ncer)". Later, when risk factors were mentioned, you changed your excuse to "risk factors don't belonging to the prevention section", ignoring the condom section just above. Later you criticize the study quality. And now you demand the article itself to say which article section it should be included, where no wikipedia policy or guideline impose that restriction. As I said and repeat: "You are just changing excuses"

My point is that "text belongs to the HPV article as a whole, not to a specific disease", the more appropriate place to preventable risk factors, in this article (as by the condom example) and most Wikipedia medical articles is the prevention section, while the established causes stay in the causes section. See the Manual of style and the example of a featured article.

If you didn't notice so far, I'm just citing the authors conclusions, which talk about "HPV infection" not disease.--Nutriveg (talk) 01:29, 19 September 2009 (UTC)

We are not limited to citing what is in the conclusions section of the article. The prohibition is against original synthesys. If the article said nothing about oral cancers and just talked about HPV transmission, then one might be able to argue that linking the articles findings to oral cancers was original synthesys. However since they make the connection, then us using that connection is not original research in the wikipedia sense. Zodon (talk) 09:56, 24 September 2009 (UTC)

WP:MEDRS is clear about how to use primary sources: "edits that rely on primary sources should only describe the conclusions of the source".--Nutriveg (talk) 10:32, 24 September 2009 (UTC)

Why is this viral disease chronic?

It would be informative to include some description as to the mechanisms used by this virus to avoid the body's immune responses. Currently in this article the only piece of information mentioning the clearing of this virus from the body is a single line from WebMD: http://www.webmd.com/sexual-conditions/hpv-genital-warts/hpv-treatment-is-there-hpv-cure. This source doesn't provide any other details about this process.

From the virus Wikipedia entry, "Viral infections in animals provoke an immune response that usually eliminates the infecting virus." On that page it also states, "However, some viruses including HIV and those causing viral hepatitis evade these immune responses and cause chronic infections." On both the HIV and the viral hepatitis pages, there are descriptions of the known mechanisms each specific chronic virus uses to avoid clearing after the initial immune response. Is this information missing from the HPV entry because the specific mechanism isn't yet known? —Preceding unsigned comment added by 97.112.132.39 (talk) 01:24, 16 October 2009 (UTC)

In short, yes, little is known about exactly how HPV manages establish persistent infections in some individuals while being effectively cleared by most others. One major reasons for this is that HPVs are notoriously difficult to culture in the lab, and no good animal models exist (there are, however, a handful of mediocre ones). It's been appreciated for a few years, though, that these viruses are, to quote this pretty good review article , "experts at avoiding or subverting the host immune response". I'm trying to find some time to rewrite this article; I'll include what I can find on this subject when I do. – ClockworkSoul 00:22, 11 January 2010 (UTC)

Thanks!--97.112.142.149 (talk) 01:36, 23 January 2010 (UTC)

Diane Harper criticisms

There seems to be some contention about the recent addition regarding Diane Harper's criticisms on the vaccine: whether Harper is a reliable source, and if so, whether the content is a reliable paraphrase of her view. I'd like to open discussion here so others may add their views. This could also effect the information added on the article Gardasil as well. Auntie E. (talk) 03:33, 12 January 2010 (UTC)

That was not a recent addition, user "SuaveArt" used a deceptive edit summary, saying he was removing spam, to remove that content so I didn't realize that until now. That is valid content. User "SuaveArt" is the one proposing changes, probably stalking user "Seregain" edits, since "SuaveArt" is not an active editor in this topic. That said "Seregain" edit looked a little bit biased but I balanced it.--Nutriveg (talk) 10:46, 12 January 2010 (UTC)

I removed the section again, since it's more than just a bit biased, and all the link to the more reliable source does is tell us more reliably that she said it (but it does nothing to tell us whether it's likely to be true). Since there's really no actual data to support her assertions, and Harper's a reasonably well-known anti-vaxx "expert", a using the quote as a source amounts to nothing more than an argument based entirely on an argument from (questionable) authority. – ClockworkSoul 03:26, 13 January 2010 (UTC) (Copyedited for clarity – ClockworkSoul 16:54, 13 January 2010 (UTC))

She is a recognized authority in the subject, he was hired by the two companies that make the vaccines and her studies were cited by other scientists. I'll rewrite that later.--Nutriveg (talk) 11:35, 13 January 2010 (UTC)

The growing scientific consensus is that human papillomavirus was created in a lab, during research on the origins of certain marine isopod diseases. The original intentions were good but it was later released in to the human population in order to sell the vaccine. —Preceding unsigned comment added by 24.91.55.102 (talk) 14:19, 28 March 2010 (UTC)

I don't think her statements can really be called "criticisms" as she never advised against people using the vaccine. Just an observation. In any case, Harper was the lead researcher for the HPV vaccine, so I don't see how she could not be seen as a reliable source. If I have misread the reports of her statements, please correct and accept my apology. Seregain (talk) 14:41, 13 January 2010 (UTC)

My major gripe with the addition isn't so much the statement itself as the complete lack of context and perspective. In fact, I wouldn't be surprised if the HPV vaccine doesn't reduce the rates of cervical cancer among women who get annual pap smears. It's important to remember a number of points, however. First, there is a significant percentage of the population that either has limited access to health care, or (which always boggles my mind) simply chooses not to use it when it is available. Second, the vaccine certainly will reduce the number of pre-cancerous neoplasms, and therefore the often very unpleasant unpleasant procedures that are used to interrupt the progression of high-grade lesions to full-blown cancer. Finally, we shouldn't forget that the vaccine also targets types 6 and 11, two agents of genital warts that have no currently measurable association to cancer. – ClockworkSoul 16:49, 13 January 2010 (UTC)

Well for me she criticizes the importance given to the vaccination compared with screening, the administration of the vaccine for children under 15, the lack of information of the duration of vaccine efficacy, the importance of continued screening, ... All we can rewrite of course, but I don't agree to represent "criticism of her opinion" that can't be equally sourced.--Nutriveg (talk) 19:01, 13 January 2010 (UTC)

Which is essentially what she's saying in the originally quoted source... however, this article doesn't read that way in its current form. One could forgive a nervous reader, confused and perhaps frightened by the bombardment of misinformation from all quarters, interpreting it as meaning that the vaccine won't reduce cancer and therefore isn't worth getting. I'm actually thinking that the comment really shouldn't be in the human papillomavirus article in the first place, since she's really discussing the vaccine, and not the virus, and while an overview of the vaccine topic is appropriate, a full examination of the issues is beyond this article's scope. So I'm actually suggesting two things: we first move the Harper stuff to HPV vaccine, and then we deal with the content as reasonably as possible over there. – ClockworkSoul 21:50, 13 January 2010 (UTC)

Sorry, my interest is restricted to HPV article, not "HPV vaccine", so I expect to discuss those issues in the context of this article.--Nutriveg (talk) 23:46, 13 January 2010 (UTC)

That's a curious response... Generally, when deciding the contents of articles, the personal interests of the editors matter less than the relevance of the material to the subject of the article. I'm not at all convinced that Dr. Harper's assertions are relevant enough to the human papillomavirus subject to be included in what should be a brief summary of the HPV vaccine article, especially when it's not even discussed to any degree in the HPV vaccine article itself. – ClockworkSoul 00:23, 14 January 2010 (UTC)

I deserve the right to decide which articles I want to edit, the HPV vaccine article is a mess I don't want to get further involved. The original source has been superseded by a secondary source by the same author, which balances pretty well the benefits listed in that section.--Nutriveg (talk) 00:45, 14 January 2010 (UTC)

I'm happy with your recent edits. Well done. – ClockworkSoul 03:48, 14 January 2010 (UTC)

Hi, just for the record, there was never any consensus to add the paragraph to begin with (it was added by Seregain, then removed and re-inserted a few times). Also please note that Seregain is an evangelical Christian and has made it obvious by several of his edits that he added this here in order to push an abstinence-only POV (which is why I searched his edits after detecting hints of bias on his part).--SuaveArt (talk) 00:22, 17 January 2010 (UTC)

Effect on infection rates of other STDs

HPV infections affect susceptibility to other STDs - in most causes elevating risk but paradoxically also preventing seroconversion of AIDS under specific circumstances. In the long term such indirect effects could become one of the most important points in evaluation of HPV vaccines, yet it is hard to predict at the moment. Did anyone have a look into this? Richiez (talk) 09:18, 27 July 2010 (UTC)

Infection in developping world as "main reason" for cancer incidence?

I do strongly disagree with this edit. The previous version imho represents mainstream opinion. Did you check that the source really claims what the edit says? Even if it does, it is not a review and should not be used to push such controversial content. Richiez (talk) 13:47, 27 September 2010 (UTC)

Hi Richiez. I think you misread my edit. Higher infection is the main cause for higher cervical cancer, Parkin says, and it makes sense, doesn't it? The cited source (Parkin, freely available via PubMed) compiles different sources, so although it is not a review, it is kind of a review. The 3rd sentence of the discussion reads

The percentage of infection-attributable cancer is higher in developing countries (26.3%) than in developed countries (7.7%), reflecting the higher prevalence of infection with the major causative agents (hepatitis viruses, HPV, HP and HIV) (Table XI).

I originally only wanted to delete the first part of the sentence related to the causal relationship between less Pap smears and higher cancer incidence, because this is not even mentioned in the cited source, but since I found in the same source the cited explanation claiming a causal relationship between infection and infection-attributable cancer incidence, I added this. If you feel that Parkin's claim is not backed up enough, we can agree to leave it out, but please also leave out the totally unsourced part about Pap smears.--Biologos (talk) 16:12, 27 September 2010 (UTC)

I deleted the Pap smear part and left the disputed part out, too. Now the rest seemed to fit better in the Epidemiology section, so I moved it. I hope we can agree on this.--Biologos (talk) 16:25, 27 September 2010 (UTC)

I agree with Richiez

Parkin's claim is dubious at best with relation to HPV. He provides no source to back up that claim. The most charitable interpretation I can figure is that the other factors are more prevalent in less developed countries (though there may be more to it for even those - since antiretrovirals, etc., are also less available in less developed countries). For HPV I have seen no evidence that it is less prevalent in developed countries, and there is no reason to expect that at this time. Higher infection with HPV could conceivably be a cause, but greater availability of preventive treatments (which come after HPV infection, but before cervical cancer) is a much more likely explanation.

The efficacy of Pap smear screening programs is well established. Such programs have resulted in an approximately 80% decrease in cervical cancers. (cite journal| journal = Annals of Oncology | volume = 21 | page = 448–458 | year = 2010| title = European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition | author = M. Arbyn; et al. | number = 3 | doi=doi:10.1093/annonc/mdp471 ) The decrease in cervical cancer in the US and many developed nations in recent decades has been attributed to Pap smear screening. Such programs are much less common in developed nations. The effect of Pap smear screening on cervical cancers is sufficiently large that it would explain most of the (approximately 80%) difference in cancer prevalence between more and less developed nations.

So a citation would improve that claim, but it does reflect the mainstream opinion.

When I added the Parkin citation (to a sentence that had no citation at all), it was as a citation for the relative prevalence, not for the reason. I tried to clarify that by putting in a citation needed tag for the first part.

As far as the claim that HR HPV is significantly more prevalent in less developed nations, would need much better sources to back up that Parkin's claim applies to HPV and that it is a widely held opinion. Zodon (talk) 19:20, 27 September 2010 (UTC)

From just reading the abstract, the de Sanjose reference also seems a bit dubious as support for the claim. It does not appear to differentiate based on development status, (for instance, Asia - which has a large proportion of developing nations has the lowest incidence in their summary). Also, it isn't clear that they adjust the data for other factors like age (HPV infection strongly correlated with age, and development status also has correlations with age distribution). Zodon (talk) 19:49, 27 September 2010 (UTC)

Hi Biologos, I did not misread your statement. Regarding the sentence you quote look at the definition of attributable that the author uses. Simply put he says 100% of cervical cancers are attributable to HPV. This is true or "good enough for all practical purposes" but he does not say that it is the only cause and nowhere does he say there are no other causes - you seem to have overinterpreted the statement. To explain it a bit drastically HPV may cause cervical carcinoma but if you amputate the cervix you are pretty safe from getting it. So you can at the same time claim that (a) 100% of cervical cancers are attributable to HPV and (b) 100% are attributable to not having an amputated cervix and (c) 100% are attributable to beeing a women. Richiez (talk) 20:59, 27 September 2010 (UTC)

Thanks to both of you for your comments. I see what you mean. Parkin's opinion is not backed up by data in the cited paper, so it's best to leave it out. Since the beneficial effect of Pap smears is already mentioned two paragraphs above*, my changes to the sentence and the move still seem the right thing to do. Agreed? *Zodon, if you apply the same high standards of scientific evidence you applied to Parkin's claim to the claim that "Pap smears have reduced the incidence and fatalities of cervical cancer", we'll need much better sources than the home page of the NCCC. According to Pap test and the discussion there, an increase in Pap smears correlates with a decrease in cervical cancer, but the relative importance of Pap smears for this is hard to quantify.--Biologos (talk) 08:00, 28 September 2010 (UTC)

The sentence is fine as it is now. The data in Parkin's paper appears sensible though highly specialised. The problem was that the earlier edit was a subtle bit of WP:SYNTH over data that is not easy to interpret. Parkin did write about infections and cancer and choose not to deal with pap smears at all which is fine but that also means that this data can not be used to establish the relative relevance of pap smears and infection prevalence. As a rule of thumb when dealing with research papers - data or claims that are not mentioned in the abstract are most often not suitable for wikipedia. As of "pap smears have reduced the incidence and fatalities of cervical cancer" it would be easy to find sources to back this statement (PMID 17296477), it is much more difficult to find sources that give an overview about how large this effect may be realistically (eg PMID 8747379)Richiez (talk) 20:18, 28 September 2010 (UTC)

Biologos - Removing it was okay by me. It was peripheral since this article is about HPV, rather than cervical CA or Pap smear. (And, as you note similar observation about efficacy of Paps already covered.) Moving it down into the body was okay too.

Not sure what you are saying about sourcing for the Pap smear reducing cervical cancer incidence. The NCCC reference seems okay (although as far as I can see it is mostly a reference for the statistics on deaths). It may not be the highest quality reference, but it isn't being used to back up some extraordinary claim. The observation that Pap smears reduce cervical cancer is a commonplace - sure, a citation is worthwhile for the sake of completeness and style (e.g. to eventually get article to a better quality grade), but there is nothing controversial or unexpected about that claim. (Extraordinary claims require extraordinarily good sources (therefore looked very closely at Parkin - since what was said was extraordinary), conversely pedestrian claims don't require as good sources. Not saying that good sources aren't better - just don't have to be so careful about undue weight, etc.)

The Arbyn reference above substantiates the claim that Pap smears have reduced cervical cancers; since Arbyn is, among other things, a review citing other sources it is a reasonably good source. It also gives an idea of what a comprehensive screening program can reasonably achieve (80% reduction in cervical CA). (I would not suggest using PMID 8747379 - some of the claims they make in the abstract are dubious at best, also it would be less preferred since it is a non-english source. There are lots of more accessible sources.) Zodon (talk) 05:01, 29 September 2010 (UTC)

Contradiction

In section "Cancers": Sexually-transmitted HPVs also cause [...] approximately 25% of cancers of the mouth and upper throat (the oropharynx) (see figure). But the figure "HPV-induced cancers" shows a much smaller fraction of both mouth and throat cancers as HPV-induced. The cited source for both the number and the graph (Parkin 2006) says on p.3033 after discussing the evidence: For the purpose of estimation, it is assumed that 3% of oral cavity cancers and 12% of cancers of the oropharynx are attributable to HPV. That can hardly add up to 25%.--94.222.122.165 (talk) 01:38, 20 February 2011 (UTC)

Rearranged content in compliance with WP:MEDMOS

This is similar to the format we see at HIV. --Doc James (talk · contribs · email) 06:28, 1 March 2011 (UTC)

Co-factors in HPV-induced Cancers

In the Genital HPVs section there's a note that "epidemiological and molecular data suggest that co-factors such as the cigarette smoke carcinogen benzo[a]pyrene (BaP) enhance development of certain HPV-induced cancers." I realize that it's a narrow point, but BaP is present in many more human activities than just cigarette smoking, including eating barbecued meats. Do we want to broaden this statement? 66.92.161.127 (talk) 15:30, 13 May 2011 (UTC)

i want to know if woman with cervical cancer can have sex and if hpv originated from male and transfered to woman? — Preceding unsigned comment added by 86.96.226.90 (talk) 03:15, 30 May 2011 (UTC)

HPV genome

Had to fix a few mistakes in the E6/E7 proteins section. The genome is stated to be composed of 'proteins' instead of genes; E3 was mistakenly listed as an HPV gene; E5 gene and long control region were absent. Casonthemason (talk) 17:41, 23 February 2012 (UTC)

Prevalence decreases with age

The following was recently deleted from the article.[2]

Note that prevalence decreases with age. This may be due to the HPV infections being cleared by the immune system, or sinking to undetectable levels while still present in the body.

The summary alleged that it was untrue. Which portion do you doubt? That prevalence decreases, or that it is unknown about clearance. The former is of course true. The latter has been true, though if you have citations that support it is now known one way or other I would be quite interested. Parking here to gather citations for reinstatement. Zodon (talk) 07:05, 4 May 2012 (UTC)