Advances in the diagnosis and treatment of human papillomavirus infections.

During the past decade, much has been learned about the natural history of HPV. Most infections occur early in one's sexual life. The overwhelming majority of infections are cleared by the host immune system and never present as warts or neoplasia. Certain patient behavior such as smoking, frequent sex with many different partners, other STD infections, especially HIV, and immune-suppressive drugs promote HPV expression and cause persistent infection. Persistent HPV infection is very strongly related to neoplasia. In addition to high-risk HPV types, variant subtypes have been identified that interact with the host immune system to subvert host immunity and encourage viral persistence. New treatment programs rely on drugs that modulate the immune system and disrupt viral persistence. There is a real possibility of HPV vaccines in the future, which may protect the unexposed patient.