Cervical and Perianal Neoplasias
GENERAL PRINCIPLES
• Both HIV-infected men and women are at high risk for HPV-related disease.
• Certain HPV subtypes such as 16 and 18 are oncogenic.
• Cancer can also arise from perianal condyloma acuminata.
• Unvaccinated males and females ages 9-26 should be given the HPV vaccination series. Current guidelines recommend offering HPV vaccine up to 45 years of age in those who have not been previously vaccinated.
DIAGNOSIS
• Screening for vaginal dysplasia with a Papanicolaou smear is indicated every 6 months during the first year and, if results are normal, annually thereafter.
• Screening for anal intraepithelial neoplasms is currently under evaluation and is recommended by some experts in populations such as MSM, any patient with a history of anogenital condylomas, and women with abnormal vulvar or cervical histology.19
TREATMENT
Refer to Chapter 22, Cancer, for specific treatments of these neoplasms.