Author Affiliations: Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Over the past 40 years, human papillomavirus (HPV) has been identified as an important pathogen. Upward of 100 types of HPV have been documented and broadly categorized into high-risk and low-risk subtypes on the basis of their association with high-grade dysplasia vs condylomata and mostly low-grade dysplasia, respectively. Infection with HPV, the most common sexually transmitted disease, begins with direct skin/mucosal contact and inoculation of immortalized basal lamina cells through the microabrasions that accompany sexual behaviors. As infected basal cells ascend the epidermal strata, HPV stimulates cell proliferation into condylomata or dysplasia, completes its life cycle, and sheds further virions. Although most people are able to clear the potential pathogen, others develop persistent infection, which if caused by a high-risk subtype, in particular HPV type 16 (HPV-16), may progress from low-grade dysplasia to a high-grade form and become malignant with local invasion across the basement membrane.
Schlecht HP. Oral Human Papillomavirus InfectionHazard of Intimacy. JAMA. 2012;307(7):724-725. doi:10.1001/jama.2012.117