Preface

**Section 2 Clinical Aspects of HPV-Infections 185**

**VI** Contents

**Present and Future 221**

**and Oral Cancers 241**

**Infections 269**

Duerksen-Hughes

Chapter 7 **Clinical Manifestations of the Human Papillomavirus 187**

Chapter 8 **Human Papillomavirus Infection and Penile Cancer: Past,**

Chapter 9 **The Role of Human Papillomavirus in Pre-Cancerous Lesions**

Lucinei Roberto Oliveira and Alfredo Ribeiro-Silva

Chapter 11 **Modern Molecular and Clinical Approaches to Eradicate HPV-**

Whitney Evans, Maria Filippova, Ron Swensen and Penelope

Chapter 10 **Epidemiology of Anogenital Human Papillomavirus**

Claudie Laprise and Helen Trottier

**Mediated Cervical Cancer 287**

Miguel Ángel Arrabal-Polo, María Sierra Girón-Prieto, Jacinto Orgaz-Molina, Sergio Merino-Salas, Fernando Lopez-Carmona Pintado, Miguel Arrabal-Martin and Salvador Arias-Santiago

João Paulo Oliveira-Costa, Giórgia Gobbi da Silveira, Danilo

Danilo Figueiredo Soave, Mara Rubia Nunes Celes, João Paulo Oliveira-Costa, Giorgia Gobbi da Silveira, Bruna Riedo Zanetti,

Figueiredo Soave, Andrielle de Castilho Fernandes, Lucinei Roberto Oliveira, Alfredo Ribeiro-Silva and Fernando Augusto Soares

Cervical cancer is the second most prevalent cancer among women worldwide, mainly af‐ fecting young women. Infection with Human Papilloma Virus (HPV) has been identified as the causal agent for this condition. The natural history of cervical cancer is characterized by slow disease progression, generally taking over 10 years from the initial infection with HPV till cancer. In essence, cervical cancer is a preventable disease, and treatable if diagnosed in early stage. Historically, the introduction of the Pap smear has markedly reduced the num‐ ber of new cases countries with an effective prevention program. The burden of disease is highest in developing countries, with peak incidence in Eastern Africa. Recently, prophylac‐ tic vaccines became available, equally contributing to a better disease prevention. Unfortu‐ nately, the global burden of disease is still very high

In the first section, diagnostic and preventive aspects of HPV related diseases are highlight‐ ed. The first two chapters describe in detail molecular approaches in HPV detection. With the introduction of the vaccine, novel challenges arose, Dr. Rodriguez-Iglesias highlights the need for differential screening strategies in the post-vaccine era. Prognosis towards progres‐ sion of lesions has for many years been an important challenge, and Dr. Hilfrich describes how the L1 protein can be instrumental in disease prediction. In the following chapter, ancil‐ lary techniques in the histopathologic diagnosis of squamous or glandural lesions are dis‐ cussed. Dr. Mueller contributed a holistic chapter on HPV prevention.

The second section focusses on updated clinical aspects of HPV infections, including general clinical manifestations of HPV infections, penile cancers, head and neck tumors. Dr. Trottier describes the epidemiology of anogenital HPV infections, and dr. Duerksen-Hughes provid‐ ed an overview of modern molecular approaches to eradicate HPV induced cervical cancer. The last chapter provides insights in the analysis of the native virus.

This book will be a useful tool for both researchers and clinicians dealing with cervical can‐ cer, and will provide them with the latest information in this field.

**Prof. Dr. Davy Vanden Broeck, MSc, PhD.**

Team leader HPV/cervical cancer research International Centre for Reproductive Health Ghent University Belgium

**Section 1**

**Diagnostic and Preventive Aspects of HPV-**

**Related Diseases**

**Diagnostic and Preventive Aspects of HPV-Related Diseases**

**Chapter 1**

**Molecular Diagnosis of Human Papillomavirus**

Human Papillomavirus (HPV) is arguably the most common sexually transmitted agent worldwide, either in its clinical (genital warts) or subclinical presentation in men and women. The main interest in HPV relates to its recognized as a causal and necessary factor for cervical cancer one of the most common cancers in women (80% of cases in most developing countries, with an annual incidence of almost half a millon and a mortality rate of approximately 50%)

The overall prevalence of HPV in cervix in women in the general population is 10%. This prevalence is higher in the less developed world than in more developed regions [7, 8]. A review of studies has also shown prevalence of HPV in men as usually 20% or greater, depending on population tested and the type and number of anatomic sities evaluated [9]. HPV infection is most common in sexually active young women 25 years of age or younger but cervical cancer is common in older woman, suggesting infection at younger age and slow

The most significant predictor for adquiring HPV infection in men or women appears to be the life time number of sexual parteners [11,12,13]. For women, the sexual activity of their partner(s) is also important, with increased risk of adquiring HPV if their partner had, or

Not all women infected with high-risk HPV develop cervical cancer, other factors are neces‐ sary: genotype, persistent infection, viral variants, viral load, integration, coinfection, age of 30 years old, inmunosupresión, smoking, condom use, coinfections, long-term use of oral

and reproduction in any medium, provided the original work is properly cited.

© 2013 Melón et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

[1-5], and other types of cancer, such as penis, anal or oral cancer [6].

Santiago Melón, Marta Alvarez-Argüelles and

Additional information is available at the end of the chapter

**Infections**

María de Oña

**1. Introduction**

progression to cancer [10].

currently has, other partners [12].

contraceptives, parity and circumcision. [10, 12, 14-24]

http://dx.doi.org/10.5772/55706
