Other clinical protocols will be revised in the future based on new evidence. Until that time, family physicians are faced not only with the challenge of appropriately triaging patients with clinical signs of HPV-associated disease but also realistically and rationally assisting the patient in understanding the disease process. Management and treatment of HPV-associated disease is undergoing significant evolution and revision as the epidemiology and biology of the virus becomes better elucidated. Debate over which management algorithm or which triage guideline is most optimal will continue until long-term prospective studies are completed. HPV infection is a multicentric disease.
Infection tends to occur throughout the lower genital system at sites of microtrauma.
The spectrum of HPV infection ranges from subclinical infection to exophytic condyloma to CIN and invasive cancer. Although an individual may exhibit one clinical symptom over another, multiple HPV types and clinical presentations can coexist. Although the different HPV types are similar structurally, they demonstrate significant specificity as far as which anatomic sites are infected and the type of lesions produced at the particular sites. 3 Decisions about treatment are often based on the individual patient's risk factors, including a past history of an abnormal Pap smear, sexual behavior, status of the immune system, age, compliance and the availability of satisfactory pathology services. The decision to perform or not perform colposcopy in women who have external condylomata but normal cervical cytology is controversial.