Affiliations: Division of Adolescent Medicine, University of
California, San Francisco, CA, USA
Note: [] Address for correspondence: Anna-Barbara Moscicki, MD,
University of California San Francisco, 3333 California Street, Suite 245, San
Francisco, CA 94118, USA. Tel.: +1 415 476 5139; Fax: +1 415 476 6106; E-mail:
moscickia@peds.ucsf.edu
Abstract: Adolescents who are sexually active have the highest rates of
prevalent and incident HPV infection rates with over 50–80% having
infections within 2–3 years of initiating intercourse. These high rates
reflect sexual behavior and biologic vulnerability. Most infections are
transient in nature and cause no cytologic abnormality. However, a small number
of adolescents will not clear the infection. Persistence of HPV is strongly
linked to the development of high-grade squamous intra-epithelial lesions
(HSIL) and invasive cancer. The HSIL detected, however, does not appear to
progress rapidly to invasive cancer. Understanding the natural history of HPV
in adolescents has shed light into optional treatment strategies which include
watchful observation of atypical squamous cells of undetermined significance
(ASCUS) and low grade (LSIL). The association between age of first intercourse
and invasive cancer cannot be ignored. Consequently, initiating screening at
appropriate times in this vulnerable group is essential. In addition, with the
advent of the HPV vaccine, vaccination prior to the onset of sexual activity is
critical since most infections occur within a short time frame post
initiation.
