Canadian Consensus Guidelines on Human Papillomavirus

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GUIA DE MANEJO DE PAPILOMA VIRUS
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   Journal of Obstetrics and Gynaecology Canada The official voice of reproductive health care in CanadaLe porte-parole officiel des soins génésiques au Canada  Journal d’obstétrique et gynécologie du Canada Publications mailing agreement #40026233 Return undeliverable Canadian copies and change of address notifications to SOGC Subscriptions Services, 780 Echo Dr. Ottawa, Ontario K1S 5R7. Abstract    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S1 Preamble  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S3 Deborah M. Money, Michel Roy  Summary Recommendations  . . . . . . . . . . S5 Chapter 1: Epidemiology and Natural History of HPV Infection  . . . . . . . S7 Deborah M. Money, Diane M. Provencher  Chapter 2: Clinical Manifestations and Diagnosis of HPV-Related Disease  . . S11 Marc Steben Chapter 3: The Role of HPV Testing  . . . S15 Diane M. Provencher, K. Joan Murphy  Chapter 4: Prevention  . . . . . . . . . . . . . . . . . S23 Marc Steben Chapter 5: Screening for Cervical Cancer  . . . . . . . . . . . . . . . . . . . . . . . S27 K. Joan Murphy, Robbi Howlett  Chapter 6: Treatment of External Genital Warts and Pre-invasive Neoplasia of the Lower Tract  . . . . . . . . . . S37 Michel Roy, Peter Bryson Chapter 7: Cost-Benefit Analysis of HPV Vaccination  . . . . . . . . . . . . . . . . . . . . . . S43  André Lalonde Chapter 8: Vaccines  . . . . . . . . . . . . . . . . . . . S51 Michael Shier, Peter Bryson Chapter 9: Counselling  . . . . . . . . . . . . . . . . S55 Marc Steben, Deborah M. Money  Canadian Consensus Guidelines on Human Papillomavirus  Volume 29, Number 8 ã volume 29, numéro 8 August ã août 2007 Supplement 3 ã supplément 3  Editor-in-Chief /Rédacteuren chef  Timothy Rowe CPLEditor /RédactricePPP Vyta Senikas Translator /Traducteur Martin Pothier  AssistantEditor/Rédactriceadjointe Jane Fairbanks Editorial Assistant /Adjointeà larédaction Daphne Sams Editorial Office /Bureau de larédaction Journal of Obstetrics andGynaecology CanadaRoom D 405AWomen's Health Centre Building4500 Oak StreetVancouver BC V6H 3N1editor@sogc.comTel: (604) 875-2424 ext. 5668Fax: (604) 875-2590The Journal of Obstetrics andGynaecology Canada (JOGC) is owned bythe Society of Obstetricians andGynaecologists of Canada (SOGC),published by the Canadian Psychiatric Association (CPA), and printed by DollcoPrinting, Ottawa, ON.Le Journal d’obstétrique et gynécologie duCanada (JOGC), qui relève de la Sociétédes obstétriciens et gynécologues duCanada (SOGC), est publié par l’Association des psychiatres du Canada(APC), et imprimé par Dollco Printing,Ottawa (Ontario).Publications Mail Agreement no.40026233. Return undeliverable Canadiancopies and change of address notices toSOGC, JOGC Subscription Service,780 Echo Dr., Ottawa ON K1S 5R7.USPS #021-912. USPS periodical postagepaid at Champlain, NY, and additionallocations. Return other undeliverablecopies to International Media Services,100 Walnut St., #3, PO Box 1518,Champlain NY 12919-1518.Numéro de convention poste-publications40026233. Retourner toutes les copiescanadiennes non livrées et les avis dechangement d’adresse à la SOGC,Service de l’abonnement au JOGC,780, promenade Echo, Ottawa (Ontario),K1S 5R7. Numéro USPS 021-912. Fraispostaux USPS au tarif des périodiquespayés à Champlain (NY) et autres bureauxde poste. Retourner les autres copies nonlivrées à International Media Services,100 Walnut St., #3, PO Box 1518Champlain (NY), 12919-1518. ISSN 1701-2163  SOGC CLINICAL PRACTICE GUIDELINES Canadian Consensus Guidelines onHumanPapillomavirus  AUGUST  JOGC  AOÛT 2007   S1 SOGCCLINICAL PRACTICE GUIDELINES These guidelines were prepared by the HPV Consensus GuidelinesCommittee and approved by the Executive and Council of theSociety of Obstetricians and Gynaecologists of Canada.These guidelines have been endorsed by:Canadian Association for Adolescent HealthCanadian Pediatric and Adolescent Gynaecologyand Obstetrics CommitteeFederation of Medical Women of CanadaQuebec Association of PediatriciansSociety of Canadian ColposcopistsSociety of Gynecologic Oncologists of Canada HPV CONSENSUS GUIDELINES COMMITTEE CHAIRS Deborah M. Money, MD, FRCSC, Vancouver BCMichel Roy, MD, FRCSC, Quebec City QC SOGC PROJECT OFFICER Judy Scrivener, Ottawa ON HPV CONSENSUS GUIDELINES COMMITTEE Lisa Allen, MD, FRCSC, Toronto ONMonica Brewer, MD, Quispamsis NBPeter Bryson, MD, FRCSC, Kingston ONGerald Evans, MD, FRCSC, Kingston ONJean-Yves Frappier, MD, FRCSC, Montreal QCMary Anne Jamieson, MD, FRCSC, Kingston ONCharles Lynde, MD, FRCPC, Markham ONK. Joan Murphy, MD, FRCSC, Toronto ONDiane M. Provencher, MD, FRCSC, Montreal QCMichael Shier, MD, FRCSC, Toronto ONMarc Steben, MD, Montreal QCRobert Lerch, Public Health Agency of Canada, Ottawa ON André Lalonde, MD, FRCSC, Executive Vice-President, Ottawa ONVyta Senikas, MD, FRCSC, Associate Executive Vice-President,Ottawa ON This guideline reflects emerging clinical and scientific advances as of the date issued and are subject to change. The informationshould not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictateamendments to these opinions. They should be well documented if modified at the local level. None of these contents may bereproduced in any form without prior written permission of the SOGC . Key Words:  anogenital cancer, cervical cancer, cervical intraepithelial neoplasia, clinical burden, colposcopy, condom, cost-benefit analysis,cost-effectiveness analysis, counselling, disease prevention, economic burden, genital warts, health promotion, human papillomavirus, practiceguidelines, recurrent respiratory papillomatosis, sexually transmitted infections, vaccination, vaccine No. 196, August 2007 Abstract Objective:  To promote guidelines for health care providers on the key aspects of HPV infection and the management of HPV-related disease inthe new era of vaccine availability. Evidence:  Medline and Cochrane databases were searched for articles from January 1995 to March 2007 on subjects related to HPV infection,HPV vaccination, HPV-related disease, Pap testing, and specific consideration of management.  Values:  The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic HealthExamination. Recommendations for practice are ranked according to the method described in this report. Sponsors:  The development of this consensus guideline was supported by unrestricted educational grants from Cytyc Canada, DigeneCorporation, Graceway Canada, GlaxoSmithKline Inc, Merck Frosst Canada Ltd, and Roche Diagnostics Canada.  S2    AUGUST  JOGC  AOÛT 2007
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