Introduction

Sexually Transmitted Infections Education Foundation Aotearoa

Promoting optimal sexual health outcomes for all peoples in Aotearoa New Zealand.

E whakatairanga ana i ngā putanga hauora onioni papai mō ngā iwi katoa o Aotearoa.

Our resources

• New Zealand HPV Project: hpv.org.nz
• New Zealand Herpes Foundation: herpes.org.nz
• Just the Facts: justthefacts.co.nz
• HPV and Herpes Helpline: 0508 11 12 13 from a landline or 09 433 6526 from a mobile
• Email: info@stief.org.nz

Other useful resources

• New Zealand Sexual Health Society (NZSHS) resources: Comprehensive STI Management Guidelines and Patient Information handouts are available on nzshs.org/guidelines
• National Cervical Screening Programme (NCSP) resources on HPV testing/screening: tewhatuora.govt.nz/health-services-and-programmes/ncsp-hpv-screening/understand-hpv-primary-screening/
• World Health Organisation resources on HPV, related cancer and vaccines: who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer and who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccine-standardization/human-papillomavirus
• Centre for disease control resources on HPV treatment guidelines: cdc.gov/std/treatment-guidelines/hpv.htm

How to cite this document

Sexually Transmitted Infections Education Foundation. Guideline for the Management of Genital, Anal and Throat HPV Infection in Aotearoa New Zealand: 10th Edition. 2024. Available at: guidelines.stief.org.nz/hpv.

Overview

The Aotearoa New Zealand HPV guidelines were first developed in 1999. The 2024 (10th) edition has been updated to reference changes to the National Cervical Screening Programme and advances in the management of anal cancer pre-cursors. In addition, the different guideline chapters are now presented as individual documents to improve accessibility.

The authors and review team of these guideline documents includes representation from patients, and medical and nursing disciplines involved in the management of people with anogenital HPV and/or genital warts. Contemporary international literature has been evaluated to develop best practice regarding the diagnosis, treatment and evaluation of patients with HPV infection/genital warts and their sexual partners in Aotearoa New Zealand. The recommendations are based on strong evidence in the literature or reasonable supposition and expert opinion.

The information contained here is accurate at the time of publication.

Evidence-based rating categories

The recommendations made in the guidelines have been rated using the following evidence-based categories:

Grade A: Very strong evidence

One or more properly randomised controlled clinical trials.

Grade B: Fairly strong evidence

One or more well-designed observational studies (i.e. non-randomised clinical trial, cohort, case control or time series study, or uncontrolled experimental trials).

Grade C: Weak evidence or firmly held opinion

Opinions of respected authorities that were based on clinical experience, descriptive studies, and/or reports of expert committees.

What's new in 2024?

• The National Cervical Screening Programme (NCSP) has changed from a cytology-based to primary HPV screening programme. Therefore, rather than including a chapter on cervical screening, we recommend visiting the full NCSP Guidelines.
• The World Health Organization has adopted a strategy for cervical cancer elimination as a public health problem through optimal HPV vaccination and cervical screening.
• There is an increased focus on the prevention of anal cancer following the publication of the ANCHOR study, which showed that treatment of anal cancer precursors reduces the incidence of anal cancer in those at high risk of invasive disease. HPV-related anal cancer incidence has been increasing, and is highest in HIV-positive MSM, women with a history of vulvar cancers or pre-cancers, and people with immunosuppression (Clifford et al, Int J Cancer, 2021: 148:38-47).
• Persistent HPV 16/18 infection has been associated with preterm birth. HPV immunisation has the potential to reduce the incidence of preterm birth.
• A recent review of the evidence for sexual transmission of clinical HPV in children has shown that there is no cut-off age to delineate between vertical versus horizontal transmission, and the possibility of sexual abuse needs to be considered in all children with anogenital warts.

Glossary of key terms and abbreviations

• AIN: anal intraepithelial neoplasia
• AIS: adenocarcinoma in situ
• ASC-H: atypical squamous cells (a high-grade lesion cannot be excluded)
• ASC-US: atypical squamous cells of undetermined significance
• CIN 1, 2 or 3: cervical intraepithelial neoplasia (1 = low grade, 2 or 3 = high grade)
• HPV: human papillomavirus
• hrHPV: high-risk human papillomavirus
• HSIL: high-grade squamous intraepithelial lesion
• LBC: liquid-based cytology
• lrHPV: low-risk human papillomavirus
• LSIL: low-grade squamous intraepithelial lesion
• MSM: men who have sex with men
• NCSP: National Cervical Screening Programme
• PCR: polymerase chain reaction amplification
• PIN: penile intraepithelial neoplasia
• RRP: recurrent respiratory papillomatosis
• SCC: squamous cell carcinoma
• SIL: squamous intraepithelial lesion
• STI: sexually transmitted infection
• TCA: trichlorocetic acid
• VIN: vulval intraepithelial neoplasia
• VLP: virus-like particle