Assessing nonsexual transmission of the human papillomavirus (HPV): Do our current cleaning methods work?

Abstract

Human papillomavirus (HPV) is thought to be sexually transmitted; however, there have been a few studies investigating a possible iatrogenic source of infection.Therefore, it is important to assess the cleaning methods of reusable medical devices. This study assessed whether cleaning methods of flexible endoscopes in an otolaryngology clinic are effective against HPV. There were 24 patients with a history of head and neck cancer in the study; however, two outliers were excluded.Nine patients were confirmed to have HPV-associated cancer. PCR was used to measure and quantify the viral genomes of samples collected before and after cleaning. After cleaning, few HPV+ samples had endoscopes with less DNA than before cleaning. Additionally, for several patients with non-HPV-associated head and neck cancer, PCR showed more DNA after cleaning than before cleaning, suggesting residual HPV DNA within the cleaning solution. There was no significant difference (p > 0.05) between pre-and post-cleaning in both cohorts. Current cleaning methods of reusable endoscopes may not be effective in completely removing viral DNA.

Exploring the role of HPV: from Sexually transmitted infection to Oropharyngeal Cancers

“…Nosocomial transmission of the HPV is also possible which may occur during the use of transvaginal ultrasound probe which is commonly used in the Obstetrics & Gynaecology departments where the probe is placed very close to the cervix which may act as a pathway of infection [56]. Like the instruments used in the Obstetrics and Gynaecology department, flexible endoscopes used in otolaryngology may also serve as a source of infection in the oral region [58]. 3% of the probes were found to be positive for HPV DNA after examination and 1.9% were found to be positive in pre-examination samples [59].…”

Letter to the Editor RE: Assessing nonsexual transmission of the human papillomavirus: Do our current cleaning methods work? By Tucker et al.

“…Tucker et al concluded current endoscope reprocessing methods do not eliminate human papillomavirus (HPV) and may allow it to be transmitted from carriers to other otolaryngology clinic patients. The authors suggested that orthophthalaldehyde (OPA) high‐level disinfectant (HLD) “may not be fully effective at removing HPV from endoscopes.” 1 We believe the evidence does not support their conclusions, and we are concerned that problems with study design and reprocessing quality may have contributed to erroneous conclusions.…”