import json

data = {
 "topic": "Human Papillomavirus Infection",
 "slug": "human-papillomavirus-infection",
 "category_id": 14930,
 "summary": "Human papillomavirus is the most common sexually transmitted infection in the US, causing cutaneous warts, anogenital lesions, and, with persistent high-risk types, cervical and other cancers, largely preventable through the 9-valent HPV vaccine.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Red_Book_2021_2024_Report_of_the_Comm_z_library_sk,_1lib_sk,", "author": None, "pages": [489, 491]},
  {"title": "Red Book Atlas of Pediatric Infectious Diseases", "author": "American Academy of Pediatrics,Carol J. Baker, MD, FAAP", "pages": [339, 416, 418]},
  {"title": "Red Book 2018", "author": "Kimberlin, David W.; Long, Sarah S.; Brady, Michael T.", "pages": [634, 640]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [149, 204, 812]},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [2061]},
  {"title": "Red Book Atlas 4th Ed.indb", "author": "American Academy of Pediatrics;Carol J. Baker, MD, FAAP;", "pages": [474]},
  {"title": "Netters Pediatrics (Florin Т., Ludwig St.)", "author": None, "pages": [583]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- HPV is the most common sexually transmitted infection in the US; over 50% of sexually active men and women are infected with HPV at some point in their lives\n"
   "- HPVs are DNA viruses grouped into cutaneous types (causing hand/foot warts, the most common lesions in children) and mucosal types, further divided into low-risk (types 6, 11 - about 90% of condylomata acuminata, recurrent respiratory papillomatosis, conjunctival papillomas) and high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73, 82)\n"
   "- High-risk HPV is detected in 99% of cervical cancers; type 16 alone causes about 50% of cervical cancers worldwide, and types 16+18 together cause about 70%; type 16 also causes most HPV-related oropharyngeal cancers\n"
   "- In the US, HPV types 16/18 cause about 12,000 cancers/year in females (cervical, vulvar, vaginal) and 7,000 in males (penile, anal); nearly 4,000 people die annually from HPV-related disease, and there are nearly 31,000 HPV-attributable cancers annually overall (cervical cancer alone: about 12,000 new cases and 4,000 deaths/year); HPV also causes about 70% of oropharyngeal cancers\n"
   "- Juvenile recurrent respiratory papillomatosis results from vertical (mother-to-infant) transmission at delivery and can cause repeated respiratory tract obstruction with stridor in infants/young children\n"
   "- Genital HPV is transmitted primarily by skin-to-skin contact during sexual activity; most infections are subclinical and clear spontaneously within 2 years; cancer generally requires decades of persistent high-risk HPV infection\n"
   "- Anogenital warts in a young child (e.g., condyloma acuminata) should raise concern for sexual abuse as a transmission route\n"
   "- The 9-valent HPV vaccine (9vHPV; types 6, 11, 16, 18, 31, 33, 45, 52, 58) is recommended for all individuals 9-26 years old; standard 2-dose series (6 months apart) if started before age 15, 3-dose series (0, 1-2, 6 months) if started at 15 or older; a 3-dose series is used regardless of age for immunocompromised patients (ages 9-26), while certain chronic conditions in children under 15 (asplenia, asthma, chronic granulomatous disease, chronic liver/lung/renal disease, CNS anatomic barrier defects, complement deficiency, diabetes, heart disease, sickle cell disease) also warrant a 2-dose (not 3-dose) schedule\n"
   "- Vaccination has no therapeutic effect on an existing HPV infection but is still indicated after a prior HPV diagnosis, since it is highly unlikely a person was already infected with every vaccine-covered serotype\n"
   "- Diagnosis of cutaneous/anogenital warts is generally clinical; there is no useful HPV serologic test for clinical decisions; cervical cancer screening uses Pap cytology and/or HPV DNA testing per established guidelines, with abnormal results (ASCUS, LSIL, HSIL) triaging to repeat Pap, HPV typing, or colposcopy depending on severity"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Human papillomaviruses (HPVs) are DNA viruses of the Papillomaviridae family that cause a variety of proliferative cutaneous and mucosal lesions, including common skin warts, benign and malignant anogenital tract lesions, oropharyngeal cancers, and, rarely, life-threatening respiratory papillomas. Most HPV infections in children and adolescents are benign. HPV types are grouped into cutaneous types, which in children most commonly cause hand and foot warts, and mucosal types, which infect the genital tract and other mucosal surfaces and are further subdivided into low-risk types (associated with benign lesions like condylomata acuminata) and high-risk types (associated with precancerous and cancerous lesions)."
  )},
  {"title": "Epidemiology", "content": (
   "HPV is the most common sexually transmitted infection in the United States; more than 50% of sexually active men and women will be infected with HPV at some point in their lives. In US females, the highest prevalence of genital HPV infection is among 20-24 year-olds. Most genital infections are subclinical and clear spontaneously within about 2 years; progression to cancer is an uncommon outcome that generally requires decades of persistent infection with a high-risk HPV type. HPV causes an estimated 31,000 HPV-attributable cancers annually in the United States: cervical cancer accounts for approximately 12,000 new cases and 4,000 deaths per year, and HPV is also responsible for most vulvar, vaginal, penile, and anal cancers, as well as about 70% of oropharyngeal cancers. High-risk HPV types 16 and 18 alone cause approximately 12,000 cancers annually in females (cervical, vulvar, vaginal) and 7,000 in males (penile, anal) in the US, with nearly 4,000 annual deaths from HPV-related disease."
  )},
  {"title": "Etiology", "content": (
   "Genital HPV infections are transmitted primarily by skin-to-skin contact, usually through sexual intercourse and other close genital contact. Cutaneous HPV types cause common skin warts, most often on the hands and feet. Low-risk mucosal types 6 and 11 are responsible for about 90% of condylomata acuminata (genital warts), recurrent respiratory papillomatosis, and conjunctival papillomas. High-risk mucosal types (including 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73, and 82) are detected in 99% of cervical cancers, with type 16 alone responsible for approximately 50% of cervical cancers worldwide and types 16 and 18 together accounting for about 70%; type 16 is also the leading cause of most HPV-related oropharyngeal cancers. Juvenile recurrent respiratory papillomatosis results from vertical transmission from mother to infant during delivery, causing recurring papillomas in the larynx and upper respiratory tract."
  )},
  {"title": "Clinical features", "content": (
   "Cutaneous warts vary by type and location: common skin warts are dome-shaped with a rough, conical-projection surface, usually painless and multiple, often on the hands and around/under the nails, sometimes showing black dots from thrombosed dermal vessels; plantar warts on the foot are often larger, can be painful with walking, and show marked hyperkeratosis; flat (\"juvenile\") warts are small, multiple, flat-topped lesions on the face and extremities of children/adolescents, rarely painful; filiform warts occur on the face and neck. Genital/anogenital warts (condylomata acuminata) result mainly from low-risk types 6 and 11. Laryngeal papillomas from juvenile recurrent respiratory papillomatosis can cause hoarseness and, from vertical transmission, repeated respiratory tract obstruction with stridor in infants and young children. Anogenital condyloma acuminata in a very young child (for example, a 13-month-old) should raise suspicion for sexual abuse as the transmission route. High-risk HPV infection is typically asymptomatic until it produces cervical cell abnormalities (detected on screening) or, after years to decades of persistence, invasive cancer."
  )},
  {"title": "Diagnostics", "content": (
   "Most cutaneous and anogenital warts are diagnosed by clinical inspection alone. Serologic testing for HPV does not inform clinical decisions and is not commercially available. For cervical cancer screening, established professional society guidelines direct the age of initiation and screening interval using cytology (Pap testing) and/or HPV nucleic acid testing (as a primary screen or in combination, \"cotesting\"), with criteria defining which abnormal results require colposcopic evaluation and biopsy. Vulvar, vaginal, penile, and anal lesions are generally assessed by visual inspection (sometimes with magnification), with cytologic screening and biopsy of suspicious lesions used selectively, since there is no routine population screening recommended for cancers at these other anogenital sites. There is likewise no widely accepted screening program for oral/oropharyngeal HPV-related cancer, though some dentists screen opportunistically."
  )},
  {"title": "Treatment", "content": (
   "There is no specific antiviral treatment for HPV infection itself; management of visible warts relies on chemical or physical destruction of the lesions. For external genital warts, patient-administered options include podofilox 0.5% solution/gel or imiquimod 5% cream; provider-administered options include cryotherapy with liquid nitrogen (repeated every 1-2 weeks until lesions resolve), podophyllin resin 10-25%, or trichloroacetic/bichloroacetic acid (TCA/BCA) 80-90%. For cervical screening abnormalities: ASCUS results should prompt a repeat Pap smear in 4-6 months (or HPV DNA typing, referring for colposcopy if a high-risk type is isolated), continuing routine screening after two consecutive normal results; LSIL can be followed with repeat Pap every 4-6 months if follow-up is reliable (referring to colposcopy if it progresses to HSIL or persists), or referred directly to colposcopy if follow-up is unreliable; HSIL should be referred for colposcopy directly. Detection of HPV nucleic acid material by molecular techniques is incorporated into many current cervical cancer screening guidelines."
  )},
  {"title": "Prevention", "content": (
   "The 9-valent HPV vaccine (9vHPV), containing virus-like particles for types 6, 11, 16, 18, 31, 33, 45, 52, and 58, is the only HPV vaccine currently available in the US market (two earlier vaccines, 2vHPV and 4vHPV, were also FDA-licensed but are no longer marketed). Vaccination is recommended for all individuals 9-26 years of age, with the series able to start as young as age 9, particularly important for victims of sexual abuse/assault in both males and females. For those starting before age 15, a 2-dose series given 6 months apart is recommended; for those starting at 15 years or older, a 3-dose series (0, 1-2 months, 6 months) is used. A 3-dose schedule is also recommended regardless of age for immunocompromised individuals ages 9-26 (including B-lymphocyte antibody deficiencies, T-lymphocyte defects, HIV infection, malignancy, transplantation, autoimmune disease, or immunosuppressive therapy). Certain chronic conditions in children younger than 15 - asplenia, asthma, chronic granulomatous disease, chronic liver disease, chronic lung disease, chronic renal disease, CNS anatomic barrier defects (e.g., cochlear implant), complement deficiency, diabetes, heart disease, or sickle cell disease - warrant the standard 2-dose (not 3-dose) schedule despite their underlying condition. Vaccination has no therapeutic effect on infection acquired prior to vaccination, but is still recommended even after a prior HPV diagnosis, since it is highly unlikely an individual was previously infected with every HPV serotype covered by the vaccine."
  )}
 ],
 "clinical": [
  {"title": "Approach at the bedside", "content": (
   "For a child or adolescent with cutaneous warts (common, plantar, flat, or filiform), diagnose clinically and manage with observation or destructive therapy as appropriate for location/symptoms - biopsy or further workup is not routinely needed. For anogenital warts in a young child, especially outside the context of consensual adolescent sexual activity, evaluate for sexual abuse, since condyloma acuminata in a young child is a recognized presentation of abuse.\n\nFor every eligible patient aged 9-26, offer the 9-valent HPV vaccine: use the 2-dose schedule (6 months apart) if starting before age 15, and the 3-dose schedule (0, 1-2, 6 months) if starting at 15 or older, or regardless of age if the patient is immunocompromised. Remember the exception for children under 15 with certain chronic conditions (asplenia, asthma, chronic granulomatous disease, chronic liver/lung/renal disease, CNS anatomic barrier defects, complement deficiency, diabetes, heart disease, sickle cell disease) - these patients still receive the standard 2-dose schedule despite their condition, not the 3-dose immunocompromised schedule. Vaccinate patients with a prior HPV diagnosis (including prior genital warts or abnormal Pap results) as well, since it is highly unlikely they were infected with every vaccine-covered type. For sexually active adolescents/young adults presenting with an abnormal Pap result, apply standard triage: repeat Pap in 4-6 months for ASCUS (or HPV typing with colposcopy referral if high-risk type positive), repeat Pap every 4-6 months for LSIL with reliable follow-up (colposcopy if it progresses or persists, or direct colposcopy referral if follow-up is unreliable), and direct colposcopy referral for HSIL. In an infant presenting with stridor or recurrent respiratory obstruction, especially born to a mother with a history of genital warts, consider juvenile recurrent respiratory papillomatosis from vertical transmission as a differential diagnosis."
  )}
 ]
}

with open("/tmp/hpv.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")