The grades of recommendations (A-E and L) and levels of evidence (I, II-1, II-2, II-3, and III) are defined at the end of the "Major Recommendations" field.
- Counseling and other educational activities should stress (a) that abstinence is the most efficient way to prevent the human papillomavirus (HPV) infection but must include avoidance of not only penetration of the vagina or the anus but also any anogenital contact and the sharing of sex toys, (b) that condoms have some efficacy against HPV infection only if used consistently, and (c) that disappearance of lesions is no guarantee that the patient is not still contagious. II-2B
- Caesarean section does not prevent neonatal HPV and should be reserved for women for obstetrical indications. II-2B
- Partner referral does not reduce the risk of re-infection and is not indicated as a preventative measure. II-2 B
- Cervical cancer screening by cytology should be considered a secondary prevention method, intended to discover precancerous lesions and diminish the risk of their progression to cancer. IA
- Smoking cessation should be strongly recommended to women with an HPV infection or any stage of an associated disease. IA
Definitions:
Levels of Evidence*
I: Evidence obtained from at least one properly randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control studies, preferably from more than one center or research group.
II-3: Evidence obtained from comparison between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
*The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.
Grades of Recommendations*†
A. There is good evidence to recommend the clinical preventive action
B. There is fair evidence to recommend the clinical preventive action
C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making
D. There is fair evidence to recommend against the clinical preventive action
E. There is good evidence to recommend against the clinical preventive action
L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making
* Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-8.
† Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.