Sexuality-human papilloma virus (HPV)

How common is HPV and the health problems caused by HPV?

-About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives. -Health problems related to HPV include genital warts and cervical cancer. -Genital warts: About 360,000 people in the United States get genital warts each year. -Cervical cancer: More than 10,000 women in the United States get cervical cancer each year. -There are other conditions and cancers caused by HPV that occur in persons living in the United States. -Each year, about 21,000 of HPV-related cancers could be prevented by getting the HPV vaccine.

Who should get vaccinated?

-All boys and girls ages 11 or 12 years should get vaccinated. -Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger. -The vaccine is also recommended for gay and bisexual men (or any man who has sex with a man) through age 26. -It is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.

How is HPV spread?

-By having vaginal, anal, or oral sex with someone who has the virus. -It is most commonly spread during vaginal or anal sex. -HPV can be passed even when an infected person has no signs or symptoms. -Anyone who is sexually active can get HPV, even if you have had sex with only one person. -Symptoms can develop years after you have sex with someone who is infected making it hard to know when you first became infected.

How can HPV and the health problems it can cause be avoided?

-Get vaccinated. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (boys and girls ages 11 or 12 years.) -HPV vaccines are given in three shots over six months; it is important to get all three doses. -Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer. -Use condoms This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom - so condoms may not give full protection against getting HPV; -Be in a mutually monogamous relationship - or have sex only with someone who only has sex with you.

Does HPV cause cancer?

-HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. -It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). -Cancer often takes years, even decades, to develop after a person gets HPV. -The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. -There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.

What is HPV? Pathophysiology

-HPV is the most common sexually transmitted infection (STI). -HPV is so common that nearly all sexually active men and women get it at some point in their lives. -There are many different types of HPV. Some types can cause health problems including genital warts and cancers. -90% of HPV are low-risk (types 6 and 11) -High risk HPV (types 16, 18, 31, 33, and 35) can be found on the skin of the genitalia and increase the risk for genital cancers, especially cervical cancer -Infection with several HPV types can occur at the same time. The presence of one strain increases the risk for acquiring a higher-risk strain. -HPV infection is thought to be the primary risk factor for development of cervical cancer. -Sites commonly affected by infection include the urinary meatus, labia, vagina, cervix, penis, scrotum, anus, and perineal area. - The incubation period is usually 2 to 3 months. -There is growing evidence that HPV infection through oral and anal sex, especially in men who have sex with men (MSM), may be a risk factor for developing oral and anal cancers

How does HPV affect pregnancy?

-If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix.

Does HPV cause health problems?

-In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. -. Genital warts(Condylomata acuminata), which are caused by certain types of HPV, are the most common viral disease that is sexually transmitted and are often seen with other infections. -They are initially small, white or flesh-colored papillary growths that may grow into large cauliflower-like masses. Multiple warts usually occur in the same area. Bleeding may occur if the wart is disturbed. Warts may disappear or resolve on their own without treatment. They may occur once or recur at the original site.

How HPV diagnosed?

-Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they've developed more serious problems from HPV, such as cancers. -The diagnosis of genital warts is made by examination of the lesions -A Pap test and HPV DNA probe are used to obtain cervical specimens to assess for dysplasia and isolate and diagnose HPV of the cervix.

How do we teach for self-mangement

-The PRIORITY for nursing management is patient and sexual partner education about the mode of transmission, incubation period, treatment, and complications, especially the association with cervical cancer. -Reinforce instructions about local care of the lesions or patient-applied treatment for self-management. -Teach patients that after treatment with cryotherapy, podophyllin, or TCA, they may experience discomfort, bleeding, or discharge from the site or sloughing of parts of warts. Instruct patients to keep the area clean (shower or bath) and dry. Teach them to be alert for any signs or symptoms of infection or side effects of the treatment. -Inform patients that recurrence is likely, especially in the first 3 months, and that repeated treatments may be needed. Urge all patients to have complete STD testing, since exposure to one may increase risk for contracting another. -Teach patients to avoid intimate sexual contact until external lesions are healed. Recommend condoms to help reduce transmission even after warts have been treated -Encourage women to have an annual Pap test.

Human Papilloma Virus (HPV)

-The most common sexually transmitted infection in the United States. -There are many different types of HPV. Some types can cause health problems including genital warts and cancers. -Some health effects caused by HPV can be prevented with vaccines. -HPV infection is thought to be the primary risk factor for development of cervical cancer

What drug therapies are used to treat HPV or health problems caused by HPV?

Genital warts: -Patients may apply podofilox (Condylox) 0.5% cream or gel twice daily for 3 days with no treatment for the next 4 days. This regimen should be repeated for four cycles. Other options are imiquimod (Aldara) 5% cream applied topically at bedtime three times a week and sinecatechins 15% ointment applied three times a day, both until the warts disappear or for up to 16 weeks. -Imiquimod boosts the immune system rather than simply destroying the warts. These self-treatments are less expensive than those performed in the health care provider's office, but they take longer for healing. TEACH PATIENTS that over-the-counter (OTC) wart treatments should not be used on genital tissue. -Cryotherapy, trichloroacetic acid (TCA) or bichloroacetic acid (BCA), and podophyllin (Pododerm) are provider-applied treatments. Cryotherapy (freezing), usually with liquid nitrogen, can be used every 1 to 2 weeks until lesions are resolved. TCA/BCA (80% to 90%) can be applied weekly. Podophyllin resin can be applied weekly but needs to be washed off 1 to 4 hours after application. Extensive warts have been treated with the carbon dioxide laser, intra-lesion interferon injections, and surgical removal.

How is HPV or health problems caused by HPV treated?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause: -Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number. -Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. . -Other HPV-related cancers are also more treatable when diagnosed and treated early.