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there is conflicting information on how the disease is spread, but from what i read, there may be cause for concern among the other HG's.
HUMAN PAPILLOMA VIRUS
(HPV: Also known as Genital Warts Chondyloma Acuminata )
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Clinical Information
What is HPV?
More than 70 types of human papilloma viruses have been identified, and are responsible for a wide range of expression in our bodies. The common warts found on hands and feet are caused by some of these viruses, as is its more dangerous relation, warts found on the cervix (the opening to the uterus) Some of these warts have been shown to be a risk factor for cervical cancer in females. Warts found in the male anogenital tract have also been linked with cancer, although such cancers are quite rare.
Most warts are benign, but cosmetically unappealing. About 1/3 of the viral types are found in the genital area. These "genotypes" are numbered in order of discovery, and each type identified is considered to be "new" if it shares less than 50% of its DNA with previously identified types. It is important to realize only certain types of warts found in the genital area are associated with cervical cancer. Most often identified through a clinical exam are the external warts, likely to be due to benign types. HPV changes are often identified by the Pap smear.
How Common is HPV?
HPV found in the genital area is the most common STD encountered today. It is considered primarily to be sexually transmitted. Current incidence in the US is estimated to be 20 million with one million new cases identified each year. This number of reported cases is up approximately 500% in the past 15 years. HPV is highly prevalent, being detected in more than 1/3 of college students.
How is HPV spread?
The virus is spread by skin to skin (or mucous membrane to mucous membrane) contact. The 'bumps' usually appear 1-3 months after exposure, but may be as long as 3-6 months or longer. Small lesions may not be visible by self exam or clinical exam at that time. In women, warts occur on the vulva, the labia, the urethra, inside the vagina, on the cervix and around the anus. (See the diagram.)
In men, they may be found on the glans (tip) of the penis, the shaft of the penis, scrotum and around the anus. There is evidence that it can be transmitted non-sexually through placentae in pregnancy and during childbirth. There is also come support for the possibility of contracting HPV through contact with inaminate objects like underwear, towels, sex toys. In both men and women, they can develop in the mouth and throat of a person who has had oral /genital contact. About 2/3 of persons having sexual contact with a partner with genital HPV will contact the virus. Newer, growing lesions are probably the most infectious.
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How can I protect myself against HPV?
Condoms can provide some protection, but will obviously not protect the entire genital area. Abstinence (no skin to skin, mucus membrane contact) is the only 100% effective means of prevention.
How do I know if I have HPV?
The presence of HPV is often first discovered in women on routine gynecological examinations. Others will come in with concerns about a bump or rash in the genital area. The skin changes are usually painless, but occasionally can be responsible for painful intercourse or rectal pain if extensive infection is present. Some lesions may be smooth and round in appearance (usually inside the vagina) others lesions have a rough, "warty" appearance. They can occur singly or in groupings. They can be very small (pencil tip) to large, cauliflower-like growths.
Your doctor or nurse practitioner may use acetic acid 5%, (a vinegar solution) to help identify possible lesions. The pap smear, an examination of cells done by a pathologist after collection by a clinician during the pelvic exam, can help to identify HPV or possible HPV changes in the cells. This exam should be performed annually on all women who have ever had intercourse. Further diagnosis, if indicated can be made by referral to a gynecological or urological specialist.
Identification of viral presence, as well as specific typing of the HPV virus has been done through collection of the cells, similar to the pap smear and performing DNA testing through PCR (polymerase chain reaction) This type of identification is performed largely in a research setting and not currently available in the community. It may be available in the near future on a more widespread basis and assist clinicians and patients with decision-making.
What is the treatment of HPV?
There are a variety of methods for treatment of the HPV infection. The locations of the virus and type of virus are often the most important factors. Early external lesions can be treated by applying a solution of 50%-80 % trichloroacetic acid (TCA) or podophyllin in the office. All clinicians in SECH and many in the out-patient services can provide this treatment. This acid destroys the virus and prompts the body to prepare an immunologic response. Often weekly treatments are needed for eradication of lesions. Cryosurgery (freezing) of the lesions can also be performed. Two prescription medications designed for home use called podofilox and Aldara might be a treatment of choice for certain cases.
In women, it is important to have routine pap smear screening to assess cervical involvement (affecting the cervix or opening to the uterus). If cervical lesions are visible during routine examination, or if the pap smear results suggest HPV infection or abnormalities, the women may be referred for colposcopy. Colposcopy is a special exam in which the cervix is magnified for examiniation and targeted tissue sampling can be performed. Sometimes laser treatments are useful for extensive lesions, as is electrosurgery. (LEEP)
New therapies are being investigated and these include interferon and 5-fluorouracil, applied by the clinician. Most of these therapies are in the investigational stage at present.
If I have HPV, can I do anything outside of medical treatment to help?
Progression or regression of HPV appears to be related to HPV type and immune status. Many factors have been identified that may affect immune status, for example, nutritional status, hormonal influences (pregnancy, puberty, oral contraceptive use, menopause), age, concurrent viral infections such as flu, HIV, EPSTEIN-BARR, herpes, smoking, and stress. All of these may affect your immune response and your body's ability to fight this virus. We do not know for certain if the human papillomavirus can be totally eradicated from a person once infected. We do have evidence to suggest that this may be true. Research has found negative HPV through DNA testing after treatment in some individuals. It is uncertain as to whether the virus is eradicated or simply hiding in a latent stage somewhere in the body, without outward manifestation or detectability. It is felt that recurrences of HPV are probably the result of the virus coming out of a latent stage, rather than reinfection from the same partner.
If I suspect I may have HPV, what should I do?
The SECH department at McCosh is often the best place to make an appointment for this problem. Privacy and adequate time for examination and questions are priorities. If appointments are not available in SECH, appointments can be made in the clinic with Carolyn Torre, Olga Hernandez or Brian Zack, MD. Often, worries can be allayed by a simple inspection, and new lumps or bumps may not be HPV. Many treatment options for HPV are available at PUHS.
How should I tell my partner if I have HPV?
Having a discussion about this subject is often difficult . Having the correct information makes it a little easier. It is very important to prevent transmission of HPV, so it is necessary to talk to your partner. McCosh practitioners have suggestions and information about this topic. In addition, Lynn Greenberg, LCSW, is the contact professional in the PUHS Counseling Center. She is interested and familiar with this topic and also can assist you in adjusting to the diagnosis and possible implications for the future .
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link
http://www.princeton.edu/puhs/SECH/hpv.html
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here's the princeton university site with good info on HPV...
