Cupids Health

Medical Surgical Women's Health Human Papillomavirus (HPV)



Hello Everyone, here is a Women’s health lecture on Human Papillomavirus (HPV) made easy to understand to help aide in your study sessions. I have gathered all of the important information from my Med- Surg Book (Brunners and Suddarth 12th edition) and NCLEX review (Saunders 6th edition) that will prepare you for your nursing test whether it is for school or NCLEX.

Here are some Extra information that may help and guide you…

Pathophysiology:

More than 100 types of HPV exist. The most common
strains of HPV, 6 and 11, usually cause condylomata
(warty growths) on the vulva. These are often visible or
may be palpable by patients. Condylomata are rarely premalignant
but are an outward manifestation of the virus.
Strains 6 and 11 are associated with a low risk for cervical
cancer. Some HPV strains (16, 18, 31, 33, and 45) may
not cause condylomata but do affect the cervix, resulting
in abnormal Papanicolaou (Pap) smears. The effects of
these strains are usually invisible on examination but may
be seen on colposcopy. They may cause cervical changes
that may appear as koilocytosis on Pap smear. Seventy
percent of all cervical cancers are caused by strains 16 and
18 (Wright, Massad, Dunton, et al., 2007). However,
most women with HPV infection do not develop cervical
cancer.
The incidence of HPV in young, sexually active women
is high. The infection often disappears as the result of an effective
immune system response. It is thought that two proteins
produced by high-risk types of HPV interfere with tumor
suppression by normal cells. Risk factors include being
young, being sexually active, having multiple sex partners,
and having sex with a partner who has or has had multiple
partners.
In 2006, the Advisory Committee on Immunization
Practices (ACIP) of the CDC recommended that a newly licensed
vaccine (Gardasil) against the four strains of HPV
that cause the majority of cases of cervical cancer be routinely
administered to girls 11 to 12 years of age—that is, before
they become sexually active. Although this vaccine is
considered an important medical breakthrough, it does not
replace other strategies important in prevention of HPV or
the need for cervical cancer screening. It is administered in
three intramuscular doses, with the initial dose followed by
second dose in 2 months and a third dose 6 months after the
first dose. This vaccine, along with regular Pap smears, has
the potential to decrease the impact of HPV-related disease
(ACOG, 2006b; CDC, 2006a, 2007; Markowitz, Dunne,
Saraiya, et al., 2007).

Medical Treatment:

Topical agents that can be applied by patients to external
lesions include podofilox (Condylox) and imiquimod
(Aldara). Because the safety of podophyllin, imiquimod, and
podofilox during pregnancy has not been determined, these
agents should not be used during pregnancy. Electrocautery
and laser therapy are alternative therapies that may be indicated
for patients with a large number or area of genital
warts (CDC, 2007).
Treatment usually eradicates perineal warts or condylomata.
However, they may resolve spontaneously without
treatment and may also recur even with treatment.
If the treatment includes application of a topical agent
by the patient, she needs to be carefully instructed in the
use of the agent prescribed and must be able to identify the
warts and be able to apply the medication to them. The patient
is instructed to anticipate mild pain or local irritation
with the use of these agents.
Women with HPV should have annual Pap smears because
of the potential of HPV to cause dysplasia (changes
in cervical cells). Much remains unknown about subclinical
and latent HPV disease. Women are often exposed to HPV
by partners who are unknowing carriers. Use of condoms
can reduce the likelihood of transmission, but transmission
can also occur during skin-to-skin contact in areas not covered
by condoms.
In many cases, patients are angry about having warts or
HPV and do not know who infected them because the incubation
period can be long and partners may have no symptoms. Acknowledging the emotional distress that occurs
when an STD is diagnosed and providing support and
facts are important nursing actions.

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