Human Papilloma Virus - Infection Control Issues - Essay Example

? Human Papilloma Virus Table of Contents Introduction 2. Summary of Article 3. Infection Control Issues 4. Critical Analysis of Infection Control Issues 4.1 Testing HPV Infection 4.2 Patient Counseling 5. Conclusion 6. References 1. Introduction Sexually transmitted human papillomaviruses (HPV) are concerned with the pathogenesis of a number of anogenital diseases varying from external genital warts to cancers of the uterine cervix and anus. Genital papillomaviruses have been associated, as well, with recurrent respiratory papillomatosis through vertical transmission during labor. This paper critically reviews recent concepts in genital HPV linked to diseases, disease prevention, viral prevention, viral testing, and treatment. Health Canada goals and strategies for the control of human papillomavirus infection are represented (Rodriquez 2010). Periodic respiratory papillomatosis is chiefly a disease of children in whom several papillomas arise in the upper aerodigestive tract, involving the larynx and vocal cords. The papillomas collectively instigates thwarting papillomas might amount to respiratory suffering. Both high and low risk HPV-DNA series have been established in the papillomas. Although the viruses linked to the respiratory papillomatosis are not contacted through sexual intercourse, they are nonetheless most likely genital in origin, contacted during labor. Anogenital human papillomaviruses infection are chiefly transmitted through sexual intercourse, though in smaller cases there seems to be further, or optional, paths of transmission. Some crucial proof asserts that rare cervical and penile infections may be contacted during labor through exposure to HPV extant in the maternal birth canal or external warts. A lot of concern has been placed on papillomatosis that is assumed to be contacted in this way. However, some peripheral anogenital warts may be contacted during labor as well (Brotzman & Julian 2006). 2. Summary of Article According to Rodriquez (2010) sexually transmitted human papillomavirus are linked to condylomata, dysplastic and malignant lesions of the anus cervix, vagina, anus, vulva and the external genitalia. Vulnerability to HPV and disease advancement is established by HPV type, viral persistence, viral load and immune status. This paper critically analyses current HPV concepts and control issues including epidemiology, prevention, testing and burden of infection. Objectives of HPV control in Canada include establishing and evaluating the prevalence of HPV infection diminishing situations of HPV linked diseases, and promoting HPV targeted rudimentary science and clinical research. The advancement of vaccines is optimistic that the prevention of transmission and acquisition of the viral STD. There is a wide range of human papillomaviruses, which are over seventy types, and of these, over twenty infect mucosal tissue and can be transmitted through sexual intercourse. Human papillomaviruses are connected to the pathogenesis of cancer of the uterine cervix, which is the second most collective cause of cancer and cancer fatalities in women worldwide. Recent research shows that there is prevalent 80 percent of cases happening mostly in the developing world. Aggressive squamous cervical cancer is heralded by preneoplastic lesions that can be established on Papanicolou (Pap) smear and consequently treated. The goal of screening for these precursor lesions has been linked to 90 percent reduction of cervical cases in some Western countries. Conceivably, over twenty types of this cancer linked types of HPV have been established; the most collective are types 16 and 18(Apple et al., 2005). These viruses are capable of integrating into the human genome, and by a range of mechanisms and mutations, including viral protein production and binding of human suppressor and retinoblastoma proteins, amount to unregulated mutations, and ultimately to malignant changes. Further, Oncogenic human papillomaviruses series have been established in the instantaneous cervical cancer precursors known as high grade squamous intraepithelial lesions, and/or cervical intraepithelial neoplasia. The well-known low grade cervical lesion, that is, CIN 1 and horizontal condyloma, also have HPV series, nevertheless, many of the types established have been the low risk viruses, most collectively 6 and 11. Many warts upon the cervix are known as horizontal condylomata and are properly visualized with a colposcope after the utilization of 3-5 percent acetic acid. Further, a few low grade cervical lesions may be caused by oncogenic HPV-these usually seem to have the potential of advancing through CIN 2 and to aggressive cancer (Rodriquez 2010). Human Papillomaviruses DNA has also been established in other anogenital aggressive cancers and their precursors including squamous cancer initiating from vagina, anus, vulva and penis. In most cases, external genital wart of the penis, vagina and canal can be triggered by infection with minimal risk human papillomaviruses. Further, these are not malignant lesions; nevertheless, they consist of an essential medical challenge because they are collective, may be challenging to treat, and seem to recur (Ferenczy 2006). 3. Infection control issues According to the Centre of Disease Control (CDC), HPV is measured as the most collective STI, with over 40 types affecting both males and females. Many people with HPV never display symptoms or suffer from health complications, and the Centre of Disease Control suggests that 90 percent of the incidences heal naturally after two years. HPV is transmitted to genital through sexual contact. Fruitful, well-known disease prevention approaches have been restricted to screening for, and treating, cervical squamous cancer, thereby amounting to reduced cases of the most collective malignancy induced by HPV. Nevertheless, there are no analogous approaches to prevent HPV infection itself. Treating clinical lesions prompted by HPV is believed to reduce the reservoir of contagious virus. Nevertheless, it does not eradicate the potential for infection, since dormant HPV infection may persevere in the neighboring standard seeming tissues. Barrier contraceptives, which have been fruitful in decreasing transmission of any sexually spread diseases, do not show to be effectual in preventing HPV infection. Conversely, there has been current call for research into the advancement of spermicidal substitutions effectual against this virus. Further, vaccines are potential approaches for prevention of HPV infection. Vaccines against HPV have been advanced; primary clinical trials are underway as well. These vaccines have provoked antibody production in women who have aggressive cervical cancer. Steadying and reversion of disease has appeared in too minimal for meaningful explanation, the vaccine appears potential for the treatment of the disease. Vaccine probe in women with pre-aggressive cervical disease is also in progress. 4. Critical Analysis of Infection Control Issues 4.1 Testing HPV Infection Customarily, genital HPV has been identified as abnormal cell transformations on a Pap smear-a test utilized chiefly to identify cancer of the cervix and/or circumstances that may amount to cancer. On the event of Pap smear, the “standardness” of the cervical cells is examined under a microscope (Bauer et al., 2007). “Low-grade” transformations to the cells upon a Pap smear may suggest an HPV infection; however there is no pure merit between high-and low-risk types. HPV-DNA testing has extended immense reception as an additional cervical cancer screening apparatus and as follow-up to abnormal transformations identified with a Pap smear. As it stands there are numerous such HPV-DNA tests (Apple et al., 2005). According to Arends et al (1997) Pap smear screening at repeated intervals can potentially amount to a 90 percent reduction in the cases of cervical cancer. Nevertheless, in the event of one-time utilization, the Pap smear sensitivity for identifying CIN/cancer is reported to vary from 20-70 percent. For this case, this usually raises apprehensions for missing essential lesions in women who incapable of complaint with recurrent screening. Optional or adjunctive screening techniques, including testing for cervicovaginal HPV, may thereby be significantly useful (Arends et al., 1997). Nevertheless, it may be utilized as a follow-up test in women who are over 21 years, and who have specific abnormal repercussions on Pap smear known as ASCUS (“atypical squamous cells for undermined significance”) (Arends et al., 1997). Additionally, screening during HPV testing may a significant role in the management of women who are detected as having a “low-grade” lesion, both ASCUS and LSIL (“low-grade” squamous intraepithelial lesion) on Pap smear. Further, 15-20 percent of these women have an essential high-grade cervical lesion. Additionally, cervical HPV testing may be useful in establishing and managing cervical neoplasia in women who are specifically immunodeficient since infection with HIV (Lungu et al., 2000). Next, the American Cancer Society, for instance, mentions that women over the age of 18 and all sexually active women have a Pap smear annually to screen for cancer or circumstances that may advance into cancer. In all, the American College of Obstetricians and Gynecologists has recently released guidelines ordering that women over 30 years be provided with an HPV-DNA test, as well as pelvic exam (Heaton 2002). According to Heaton (2002) the identification of oncogenic HPV in cervicovaginal samples associates with the coexisting and future presence of CIN. Nevertheless, numerous problems must be determined before screening with HPV testing can be encouraged. Many HPV-positive women, specifically those who are young, will both have no lesion or a “low-grade” lesion; many of the latter will revert impulsively. It is, however, not yet apparent how to establish those women whose “low-grade” lesions moreover need, or will require, treatment. Next, HPV testing has been technically challenging but, progressively, commercial tools are gradually becoming obtainable. The capability to identify a lot more oncogenic types of HPV and provide a quantitative result may give increased specificity. On the whole, screening high-risk groups for anal carcinoma has been recommended, and is being investigated in HIV seropositive men. ANOSCOPY and exfoliate cytology are currently been utilized to establish premalignant anal lesions (Kurman 2009). 4.2 Patient Counseling Health care workers, specifically those at STD clinics, regularly treat patients with HPV-associated abnormal Pap smears or genital warts. Furthermore, the suitable medical treatment, these patients frequently needs psychosexual counseling. Patients with genital warts may contemplate them both repugnant and mutilating. Studies show that the diagnosis may have a deleterious effect on mood, in sexuality, mood, and emotional relationship with partners. It is therefore critically important to dismiss potential misunderstandings that patients may have about HPV. For instance, a bunch of patients will require, information about the high occurrence rate of HPV, the normally benevolent natural history of most HPV infections, and the comparatively low-risk of consequent genital cancer if management guidelines are followed (Schiffman 2006). 5. Conclusion Human papillomavirus infection is a general sexually transmitted disease with underlying morbidity as well as increases risk of death. The presumptuous strategies put by Health Canada offer a framework for work in the area of HPV infection. It is expected that these strategies will amount to measurable control of this viral infection and its interrelated diseases. References Apple, R.J., Erlich, H.A., Klitz, W., Manos, M.M., Becker, T.M., & Wheeler, C.M. (2005). HLA DR-DQ associations with cervical carcinoma show papillomavirus-type specificity. Nature Genetics, 6, 157- 162. 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