HPV AND THINGS THAT GO BUMP: TIME FOR ACTION ON GENITAL WARTS

A Nursing Journal Presented To The

Nursing Services Of

Ilocos Training and regional Medical Center

San Fernando City, La Union

In Partial Fulfillment of the

Requirements for the

RN Heals Project Batch IV of the

Department of Health

By: Maria Kristina Camille M. Espinosa RN Heals

Date: April 1, 2013

ARTICLE:

HPV AND THINGS THAT GO BUMP: TIME FOR ACTION ON GENITAL WARTS by William Smith, National Coalition of STD Directors (NCSD) February 11, 2013 - 11:02 pm

Last year, my organization, the National Coalition of STD Directors (NCSD) increased our focus on disease caused by human papillomavirus (HPV) infection. And while much deserved attention has been paid to the critical outcome of cervical cancer, we also decided to tackle the more frequent clinical outcome of HPV infectiongenital warts. Those unsightly, bumpy, cauliflower-like growths that go by the more clinical term condyloma. Long considered more an unsightly and anti-erotic nuisance because genital warts are not life threatening, they do play a role in the spread of HPV by increasing the shedding of virus and for anyone whos ever had themespecially when they are invasivethey are more than just a nuisance. Sexual health is more than the absence of disease, so preventing and treating genital warts should be part of our collective efforts. And from a primary prevention perspective, it syncs up directly with eliminating cervical and anal cancers. While reducing genital warts and cervical and anal cancers is key from a public health standpoint, we decided to look more closely at genital warts from a business perspective. Namely, as public health entities that offer STD clinical servicesmany of NCSDs own membersseek to diversify sources of revenue to keep their doors open, getting reimbursed for treating a common STD seems like a way to bring in additional revenue. Diagnosing genital warts doesnt require much more than a glance from a provider and speedy, in-office treatment is readily available. In addition, patient-applied products have been approved by the Food and Drug Administration (FDA) making treatment even more accessible. In our scaled up work, we also discovered that genital warts are such a common reason for a visit to a public heath STD clinic that as clinic resources, staff, and hours of operation have been cut back, some clinics no longer see genital wart patients. I was at first a bit stunned by this disclosure, but the reality

became clear when one provider said: If we see all the wart patients, we dont have the time to see the gonorrhea and chlamydia patients or their partners. Point taken. But what if those turned away patients could generate streamlined revenue due to easy diagnosis and treatment? It seems to meet multiple needs: public health outcomes, individual patient outcomes, and adding some new revenue to aid dwindling discretionary monies from government. So while we pursue diagnosis and treatment of genital warts in public health clinics, we can also turn to primary prevention. Most genital wartsas high as 90 percent of all casesare caused by two types of HPV, 6 and 11. These two types are among the four types covered by Gardisil, one of the vaccines widely available and approved by the FDA. A study from the British Medical Journal found 82 percent of genital warts are prevented by Gardisil. Yet, uptake of HPV vaccines in this country remains appallingly low, particularly in the South. In Mississippi, less than 20 percent of adolescent females received all three doses of an HPV vaccine according to the 2011 National Immunization Survey. In Arkansas, only 15.5 percent of adolescent females received all three doses; and in South Carolina, only 23.3 percent. While we await the expected and demonstrated good news of few cervical and other cancer deaths among persons immunized against HPV, a recent study from Denmark already shows us that vaccination can significantly reduce genital warts. The February 2013 issue of the journal Sexually Transmitted Diseases highlights a study from Denmark showing the countrys national HPV vaccination program has had a huge impact on reducing genital warts. Since 2009, Denmark has provided Gardisil to all 12-year-old girls and also to those up to age 15 since 2008 as a catch-up vaccination. According to the studys authors, the vaccination program turned the corner on continued increases in new genital warts casesfor women on an average of 3.1 percent fewer cases each year. Moreover, for those young women vaccinated and coming of agenow 16 to 17 years oldgenital warts were virtually eliminated. Finally, NCSD has developed a brochure for providers on talking about genital warts that has a great deal of information that might be useful.

Focusing on genital warts is in the best interest of patient and public health, as well as a good way to bring in money in an era of dwindling resources. The Danes are telling us something and we should be listening and acting.

SOURCE:

http://rhrealitycheck.org/article/2013/02/11/hpv-and-things-that-go-

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SUMMARY:

Genital warts usually develop within six weeks to six months after exposure, but could take longer to appear. If our immune systems are healthy, our bodies may be able to fight off the virus our immune systems are normally able to clear 90 percent of genital-wart infections within two years of exposure. Unfortunately, if the immune system cant fight off the virus, the infection will become chronic, in which case warts can resurface throughout ones lifetime. The warts can be removed by a doctor, but you could still transmit the virus to others and you might experience a recurrence of the warts. Smokers immune systems are less likely to be able to fight off the infection, and in the case of a chronic infection, smokers warts are more likely to return even after being removed by a health care provider. Genital warts affect both men and women and can occur at any age. Most patients with genital warts are between the ages of 17-33 years. Genital warts are highly contagious. There is around a 60% risk of getting the infection from a single sexual contact with someone who has genital warts. In children younger than three years of age, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse. In 2006, an HPV vaccine (Gardasil) was approved by the FDA. It is currently recommended for both males and females aged 9 to 26 years. This vaccine has been shown to be safe and 100% effective in preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had no previous exposure to the virus. However, it is less effective in those who have already been infected with HPV, and it does not protect against all types of HPV infection.

Studies are underway to determine whether the vaccine is safe and effective in older women and in males. Genital warts by themselves are not life-threatening, though they can cause bleeding; when open wounds are present, the risk for the transmission of other STDs increases. Warts can also cause emotional distress, so most people who have them want to find ways to get rid of them. Old folk remedies included strategies such as rubbing a dead toad on the warts; these days there are many effective ways of getting rid of them, including surgical and nonsurgical methods. Talk to a health care provider to find out which option is best for you. They are easier to treat if therapy is sought within the first year of their appearance. Unfortunately, each treatment can cost several hundred dollars and the warts could return in the future (annually, about $200 million is spent to treat genital warts in the United States alone). Furthermore, evidence shows that warts can still be transmitted even when they have been removed because viruses can lurk in the surrounding skin cells. It is possible, however, that the removal of warts makes transmission less likely but right now researchers dont know for sure.

REACTION:

Being assigned to OB-OPD was quiet a tough job. You need to assist the doctors and patients at full effort you can give. The upsetting side of being there is figuring out that most of woman diagnosed of genital warts are younger than 19 years old. Teens are the most common group which is affected by sexually transmitted diseases. Due to lack of sex health education, they are vulnerable enough to acquire such diseases. Their aggressiveness of doing sexual acts without practicing safe sex would lead them to inevitable agony. Our teens today are oblivious about the long run complications of STDs and increasing the numbers of affected teens which has the disease brings imminent apprehension to our society. The importance of knowledge should be stressed so that teens can make the right decision to protect them when they choose to become sexually active. Nurses need to advertise health clinics so that teens can access it to get more information.

The stigma that comes with having sexually transmitted infections is indubitable. Anyone who is labeled a carrier faces disgrace or public humiliation. Worse, patients afflicted with STDs are victims of their own personal issues? Low self-esteem, avoidance behavior and decreased libido. While the world has embraced breakthrough technology in cervical cancer treatment, the mortality rates remain high. The incidence of cervical cancer starts rising at age 35. Worldwide 500,000 women are diagnosed with cervical cancer each year. In the Philippines alone, an average of 12 Filipino women dies of cervical cancer each day according to pharmaceutical firm. The number of people who has genital warts remains unaccounted for.

IMPLICATIONS TO NURSING PROFESSION:

A strong fear of acquiring HIV infection at work substantiated by the fact that needlestick and sharps injuries are the most common method of transmitting blood-borne pathogens between patients and the nurses.

Studies show that nurses unwillingness to care for such patients was associated with a lack of prior experience in STD patient care and the majority perceive their risk of occupational infection with HIV as high especially following a needlestick injury with a needle contaminated with HIV-positive blood. Studies have also shown that nurses want to prevent themselves or colleagues from becoming infected after experiencing a needle stick accident Studies have also shown that nurses who have training in communication aspects of STD care are better equipped to care STD patients. Therefore, nurses should upgrade their knowledge and skills especially on how to handle STD patients so that they would meet the needs of those infectious clients. Sexual health must be continued and improved within schools, as this is a forum in which young people can be educated about health during their formative years. This will also be of value to parents that are not comfortable talking to their kids about sex or those parents that dont know too much about different STDs. Nurse care for such patients is complex in the sense that such sexually transmitted infections can occur even in patients who are not actually guilty of an act that can cause a STD. For example, Gonorrhea or Syphilis is transmitted to a child via the birth canal and HIV is transmitted by blood transfusion process. STD nurse care and risk assessment involves sexuality and intimacy issues that can be challenging for nurses. Although treatment of STDs has been the primary focus, little has been done to know about the attitudes, beliefs and problems of nurse practitioners who care for such patients.

IMPLICATIONS TO NURSING EDUCATION:

Sex education is a difficult course to teach, particularly when taught to teenagers; nevertheless, it is a matter that needs to be addressed. Bequeathing students with a sex education allows them to make responsible decisions for their future. Everyone, including adolescents, have hormones and sexual needs. Depriving students of an informative sex education would be denying this reality. Honest method to teaching sexual education has also been verified to be successful.

Since teens often become sexually active at an early age, it is vital that nurses provide them with the information they need to protect themselves.

Nurses have a key role in educating, managing and supporting patients across a range of clinical and non-clinical settings. Communication is a key factor on how to get the information across with this age group. One of the most important techniques for this age group is to listen first and remain nonjudgmental. Every effort should be made to give the adolescent a sense of modesty and privacy.

STDs may or may not cause symptoms and it is easy to pass it around. Teens need to know the right tools to protect themselves against STDs and it is vital that they learn to practice safer sex to reduce their risk. Getting tested is also important so that the necessary early treatment can be provided. Honest method to teaching sexual education has also been verified to be successful. Teens that are infected with the virus are not even aware of it. It is important that people get tested to make sure they do not contract and spread the disease without knowing the consequences of their unsafe behavior. There is either unsafe sex or safe sex. Safe sex means sexual activities which you can do even if one person is infected with HIV, and they definitely won't pass it on to the other person. Loads of activities are completely safe. You can kiss, cuddle, massage and rub each other's bodies. But if you have any cuts or sores on your skin, make sure they are covered with band - aid. Safer sex also means using a condom during sexual intercourse. Using a condom is not absolutely safe as condoms can break, but condoms can be effective if they are used correctly.

IMPLICATIONS TO NURSING RESEARCH:

Sexually transmitted diseases are a common source of morbidity for adolescents and young adults. They are passed from one person to another through sexual intercourse or intimate contact. Some common STDs include chlamydia, gonorrhea, HIV, genital herpes, HPV, hepatitis, and syphilis. STDs contribute to pelvic inflammatory disease, infertility, ectopic pregnancy, premature births, and anogenital cancer and may contribute to the spread of the HIV epidemic. Some STD symptoms can be treated easily and eliminated and some require more involved and long-term treatment. Either way, it's essential to be evaluated, and if diagnosed with an STD be treated. It's also essential to inform any partners so that they can be evaluated and treated. Teens often dont inform their partners because some STDs are asymptomatic.

STDs have a long term effect on the reproductive health and that is why early screening and treatment is necessary. When it comes to screening for STDs, teens encounter barriers that deter them from seeking treatment. Many barriers to STD care include lack of knowledge of STDs, cost, inconvenient services, shame, and urethral swabs as method of specimen collection. Teens start becoming sexually active at such a young age that most cant drive themselves to clinics or let alone pay for the cost of treatment. It is the nurses role to bridge these barriers so that teens can get the proper care they need. STDs are a major public health problem among teens. They can cause reproductive morbidity and poor health outcomes. Young people may experience more barriers to STD services due to limited resources, lack of information, and increased sensitivity to others perception of themselves. Since there's an epidemic of STDs among teens, nurses need to find a way to reach out to teens and provide them the right tools to protect themselves. By nurses being actively involved with teens, further transmission of STD and morbidity can be reduced.