Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)

Hey there! Welcome to our lesson on Human Papillomavirus, or HPV. Let’s get started.

So let’s hit the high points really quick. First, Human Papillomavirus- or HPV- is spread through sexual contact. It’s the leading cause of both genital warts and cervical cancers. The important thing to know is that HPV is preventable with vaccination and safe sex practices, so there’s a large patient education component to HPV.

Here is what I want you to remember throughout this lesson: HPV lays dormant for 1-8 months after a person is infected. AND, even after a patient no longer has warts, they will have HPV for the rest of their life. It is possible to have flare-ups, and this is why using condoms during sexual activity is so important! Your patient needs to understand the risks they and their sexual partners face with HPV.

So, because HPV is an STI, it makes sense that most risk factors deal with sexual activity. Unprotected sex and multiple sexual partners greatly increase the likelihood of infection. Combined, these practices are dangerous and make it so much more likely that a person contracts HPV or another STI. Safe sex is so important! Sexual activity at a young age is also a determinant, as unprotected sex is common. This is sad- because like we said, HPV is a lifelong infection. And finally, immunosuppression can increase chances of infection, so coaching safe sex to our vulnerable populations is also important – and that is something that is often missed.

First we will talk about venereal, or genital warts. The most common places they occur are in the most high-contact sexual areas: labia, anus, penis, scrotum, cervix, and oral cavity. Once the  patient has been infected, it can take months before symptoms begin to appear. While contact with a lesion is the easiest way for HPV to spread, it is still possible to transmit HPV without visible lesions present. Depending on the area of infection, the warts may look different. In the genital regions, warts are round and appear like cauliflower, whereas warts in the mouth and on the hands appear more flat. The only cure for any genital wart is to remove it- by ablation, cutting it out, or freezing it off. The reason I put cure in quotes is that it removes the physical sign of HPV, but remember, the patient still has HPV and can transmit it even without visible warts.

In addition to venereal warts, HPV is also the leading cause of cervical cancer. As we continue to better understand the connection between HPV and cancer, the guidelines for screening continue to evolve. The standards right now are to begin pap smears for all women once they hit age 21. After that, low risk patients may only need screening every 3 years. This can be really scary for patients – some will have abnormal pap smears and be considered low risk. This has happened to me personally, and I was mortified until I understood what this meant. When a woman has an abnormal pap, the pathologist reviews the cells to identify if there are any strains of HPV at all- and if there are, they’re looking for the high risk strains of HPV that cause warts and cancer. When my doctor left me a voicemail saying I had an abnormal pap, I thought this meant I had HPV- it wasn’t until my nurse explained they saw a few suspicious cells but no HPV or cancer that I understood what this meant. Moral of the story – support your patients, this stuff is scary! In addition to cervical cancers, HPV is linked to anorectal and in some rare cases, lung cancer. Head and neck and oral cancers are also being linked to HPV more and more and are the fastest growing area for HPV-related cancers. In my work in oncology, there has been a noticeable increase just in the last 3 years! Bottom line – we know HPV causes many different types of cancer, and this correlation is only likely to grow. Pay attention to this area as you enter practice because I expect to see a lot of changes.

We vaccinate adolescents and young adults with the Gardasil 9 vaccine. We call it this because it guards the body against the 9 strains most commonly associated with abnormal cells, cancers, and venereal warts. Vaccination recommendations continue to evolve. Just recently, the CDC announced they now advise Gardasil shots for all males up to age 21. This is another area we need to watch closely, because recommendations are likely to change. The official CDC line is that all children can begin the 3 shot series as early as age 9, but at least by age 11-12. Males and females who are past this range can still receive the shots through early adulthood, ideally before infected with a strain of HPV. Once an individual is infected with HPV, the provider may still recommend Gardasil based on the strain or strains of HPV they have. For example, if a patient has a strain of HPV not linked to genital warts or cervical cancer, there’s still great value in receiving the vaccination because it could prevent infection with a totally life altering illness.

So let’s review the key nursing concepts involved in preventing and treating HPV infection. Because HPV is a virus and therefore untreatable, health promotion and infection prevention are so so so so important! We need to encourage patients to keep their appointments, attend routine examinations, and practice safe sex! This will help us to prevent them from ever having to deal with an HPV infection. And of course, HPV affects sexuality. Not only is HPV sexually transmitted, but it can lead to very vulnerable and intimate conversations with sexual partners if an infection occurs.

So once more, let’s review our key points. HPV is sexually transmitted and can cause truly uncomfortable genital warts. The link between HPV and cancer is strong and we continue to learn more and more about this connection. And finally, HPV is preventable if we coach and promote safe sex and encourage our patients to get vaccinated!