Clinical Guidelines HPV



HUMAN PAPILLOMAVIRUS (HPV)INTRODUCTION Over 100 types of Human Papillomavirus (HPV) infections have been identified, more than 40 of which can infect the genital area. Most HPV infections are self-limited, asymptomatic, or unrecognized. Oncogenic, or high-risk HPV types (e.g., HPV types 16 and 18), are the cause of most cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers and precancers. Nononcogenic, or low-risk HPV types (e.g., HPV types 6 and 11), are the cause of genital warts and recurrent respiratory papillomatosis.SUBJECTIVE DATAHistory may include:Bumps, growths or lesions on the genital area (vulva, perineum, vagina, urethra, penis, and/or rectum)Bumps, growths or lesions in the oral cavity (mouth, throat)Genital or anal pruritusPersonal history of previous STDsPartner symptomsZika Risk Assessment- As per current CDC guideline- and partner(s)Past travel – where and whenPlans for future travel – where and whenOBJECTIVE DATAAssessment may include: Flat, papular, or pedunculated wart on genital mucosaFemale: assess around introitis, perineum, vagina, cervix, urethra, perianal skin and anusMales: under foreskin in uncircumcised penis, shaft of circumcised penis, and scrotumLesions (warts) on the oral, laryngeal, nasal or conjunctival mucosa ASSESSMENTVisual inspectionRecommended cervical cytology (per current pap screening guidelines) starting at age 21.PLAN Treatment:Recommended Regimens for External Genital Warts-Penis, groin, scrotum, vulva, perineum, external anus, and peri-anusClient-Applied:Podofilox 0.5% solution or gelORImiquimod 3.75 or 5% creamORSinecatechins 15% ointmentProvider–Administered:Cryotherapy with liquid nitrogen or cryoprobe. Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%–90% ORSurgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery. Laser is also another optionCreams and ointment treatments may weaken condom and vaginal diaphragmsRefer client to the STD clinic for treatment (if not provided in family planning).SPECIAL CONSIDERATIONSInfection in pregnancy--refer to prenatal providerCLIENT EDUCATIONClients with genital warts should inform current sex partner(s). Screening sex partners for genital warts, and treatment, as indicated, is essential for decreasing the risk for re-infection. Provide Medication Information SheetProvide current educational information on HPVClients 9-26 should be encouraged to obtain the HPV9 vaccine seriesNote: FDA has approved HPV9 vaccine for persons up to age 45, but not yet a recommendation.Clients should receive Pap screening as recommended (regardless of vaccination or genital wart history). HPV co-testing is recommended for women beginning at age 30.Provide contraceptive information, if indicated Provide STD education and informationOffer other STD testingEncourage consistent and correct condom use to prevent STDs Encourage education of partners about symptoms and encourage partners to seek clinical evaluationFOLLOW-UP If HPV is found on cervical cytology (Pap screening) refer to the ASCCP 2014 Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors at ASCCP Website Link.REFERRAL Lesions that lack the classic appearance or are in the vagina, urethra, rectum or on the cervix should be referred.Clients needing a colposcopy based on pap screening follow-up recommendationsREPORTING Mandated state reporting is not requiredREFERENCESCDC: Sexually Transmitted Diseases Treatment Guidelines, 2015 Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories, 2019ASCCP 2014 Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors- : 2020 ................
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