Viral Infections

Human Papilloma Viruses

There are many (well over 30) different papilloma viruses which infect humans.¬† They are called ‚ÄúHuman Papilloma Viruses‚ÄĚ, wart viruses or HPV.¬† Some do cause papillomata or warts but many infect cells without obvious disease.¬† In the genital area, they can produce warts (condylomata). These are usually painless, may be multiple and may grow and multiply or go away spontaneously.¬† Genital warts are sexually transmitted.¬† There is no good evidence that they can be caught from toilet seats.¬†
Only three or four HPV subtypes seem to cause cancer of the cervix. These are called ‚ÄúHigh Risk‚ÄĚ strain‚ÄĚ or subtypes although cancer only develops in some.¬† It seems that another factor might be necessary to set off the development. HPV infection of the cervical cells can be recognised in a cervical smear (Papanicolau, ‚ÄúPap smear‚ÄĚ or Liquid Based Cytology).¬† If liquid based cytology was used, the HPV subtype can be identified.¬†
How can I prevent HPV infection?
HPV is a sexually transmitted virus and so the only real way to prevent infection is to abstain from sex.  If you do decide to have sex, you can reduce your risk

  • By limiting the number of partners you have
  • By using a condom (sheath) every time.¬† However, HPV can infect areas that are not covered by the sheath.
  • Females and males can be vaccinated to protect against the types of HPV that most commonly cause health problems.¬† These vaccines are given in 3 doses over 6 months.¬†
  • Washing the genitals, douching or urinating after sex will NOT prevent any sexually transmitted diseases.

How can Genital Warts be treated?
There are many proprietary tinctures to apply to warts.  If the warts are very numerous they can be frozen or burned with diathermy.  This usually needs a short admission to hospital and pain killers for a few days afterwards. 

How can High Risk HPV infection be treated?
Infection with a ‚Äúhigh risk‚ÄĚ HPV subtype will not produce cancer for many years, if at all.¬† So there is no urgency to treat a simple infection.¬† However, it is important for anyone who harbours such a virus to have regular surveillance of her cervix to catch the earliest signs of change.¬† This is called ‚ÄúCervical Intra-epithelial Neoplasia‚ÄĚ or CIN.¬† It is not cancer.¬† We describe three stages of development from CIN1 (hardly any change) which might return to normal to CIN3 (lots of changes) which is nearly cancer.¬†
The cervix is inspected very closely with a microscope (Colposcope).  The areas where changes have occurred can be identified at colposcopy and destroyed or, preferably cut out for histological examination.  Currently, large loop excision of the transformation zone (LLETZ) is the procedure of choice.
After this, cervical smears must be continued to ensure that no other areas undergo the same changes.  Some women who have had their families will opt for hysterectomy.  This removes all of the cervix along with the body of the womb.

Herpes simplex virus

(HSV) causes cold sores at the mouth.  It is generally felt that HSV type 1 causes cold sores and HSV2 causes genital herpes but they can both infect each place.  They behave like other herpes viruses.  The first infection can be the most painful with multiple ulcers.  It resolves and the virus lies dormant in the nerves supplying that area of skin.  Some sort of stress can reactivate virus production.  There is localised pain before the production of vesicles (blisters) full of virus and skin ulceration follows.  It is highly infectious when vesicles or ulcers are present.


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