BIOS242 Human Papilloma Virus Epidemiology DQ

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BIOS242 Human Papilloma Virus Epidemiology DQ

BIOS242 Human Papilloma Virus Epidemiology DQ

For this assignment, you will identify a pathogen in a newspaper article or publication of your choice, apply principles learned in BIOS 242, and research the pathogen for its connection to nursing/health care. You must get approval for your chosen article and pathogen. You will then write a paper on their chosen pathogen/topic.

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The pathogen can be a bacteria, fungus, protozoa, or virus. In addition to the article, information to include in the paper should include, morphology, gram stain characteristics, virulence factors, susceptibility to antibiotics, host cells, nutritional needs, growth conditions, mechanisms used to evade the immune system and invasion into the host(s), interactions with the hosts and diseases caused and affected body systems. Additionally, students should explain symptoms when the pathogen infects a host, as well as a diagnosis and the therapeutic intervention needed after infection. You may also add information on statistics related to infection (epidemiology) and any new research findings related to the pathogen.

Writing Requirements (APA format)

Length: 2 pages (not including title page or references page)
1-inch margin
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 2 scholarly sources)
below are the attachment of the rubric and the articles.

QUICK LESSON Human Papillomavirus (HPV) Description/Etiology The human papillomavirus (HPV) is a double-stranded DNA virus of the family Papovaviridae. There are over 150 types of HPV. Approximately 40 HPV types are sexually transmitted and affect the genital area, while the remainder produce warts that affect the hands, fingers, and feet (e.g., plantar warts, flat warts, butcher’s warts). HPV infection is the most common sexually transmitted disease (STD) worldwide. Genital HPV infections can produce genital warts (also known as venereal warts and condylomata acuminata) and cancers of the cervix, vagina, vulva, anus, penis, and oropharynx. (For information on genital warts, see Quick Lesson About … Condylomata Acuminata (Genital Warts) , Quick Lesson About … Cervical Cancer: an Overview , and related Quick Lessons). ICD-9 079.4 ICD-10 B97.7 Authors Tanja Schub, BS Cinahl Information Systems, Glendale, CA Jeanne Parks-Chapman, RN, BSN Cinahl Information Systems, Glendale, CA Reviewers Rosalyn McFarland, DNP, RN, APNP, FNP-BC Cinahl Information Systems, Glendale, CA Sara Richards, MSN, RN Cinahl Information Systems, Glendale, CA Nursing Practice Council Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA October 20, 2017 HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 are considered oncogenic (i.e., capable of malignant transformation). Types 6 and 11 cause > 90% of all genital warts and recurrent respiratory papillomatosis (i.e., a disease characterized by warty growths in the upper airway that may cause voice changes and airway obstruction), and types 16 and 18 cause ~ 70% of cervical cancers. HPV is transmitted primarily through sexual—including oral, genital-to-hand, and genital-to-genital—contact, although it can also be spread by skin-to-skin (e.g., kissing) contact. BIOS242 Human Papilloma Virus Epidemiology DQ

Fomites (i.e., inanimate objects capable of retaining and transmitting infectious agents; e.g., towels) have been suggested as a means of nonsexual transmission. Maternal HPV can infect the newborn during vaginal delivery, resulting in the development of respiratory papillomatosis in the infant. HPV infections are often asymptomatic but may present as abnormal cells or tissue growth, which can be detected by Papanicolaou (Pap) tests, or as genital warts, which are soft, pink- or flesh-colored bumps or growths that appear in and around the anogenital area or in the mouth or throat after oral sex with an infected individual. Treatment of HPV-related warts includes podofilox, imiquimod cream, podophyllin resin, trichloroacetic or bichloracetic acid, cryotherapy, or surgery by excision, curettage, or electrosurgery. For large warts, surgery may be required. Treatment of HPV-related cancer may involve surgery, chemotherapy, and/or radiation therapy. Two vaccines that protect against HPV infection are available. Gardasil 9 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, and Cervarix protects against HPV types 16 and 18. (As of late 2016 only Gardasil 9 is being distributed in the United States). The United States Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination in both males and females aged 11–12years, with clinician discretion for use in those as young as 9 years of age; the ACIP also recommends a catch-up vaccination for females aged 13–26 years and males 13–21, who have not been previously vaccinated or who have not completed the full vaccination series. As of December 2016, the ACIP recommends the use of a two-doseschedule for girls and boys who initiate the vaccination series at aged 9–14 years, and a three-dose schedule if the vaccination series is initiated at ages 15–26years. The American College of Obstetricians and Gynecologists endorses these recommendations. Facts and Figures About 79 million people in the U.S. are infected with HPV and ~ 14 million new cases occur each year in individuals between the ages of 15 and 59 years. In the U.S., young Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2017, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 adults between the ages of 15 and 24 years account for ~ 50% of the new HPV infections each year. Most HPV infections are asymptomatic and transient; 70% of women with cervical HPV infection clear the infection within 1 year and 90% do so within 2 years. HPV causes 100% of cervical cancers, 90% of anal cancers, 40% of vaginal cancers, 40% of vulvar cancers, 12% of oropharyngeal cancers, and 3% of oral cancers. Each year in the U.S., HPV is thought to cause 360,000 cases of genital warts, more than 12,000 cases of cervical cancer, more than 8,400 cases of oropharyngeal cancer (80% of which occur in men), 4,300 cases of anal cancer (35% of which occur in men), and 2,600 cases of vulvar and vaginal cancer. BIOS242 Human Papilloma Virus Epidemiology DQ

Risk Factors Multiple sex partners, sex with a partner who has had multiple sex partners, unprotected sex, having another STD, and sexual intercourse at a young age are all risk factors for genital HPV infection. Cigarette smoking and oral contraceptive use also increase the risk for HPV infection (see Food for Thought, below). Circumcision in men has been found to reduce the risk of transmitting HPV. Signs and Symptoms/Clinical Presentation › Genital warts: single or multiple soft, pink- or flesh-colored bumps or growths that can be raised, flat, or cauliflower-shaped that appear on the penis, scrotum, groin, anus, or thigh in men and on the cervix, vulva, or in and around the anus or vagina in women › Cervical cancer: foul-smelling vaginal discharge, back or pelvic pain, painful urination, blood in the stool or urine, and abnormal bleeding (e.g., between periods, after sexual intercourse, after menopause) Assessment › Physical Findings of Particular Interest • Genital warts are diagnosed by visual inspection; raised, flat, or cauliflower-shaped warts may be present on the genitalia and/or other areas in individuals with HPV-related warts • Abnormal bleeding, vaginal discharge, painful urination, and pain during sexual intercourse are common in women who present with HPV-related cervical cancer › Laboratory Tests That May Be Ordered • Histopathologic analysis of the biopsied wart or wart tissue may show HPV • A cervical Pap test, a colposcopy, and HPV DNA test screens for HPV in women. There is no approved test to detect HPV in men • Histologic analysis of biopsied cervical tissue may show cervical cancer › Other Diagnostic Tests/Studies • CT scan, MRI, PET scan, or other tests may be ordered if metastasis is suspected Treatment Goals › Administer Prescribed Agents to Resolve HPV Infection and Reduce Risk of Complications • Assess all physiologic systems and review laboratory/diagnostic study results; immediately report abnormalities and treat, as ordered –See the Quick Lessons referenced above for details of treatment strategies specific to genital warts and cervical and other HPV-related cancers • Follow facility pre- and post-treatment protocols if patient becomes a candidate for surgery, chemotherapy, or radiation therapy; reinforce pre- and posttreatment education and verify completion of facility informed consent documents; monitor closely for complications following treatment • BIOS242 Human Papilloma Virus Epidemiology DQ

Monitor treatment efficacy and for adverse treatment effects › Provide Emotional Support and Educate About Risk-Reduction Strategies • Assess patient’s anxiety level and coping ability; educate and encourage discussion about HPV infection, potential complications, treatment risks and benefits, risk-reduction strategies, the importance of continued medical surveillance, and individualized prognosis • Educate that the treating clinician may request testing for additional STDs • Educate pregnant patients that antenatal screening is recommended to minimize or eliminate risk of HPV transmission to the fetus or infant • Encourage asking the treating clinician about HPV vaccines, if appropriate • Request referral to a mental health clinician, if appropriate, for counseling on coping strategies, particularly for patients with HPV-related cancers Food for Thought › Genital warts do not undergo malignant transformation › Despite ACIP recommendations of routine vaccination of 11–12-year-oldchildren with Gardasil or Cervarix, HPV vaccine uptake in the U.S. remains low. The U.S. Centers for Disease Control and Prevention reported that, in 2013, 57.3% of teenaged girls aged 13–17 years and 34.6% of teenage boys had received one or more doses of the vaccine. Just 32.7% of girls had received the full 3-dose series (Elam-Evans et al., 2014) › Concerns about vaccine safety has been identified as an important barrier to vaccine update, but researchers in Denmark and Sweden who studied nearly 1 million adolescent girls over a 4-year period found no evidence that Gardasil is association with increased risk of autoimmune, neurological, or venous thromboembolic adverse events (Arnheim-Dahlström et al., 2013) › Researchers who analyzed data from 6,887 participants in the National Health and Nutrition Examination Survey found a significant correlation between cigarette smoking and risk of oral HPV infection; risk of oral HPV type 16 infection was increased by 31% in participants who smoked 3 cigarettes per day and by 68% in those who smoke 4 cigarettes per day (Fakhry et al., 2014) › Based on a study of 135 pregnant women tested for HPV DNA by means of polymerase chain reaction (PCR), researchers concluded that asymptomatic HPV infection constitutes significant risk factor of vertical transmission (Skoczynski et al., 2014) › Although the duration of the HPV vaccine efficacy has yet to be determined, researchers report results from clinical trials show no evidence of decrease in protection at 10 years post-vaccination(Meites, et al 2016) › Because HPV is a global public health issue, vaccination efforts should include males and females to prevent the spread of this disease (Tanveer, 2017) Red Flags › HPV-related cancers often exhibit no symptoms until quite advanced › Many topical treatments for genital warts (e.g., podofilox, podophyllin, imiquimod) are contraindicated during pregnancy because the potential for skin absorption increases risk for birth defects (for more information about HPV infection during pregnancy, see Quick Lesson About … Cervical Cancer during Pregnancy ) ›BIOS242 Human Papilloma Virus Epidemiology DQ

Prompt antenatal screening is recommended in pregnant women with HPV infection to allow for appropriate treatment and reduce risk for birth canal obstruction by enlarged warts, which increases risk for fetal transmission What Do I Need to Tell the Patient? › Encourage women to have regular Pap tests to screen for HPV infection and cervical cancer › Advise patient to abstain from sexual activity until genital warts have been removed and the treating clinician has declared patient free of infection › Emphasize the importance of strict treatment regimen adherence to promote infection resolution, and continued medical surveillance to allow for prompt treatment of any recurrences › Educate the patient on safer sexual behavior such as abstinence, mutually faithful sexual relationships, reducing the number of sex partners, and condom use References 1. Arnheim-Dahlström, L., Pasternak, B., Svanström, H., Sparén, P., & Hviid, A. (2013). Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: Cohort study. BMJ: British Medical Journal, 347, f5906. doi:10.1136/ bmj.f5906 2. Committee opinion no. 588: Human papillomavirus vaccination. (2014). Obstetrics & Gynecology, 123(3), 712-718. doi:10.1097/01.AOG.0000444458.00612.6b 3. Elam-Evans, L. D., Yankey, D., Singleton, J. A., Curtis, R. C., MacNeil, J., & Hariri, S. (2014). National, regional, state, and selected area vaccination coverage among adolescents aged 13-17 years–United States, 2013. MMWR. Morbidity and Mortality Weekly Report, 63(29), 625-633. 4. Fakhry, C., Gillison, M. L., & D’Souza, G. (2014). Tobacco use and oral HPV-16 infection. JAMA: Journal of the American Medical Association, 312(14), 1465-1467. doi:10.1001/jama.2014.13183 5. Gearhart, P. A., Randall, T. C., Buckley, R. M., Jr, & Higgins, R. V. (2017, January 5). Human papillomavirus. Medscape. Retrieved July 23, 2017, from http://emedicine.medscape.com/article/219110-overview 6. Markowitz, L. E., Dunne, E. F., Saraiya, M., Chesson, H. W., Curtis, C. R., Gee, J., … Unger, E. R. (2014). Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Morbidity and Mortality Weekly Report, 63(RR05), 1-30. 7. Meites, E., Kempe, A., & Markowitz, L. E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination-updated recommendations of the advisory committee on immunization practice. Morbidity and Mortality Weekly Report, 65(49), 1405-1408. 8. Skoczynski, M., Gozdzicka-Jozefiak, A., & Kwasniewska, A. (2014). Risk factors of the vertical transmission of human papilloma virus in newborns from singleton pregnancy – preliminary report. Journal of Maternal-Fetal & Neonatal Medicine BIOS242 Human Papilloma Virus Epidemiology DQ

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