Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
More than 40 types of human papillomavirus (HPV), which
are the cause of genital warts (known as
condylomata acuminata or venereal warts), can infect the genital tract of men
and women. These warts are primarily transmitted by sexual intimacy. Note that
these are generally different from the HPV types that cause common warts
elsewhere on the body. Genital warts are smoother and softer lesions than the
typically rougher and firmer common warts. Genital warts usually appear as
small, fleshy, raised bumps, but they can sometimes be extensive and have a
cauliflower-like appearance. In men, the lesions are often present on the penis
or in the anal region. In most cases genital warts do not cause any symptoms,
but they are sometimes associated with itching, burning, or tenderness.
While HPV infection has long been known to be associated
with cervical cancer and other cancer of the genitals and anus (anogenital) in women, it has also
been linked with both anal and penile cancer in men. In patients who are
simultaneously infected with HIV, the HPV infection is more severe and the
associated cancers are even more frequent.
HPV infection is common and does not usually lead to the
development of warts, cancers, or specific symptoms. In fact, the majority of
people infected with HPV have no symptoms or lesions. Determination of whether
or not a person is infected with HPV involves tests that identify the genetic
material (DNA) of the virus. Furthermore, it has not been definitively
established whether the immune system is able to permanently clear the body of an HPV infection. For
this reason, it is impossible to predict exactly how common HPV infection is in
the general population, but it is believed at least 75% of the reproductive-age
population has been infected with sexually-transmitted HPV at some point in
their life. Asymptomatic (those without HPV-induced warts or lesions) people who
have HPV infections are still able to spread the infections to others through
sexual contact.
How is HPV treated?
Treatment of external anogenital warts
There is no cure or treatment that can eradicate HPV
infection, so the only currently possible treatment is to remove the lesions
caused by the virus. Unfortunately, even removal of the warts does not
necessarily prevent the spread of the virus, and genital warts frequently recur.
None of the available treatment options is ideal or clearly superior to others.
A treatment that can be administered by the patient is a
0.5% solution or gel of podofilox. The medication is applied to the warts twice
per day for 3 days followed by 4 days without treatment. Treatment should be
continued up to 4 weeks or until the lesions are gone. Alternatively, a 5% cream
of imiquimod (a substance that stimulates the body's production of cytokines, chemicals that
direct and strengthen the immune response) is likewise applied by the patient
three times a week at bedtime, and then washed off with mild soap and water 6-10
hours later. The applications are repeated for up to 16 weeks or until the
lesions are gone.
Only an experienced clinician can perform some of the
treatments for genital warts. These include, for example, placing a small amount
of a 10%-25% solution of podophyllin resin on the lesions, and then, after 1 to 4
hours, washing off the podophyllin. The treatments are repeated weekly until the
genital warts are gone. An 80%-90% solution of trichloroacetic acid (TCA) or
bichloracetic acid (BCA) can also be applied weekly by a physician to the
lesions. Injection of 5-flurouracil epinephrine gel into the lesions has also been shown to be
effective in treating genital warts.
Interferon alpha, a substance that stimulates the body's
immune response, has also been used in the treatment of genital warts. Treatment
regimens are injections of interferon into the lesion every other day over a period of 8 to
12 weeks.
Alternative methods include cryotherapy (freezing the genital warts with
liquid nitrogen) every
1 to 2 weeks, surgical removal of the lesions, or laser surgery. Laser surgery and
surgical excision both require a local or general anesthetic, depending upon the extent of the lesions.
What should a person do if exposed to someone with genital warts?
Both people with HPV infection and their partners need
to be counseled about the risk of spreading HPV and the appearance of the
lesions. They should understand that the absence of lesions does not exclude the
possibility of transmission, and that condoms are not completely effective in
preventing the spread of the infection. It is important to note that it is not
known whether treatment decreases infectivity. Finally, female partners of men
with genital warts should be reminded of the importance of regular PAP smears to
screen for cervical cancer and precancerous changes in the cervix (since precancerous
changes can be treated, reducing a woman's risk of developing cervical cancer).
Similarly, men should be informed of the potential risk of anal cancers,
although it is not yet been determined how to optimally screen for or manage
early anal cancer.
The HPV vaccine
A vaccine is available against four
common HPV types associated with the development of genital warts and cervical
and anogenital carcinomas. This vaccine (Gardasil) has received FDA approval for use in
males and females between 9 and 26 years of age and confers immunity against HPV
types 6, 11, 16 and 18. Another vaccine directed at HPV types 16 and 18, known
as Cervarix, has been approved for use in females aged 10 to 15.
Scabies are itch mites that burrow under the skin and produce intense itching that's usually worse at night. Symptoms of scabies are small bumps and blisters on the wrists, knees, between the fingers, on the back of the elbows, in the groin and on the buttocks. Treatment involves applying a mite-killing cream, antihistamines for itch relief, washing bedclothes and linens.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Genital herpes, a viral infection by the herpes simplex virus (HSV), is transmitted during sexual contact with the mucous-covered linings of the mouth, vagina, or the genital skin. A typical outbreak begins with an itching or tingling sensation followed by redness of the skin and blister formation. The blisters and ulcers that form when the blisters break are painful to the touch, and last from 7 days to 2 weeks. Though there is no cure for herpes, there are ways to treat outbreaks.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Prostatitis is a painful condition of the prostate gland. There are four types of prostatitis, acute bacterial, chronic bacterial, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Diagnosis is made with a digital rectal exam, urinalysis, ultrasound, MRI, biopsy, or blood test. Treatment depends upon the type of prostatitis.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Blood in semen is also known as hematospermia. Blood in semen can be caused by many conditions affecting the tubes that distribute semen from the testicles (seminal vesicles) or the prostate gland. Symptoms that may accompany blood in semen include blood in the urine, fever, painful urination, pain with ejaculation, tenderness, and swelling in the testes or groin area. Urinalysis, ultrasound, and MRI may be used to diagnose blood in the semen. Treatment depends upon the underlying cause of blood in the semen.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Anal cancer, cancer located at the end of the large intestine, has symptoms that include anal or rectal bleeding, anal pain or pressure, anal discharge or itching, a change in bowel movements, and/or a lump in the anal region. Treatment for anal cancer may involve radiation, chemotherapy, or surgery and depends upon the stage of the cancer, its location, whether cancer is eradicated after the first treatment, and whether the patient has HIV.
Pubic lice (crabs) are parasitic insects found in the genital area, and are primarily spread through sexual contact. Symptoms of crabs include itching and visible nits (lice eggs) and crawling lice. Treatment includes using lice-killing shampoo and washing bedding and clothing in hot water.
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Medication is the only treatment for trichomoniasis.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
The HPV virus (genital warts) in men can cause health problems. Genital warts are confined primarily to the moist skin of the genitals or around the anus. Genital warts are caused by the human papillomaviruses (HPVs), which are transmitted through sexual contact.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
A urethral stricture, or narrowing of the urethra, may cause decreased urine output. Symptoms include painful urination, urinary retention, and pelvic pain. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing.
AIDS is the advanced stage of HIV infection. Symptoms and signs of AIDS include pneumonia due to Pneumocystis jiroveci, tuberculosis, toxoplasmosis, seizures, weakness, meningitis, yeast infection of the esophagus, and Kaposi's sarcoma. Anti-retroviral therapy (HAART) is used in the treatment of AIDS.
Drug resistance (antimicrobial resistance) is the ability of bacteria, fungi, parasites, and viruses to grow, even in the presence of a drug that would normally kill it (or limit it's growth). Drug resistance is a growing problem, particularly for infections such as MRSA, VRE (vancomycin-resistant enterococci), tuberculosis, HIV, STDs, gonorrhea, flu, pneumonia, malaria, E. coli, salmonella, Campylobacter, which causes diarrhea and gastroenteritis. Learn how to protect yourself from resistance to drugs.
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