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 HPV, which are the cause of
genital warts (also known as condylomata acuminata or venereal warts), can infect the genital tract of men and women. These warts
are primarily transmitted during sexual contact. Other, different HPV types
generally cause common warts elsewhere on the body. HPV infection has long been
known to be a cause of cervical
cancer and other anogenital cancers in women, and it has also been linked
with both anal and penile cancer in men.
HPV infection is now considered to be the most common sexually transmitted
infection in the US, and it is believed that at least 75% of the
reproductive-age population has been infected with sexually transmitted HPV at
some point in life.
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 at all. The ultimate test to detect HPV
involves identification of the genetic material (DNA) of the virus.
Of note, 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.
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.
Diagnosis of HPV and genital warts
A typical appearance of a genital lesion may prompt the physician to treat
without further testing, especially in someone who has had prior outbreaks of
genital warts. Genital warts usually appear as small, fleshy, raised bumps, but
they can sometimes be extensive and have a cauliflower-like appearance. They may
occur on any sexually-exposed area. In many cases genital warts do not cause any
symptoms, but they are sometimes associated with itching, burning, or
tenderness.
HPV can sometimes be suspected by changes that appear on a
Pap smear, although Pap smears were not really designed to detect HPV. In
the case of an abnormal Pap smear, the clinician will often do advanced testing
on the material to determine if, and which kind, of HPV may be present. HPV can
also be detected if a biopsy (for example,
from a genital wart
or from the uterine cervix) is sent to the laboratory for analysis.
How is HPV treated?
Treatment of external genital warts
There is no cure or treatment that can eradicate HPV infection, so the only
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 treatments are ideal or
clearly superior to others.
A treatment that can be administered by the patient is a 0.5% solution or gel
of podofilox (podophyllotoxin). The medication is applied to the warts twice per
day for three days followed by 4 days without treatment. Treatment should be
continued up to three to four weeks or until the lesions are gone. Podofilox may also be
applied every other day for a total of three weeks. 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 physician 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 a period of 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-fluorouracil 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 require 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 one to
two 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.
Treatment of precancerous changes (dysplasia) of the cervix related to HPV
infection
Women who have evidence of moderate to severe precancerous changes in the
uterine cervix require treatment to ensure that these cells do not become
invasive cancer. In this case, treatment usually involves surgical removal or
destruction of the involved tissue.
Conization is a procedure that removes the precancerous area of the cervix
using a knife, a laser, or a procedure known as LEEP (loop
electrosurgical excision procedure, which uses an electric current passing
through a thin wire that acts as a knife). Cryotherapy (freezing) or laser
therapy may be used to destroy tissue areas that contain potentially
precancerous changes.
What should a person do if sexually 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 and reduce 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 best screen for or manage early anal cancer.
The HPV vaccine
A vaccine 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 10-15.
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.
Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge resulting from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
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.
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.
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.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
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.
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.
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.
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.
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.
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.
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.
Group B strep are bacteria called Streptococcus agalactiae that may sometimes cause infections both in a pregnant woman and her newborn. Symptoms include fever, seizures, heart rate abnormalities, breathing problems, and fussiness. Intravenous antibiotics are used to treat group B strep infections.
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.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the U.S. HPV is primarily transmitted by sexual contact. While some people develop warts in the genital region after infection, others experience no symptoms. Though genital warts can be removed, there is no cure for HPV infection. There is a vaccine to prevent infection from four common HPV types.
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. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Gonorrhea is a bacterial infection transmitted during sexual contact. In women, symptoms include a yellow vaginal discharge, burning or frequent urination, and redness, swelling, burning and itching of the vaginal area. Gonorrhea can be treated with injectable (penicillin) or oral medications.
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.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
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 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.
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.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
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.
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.
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.
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