Do you have HPV?  We just heard about a new online support group.  Share your dilemmas, your feelings and experiences at:  mdjunction.com/hpv.

Human papillomavirus (HPV) is the most common newly acquired sexually transmitted infection (STI) in the United States.  Furthermore, the incidence of HPV infection has increased during the past two decades, with approximately 6.2 million newly diagnosed cases annually.  HPV infection has a very high prevalence rate in sexually active adolescent girls and young women. One study showed that 36% of women 25 years of age or younger are HPV-positive. Although HPV can cause genital warts, cervix dysplasia (a precursor to cervical cancer) and cervical cancer, most HPV infections do not cause symptoms.

Transmission typically occurs at the time of sexual intercourse.  Increased risk for contracting HPV has been associated with multiple sex partners, younger age of sexual debut and failure to use condoms.  One study reported that 20% of women became infected with only one lifetime sex partner, suggesting that both partners must be sexually naïve to prevent infection.  The risk of infection increases substantially when initiating a new sexual relationship. The transmission of HPV infection can be blocked by latex condoms if the infected area is physically covered.  However, HPV lesions often occur on external genital sites not covered by a condom, and so the latter does not prevent all infections.

The currently available HPV vaccine is effective in preventing infection with HPV types 16 and 18, the types that cause abnormal Pap smears and are related to cervical dysplasia and 70% of cervical cancer.  The vaccine also prevents infection due to types 6 and 11, the types responsible for 90% of genital warts.  Since other HPV types are not covered by the vaccine you should continue to have regular Pap smears. 

Girls and women aged 9 to 26 years old are candidates for the vaccine.  The vaccine is administered in three separate doses with an initial dose followed by additional doses at 2 months and again at 6 months.

Women with a history of an abnormal Pap smear are still candidates for the vaccine.  Most abnormal Pap smears are due to infection with a single type of HPV.  Since the vaccine covers 4 different types of HPV (types 6, 11, 16, and 18) it will offer protection against the types of HPV not causing the prior abnormal Pap smear.

by:  David Soper, M.D.

Request an appointment with a MUSC provider.

Beginning February 23rd, MUSC Women’s Health will offer a specialty clinic for sexually transmitted infections (STI’s). The goal of the clinic is to offer screening, treatment, and counseling regarding STI’s.  We welcome women to bring their partners.

In celebration of these new services, Women Speak will be introducing a blog series about sexually transmitted infections.  Each installment will discuss a common STI, symptoms, diagnosis, treatment, pregnancy complications, long-term consequences, and prevention.  In this inaugural installment of the “The Lowdown on STD’s,” I will discuss Trichomonas.

Trichomonas vaginalis is the second most common STI in the United States with 3-4 million cases diagnosed each year.  Unfortunately, women of color are disproportionately represented.  The rates of Trichomonas in African American women seeking STI screening have been recorded as high as 13%.  In comparison to other STI’s, which are more common among adolescents, Trichomonas is frequently diagnosed in older women. 

Trichomonas is unique among sexually transmitted infections because it is not a virus or bacteria.  T. vaginalis is a single-celled protozoa that swims using a flagellated tail.  It is large enough to be seen using a low-power microscope.  (See picture)
 
In women, Trichomonas is a common cause of vaginal discharge and vulvar symptoms.  Men infected with Trichomonas most commonly have painful urination. Like other sexually transmitted infections, Trichomonas enters a woman’s body during sexual contact with an infected partner. It can live in both the vagina and around the opening of the bladder or urethra. 

Not all women who are infected by Trichomonas have symptoms.  For those that do, the most common is a foul-smelling vaginal discharge.  Other symptoms include: painful urination, vaginal and vulvar itching, and spotting after intercourse or between periods. If you are concerned about infection or have any of these symptoms, you should consult your physician.

Trichomonas can be diagnosed by your doctor.  A pelvic exam is required in which specimens are collected for microscopic examination or culture.  Most results are available in 1-5 days. It is treated with antibiotics, which should be taken by both partners.  Patients cannot drink alcohol within 48 hours of taking these medications.  If your partner is unable to receive treatment, it is necessary to use condoms to avoid re-infection.

During pregnancy, infection with Trichomonas has been associated with preterm labor and low birth weight.  Treatment of symptomatic women during pregnancy is recommended.  Untreated infection can lead to long-term consequences.  Women infected with Trichomonas are at an increased risk of acquiring HIV, the virus that causes AIDS.  Trichomonas can also increase the risk of infection with other common STI’s.  If Trichomonas is present during or shortly after gynecologic surgery, women can develop abscesses that require a longer period of therapy.  Screening and treatment are imperative to avoid these complications.

Trichomonas infection can be avoided by consistent use of condoms.  Latex condoms are the only form of birth control that prevents STI’s.  If you have any questions regarding Trichomonas or STI’s, please feel free to send questions via the comment function or attend our specialty clinics at MUSC Women’s Health.

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.