Sexual Health

HPV

Over the last 20 years OIC has developed specialized preventative medical care tailored to our patient’s needs. It ensures you receive state of the art screening and treatments. While Human Papilloma Virus (HPV) is common in sexually active adults, screening is not. HPV can lead to cancer if untreated. Early detection and treatment can reduce this risk so we screen everyone at risk as a preventative measure.

Preventative HPV Medical Care

Anal dysplasia is most commonly linked to HPV which is considered the most common sexually-transmitted infection. Roughly 80% of people who have had one or two lifetime sex partners and 100% of people who have had five lifetime sex partners have had HPV infection. Thus, HPV is extremely prevalent, particularly in young, sexually active populations. This original infection may resolve itself or may persist for life.
Anal dysplasia is an abnormal condition which occurs when the mucosal lining of the anal canal undergoes abnormal changes. During this condition, lesions or visible pattern of clustered abnormal cells appear. These cells may then progress from low-grade lesions to high-grade lesions.

Symptoms may include genital and or anal warts in and around the anus. In some patient’s abnormalities in the lining of that anal region can occur without the presence of warts and any other symptoms.

Anal cancer, like cervical cancer, is a member of a broader group of anogenital cancers known to be associated with sexually transmitted viral HPV infection. Anal cancer is rare in the general population but it is significantly more common in the HIV infected population.

Unfortunately, the risk for anal cancer is reported to be increasing dramatically in HIV-positive males and females, despite the introduction of highly active antiretroviral therapy in the mid-1990s. This may be because people are living longer and some may continue to get newly exposed to other HPV viral strains.

Anal Dysplasia Screening

An anal Pap smear is a very simple procedure performed by your medical provider as part of a routine physical evaluation. The purpose of the Anal Pap smear is to screen for abnormal cells and if detected, refer for HRA for further evaluation. It is recommended that HIV positive patients, patients with history of genital or anal warts, previous anal dysplasia, and women with abnormal cervical Pap smears or solid organ transplant recipients have this procedure done once a year.

The procedure takes only 30 seconds. Your provider will insert a moist Q-tip into your anus and remove it slowly in a circular motion. The procedure is essentially painless, and rarely associated with minor discomfort. It does not require special bowel cleansing. The sample is then sent to the laboratory where it is read by a pathologist. Results are available in approximately three weeks. Your provider will discuss your results with you.

Anal Dysplasia Treatment

Anal Dysplasia can be treated successfully with very close follow up and monitoring. Individuals with low-grade lesions will generally have repeat HRA in 6 to 12 months. Individuals with high-grade lesions will have repeat HRA every 3-6 months. This will continue until there is no further evidence of high- grade dysplasia.

Human Papilloma Virus (HPV)

HPV is a virus transmitted through contact with the skin and mucosal membranes found in the mouth, throat, vagina, cervix, anus and penis. There are over 100 HPV strains that can affect the human body. The vast majority of these viruses affect the skin and cause benign warts. About 40 HPV types are sexually transmitted and about 16 of those strains cause lesions that can progress to dysplasia and cancer. A person can be infected with multiple HPV strains simultaneously.

HPVs can be classified into high-risk and low-risk groups according to the likelihood that an infection by the HPV type can lead to a cancer. Most sexually active people will be infected with at least one type of HPV at some point in their lives. Having just one sex or oral sex partner can expose you to HPV. Although the immune system generally clears an HPV infection within several months to a few years, some infected people may not resolve the infection. The virus can remain in the skin layer and gradually alter cells so that they become abnormal and cancerous usually after a period of years or decades after the initial infection.

Men and women infected with HPV can unknowingly spread the virus as the infection may present no symptoms and infected individuals may not realize that they carry it. Though a condom may help reduce transmission, HPV is spread via skin-to-skin contact through the moist layer of skin and can therefore be passed onto a partner even when a condom is used. Nevertheless, safe sex practices including the use of condoms should still be utilized as a method to reduce the likelihood of transmission.

Genital and Anal Warts

High Resolution Anoscopy, or HRA, is a procedure that allows for examination and evaluation of the anal canal.
Using a small thin round tube called an anoscope, the anal canal is examined with a high-resolution magnifying instrument called a colposcope.

Anogenital Warts

Anogenital warts are small, skin-colored or pink growths that form on the vulva (the lips of the vagina), vagina, penis, or anus. They are caused by HPV. Anogenital warts are often called just “genital warts” or “anal warts”.

The types of HPV that cause most forms of genital warts are not usually dangerous. But other types of HPV can lead to cancer of the cervix (a part inside the woman’s body), throat, penis, or anus. Most people with genital warts have no symptoms (other than the warts). But some people have itching, burning, or tenderness.

FAQs

Is there a test for genital warts?

How are genital warts treated?

There are several medicines that can help get rid of warts. Some work by slowly destroying the warts. Others work by getting your body’s own infection- fighting system to attack the warts.

Other treatments to remove warts include:
Cryotherapy, which uses a chemical to freeze warts
Electrocautery, which uses electricity to burn away warts
Traditional surgery, which involves cutting away warts
Laser surgery, which uses light to destroy warts

Can genital warts be prevented?

What is an HRA?

What happens during an HRA?

First, a physician will perform a digital rectal exam. During a digital rectal exam, the physician will put on a glove and insert a lubricated finger into the anal canal. Then, a lubricated anoscope is placed in the anal canal. Application of a mild acidic liquid onto the anal canal facilitates evaluation of abnormal tissue such as anal dysplasia and internal warts. If indicated, a biopsy will be obtained and sent for analysis.
The procedure is performed in the office and generally lasts about 25 minutes. It is usually very well tolerated with mild if any discomfort. Significant risks such as bleeding or infection are extremely rare. It should be noted that HRA is very different from colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA. No bowel prep is needed for this examination but appropriate external hygiene is suggested.

Who needs an HRA?

The procedure is used in the treatment and surveillance of anal dysplasia and the prevention of anal cancer. It is performed on patients with an abnormal anal cytology or anal Pap test. Anal Pap tests are obtained on individuals who are at risk for genital or anal HPV (Human Papilloma Virus) infections, even in the absence of signs or symptoms of infection.

-SYPHILIS: is a common STI caused by a microscopic cork-screw shaped organism that at the site of entry leaves a sore called a chancre. It is painless and self resolves. If left untreated, the disease progresses to various stages. Secondary syphilis can present 4-8 weeks after untreated initial infection. A rash can appear on the hands and feet and the body. If left untreated it can progress to tertiary syphilis which can produce disfiguring lesions and referred to as gummatous syphilis. It can also produce end stage organ failure as well as psychiatric issues. It is commonly treated with Penicillin, the doses determined by the length of infection.

-CHLAMYDIA: Is the most common STI. Many times, it presents without any symptoms. When it does, it can present with a clear cloudy discharge from the penis, vagina, anus or throat. In females, untreated, can lead to Ectopic pregnancy, infertility and Pelvic Inflammatory Disease. In males, prostatitis, arthritis and epididymitis. It is easily treated with a course of antibiotics.

-GONORRHEA: Has become a problem due to its capability of mutating, making many medications that previously treated it ineffective. In pregnancy, left untreated, it can cause blindness in newborns. Untreated, it can cause infertility. Its symptoms include a white/yellow creamy discharge from the penis, vagina, anus or throat. If untreated it can spread causing heart, skin and joint problems. It is currently treated with ceftriaxone injection, however due to resistance, doses have been recently increased.

-IMMUNIZATIONS:

Getting vaccinated can help keep you from getting sick with certain infections. Plus, being vaccinated helps protect the people around you from getting sick. Your doctor or nurse will recommend a vaccine schedule that is right for you. Most vaccines take a couple of weeks to work.

Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually administered through needle injections, but can also be administered by mouth or sprayed into the nose.

Vaccination: The act of introducing a vaccine into the body to produce immunity to a specific disease.

Immunization: A process by which a person becomes protected against a disease through vaccination. This term is often used interchangeably with vaccination or inoculation.

Why should I get vaccinated?

Which vaccines should adults get?

Your doctor or nurse will tell you which vaccines you should get.

There are some vaccines that all adults should get, even if they got their childhood vaccines. These vaccines protect against the following infections:

Influenza (flu) – The flu can cause fever, chills, muscle aches, cough, and sore throat. It can even cause a lung infection.

Diphtheria and tetanus – Vaccines against these 2 diseases are usually together in 1 shot. Diphtheria can cause a thick covering in the back of the throat that can lead to breathing problems. Tetanus causes the muscles to work abnormally.

Pertussis – This infection is also known as “whooping cough” and can cause a severe breathing illness in babies. It can also make older children and adults sick. Vaccinating adults helps prevent babies around them from getting the infection. The pertussis vaccine comes in the same shot as the diphtheria and tetanus vaccines.

Some adults will need other vaccines, depending on their age, medical conditions, jobs, travel plans, and other factors. These can include vaccines to protect against:

Pneumococcus – Pneumococcus is a germ that can cause an infection of the lungs (pneumonia), ears, blood, or tissues around the brain.

Meningococcus – Meningococcus is a germ that can cause an infection of the blood or tissues around the brain.

Human papillomavirus (HPV) – HPV infection can lead to cancer of the cervix (in women) and anal cancer (in men). It can also cause genital warts in men and women. Young adults, especially women, should get this vaccine. Hepatitis A and Hepatitis B
Other infections such as measles, and chickenpox.

How many vaccine doses do I need?

Each vaccine is different. Some vaccines work after just 1 dose. Others need 2 or more doses to prevent an infection. Some vaccines prevent an infection for the rest of your life. Others do not. A “booster” is a vaccine dose given after a certain number of years. It reminds the body how to prevent an infection. People who got childhood vaccines sometimes need booster doses in adulthood. People who travel to other countries also sometimes need booster doses of certain vaccines.

When should I be vaccinated?

Different vaccines are given at different ages. Your doctor or nurse will recommend a vaccine schedule that is right for you. Most vaccines take a couple of weeks to work.

ROUTINE STD SCREENING:

Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are generally acquired by sexual contact. STIs are caused by bacteria, viruses and parasites. Many of these infections can be transmitted through any type of sex. That includes not just intercourse, but also oral sex and other types of sex play.

The most common STIs include:
Chlamydia
Gonorrhea
Genital herpes, also called “herpes simplex virus” or “HSV”
Genital warts, also called “human papillomavirus” or “HPV”
Some types of HPV can cause cervical cancer in women
Hepatitis A, B, and C
Syphilis
Trichomoniasis
Human immunodeficiency virus, also called “HIV” – This is the virus that causes AIDS.

What are the symptoms of STIs?

Sexually transmitted infections (STIs) have a range of signs and symptoms. That’s why they may go unnoticed until complications occur or a partner is diagnosed. Signs and symptoms that might indicate an STI include:
Sores or bumps on the genitals or in the oral or rectal area Painful or burning urination
Discharge from the penis
Unusual or odd-smelling vaginal discharge
Unusual vaginal bleeding
Pain during sex
Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread
Lower abdominal pain
Rash over the trunk, hands or feet
Signs and symptoms may appear a few days to years after exposure, depending on the organism.

What are the risk factors of STDs?

How are STIs diagnosed?

How are STIs treated?

Sexually transmitted infections (STIs) that are caused by bacteria are easier to treat than viral infections. Depending on the infection, STIs can be treated with antibiotics or antiviral drugs, creams. If tests show that you have an STI, your sex partners — including your current partners and any other partners you’ve had over the last three months to one year — need to be informed so that they can get tested and treated if infected.

How are STDs prevented?