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  1. 1. Human Papilloma Virus HPV
  2. 2. Clinical Warts <ul><li>Cauliflower-like lesions </li></ul><ul><li>White or flesh-colored </li></ul><ul><li>May cause itching/burning </li></ul><ul><li>May have no symptoms </li></ul>
  3. 3. Sub-clinical Warts <ul><li>Flat </li></ul><ul><li>Virtually invisible </li></ul><ul><li>May cause itching/burning </li></ul><ul><li>May have no symptoms </li></ul><ul><li>Identify with vinegar and 4-10X magnification </li></ul>
  4. 4. Transmission <ul><li>Skin to skin contact </li></ul><ul><li>Condoms offer little protection </li></ul><ul><li>Don't treat partners unless symptomatic </li></ul>
  5. 5. Relationship to Cancer <ul><li>Appears to be a pre-requisite to cervical cancer </li></ul><ul><li>Vast majority of those with HPV do not develop cancer </li></ul><ul><li>Smoking, immune response are co-factors </li></ul>
  6. 6. Treatment of Warts <ul><li>All treatment involves destroying the patients skin which has grown in a strange and annoying way. </li></ul><ul><li>You are not eliminating the virus, nor eliminating any chance of re-occurrence. </li></ul><ul><li>Don’t overtreat. </li></ul>
  7. 7. Treatment with Cryosurgery <ul><li>Liquid nitrogen </li></ul><ul><li>Nitrous oxide/CO2 gun </li></ul><ul><li>Use only on wart </li></ul><ul><li>DON’T USE INSIDE THE VAGINA </li></ul><ul><li>Multiple treatments </li></ul>
  8. 8. Treatment with Podophyllin <ul><li>Wash off in 4-6 hours </li></ul><ul><li>Hepatotoxic, nephrotoxic </li></ul><ul><li>Small amounts </li></ul><ul><li>Don't use inside vagina </li></ul><ul><li>MULTIPLE TREATMENTS </li></ul>
  9. 9. Other Treatments <ul><li>Bichloracetic Acid (BCA or TCA) </li></ul><ul><li>Cut them out </li></ul><ul><li>Burn them off </li></ul><ul><li>Electrocute them </li></ul><ul><li>Nothing (50% resolve in 1 year) </li></ul>
  10. 10. Human papillomavirus vaccines www.freelivedoctor.com
  11. 11. <ul><li>The relationship between Human papillomavirus [HPV] and cervical cancer has been confirmed, it is responsible for 99.7% of cervical cancer particularly HPV – 16 and 18 – which are responsible for 70 % of cases. </li></ul><ul><li>More than 80 % of females get HPV infection at some point in their lives. </li></ul><ul><li>Studies suggest that the vaccine can be 100 % effective in blocking two virus strains HPV – 16 and 18 – and subsequently can prevent up to 70% of cervical cancers, That is to say it can save 7 from 10 women from being affected by cervical cancer. </li></ul>www.freelivedoctor.com Why we need HPV vaccines ?
  12. 12. How does the vaccine work ? The vaccine is a Virus–like particles [ VLPs ], it has the outer capsid of HPV and looks morphologically similar to The virus, it is highly immunogenic and can generate neutralizing antibodies that can prevent infection in subsequent exposure. In addition, they are not infectious by themselves as they don’t have the oncogenic viral DNA core. Diagrammatic representation of (HPV) virion and an HPV -VLP demonstrating structural similarity without the oncogenic viral DNA core Electron micrograph of HPV16 L1 VLPs. www.freelivedoctor.com
  13. 13. Types : <ul><li>There are two new vaccines against HPV : </li></ul><ul><li>Quadrivalent vaccine [Gardasil] : licensed by the FDA and European Union, it provides protection against 4 types: 6, 11, 16 and 18. </li></ul><ul><li>Bivalent vaccine [Cervarix]: protects against type 16 & 18. </li></ul><ul><li>Cross protection against other HPV types is possible . </li></ul>www.freelivedoctor.com
  14. 14. The decision that will saves women's lives : <ul><li>The English Government has announced that from September 2008, all girls aged 12 or 13 in England will be routinely offered the HPV vaccine.   </li></ul><ul><li>They also announced a 2 year 'catch up' programme, starting in Autumn 2009, to vaccinate girls under the age of 18. </li></ul>www.freelivedoctor.com
  15. 15. www.freelivedoctor.com Schedule : : Vaccination will be most effective if introduced prior to onset of sexual activity; therefore, the target will be girls of 12&13 years old. The vaccine is given by injection into the muscle of the upper arm or upper thigh in three doses over six months. Minor side-effects like soreness at the injection site and fever can occur. Rarely it can cause joint pain and urticaria and very rarely bronchospasm. The protection offered by the vaccines lasts at least five years but is probably life long. At the moment boosters are not thought to be needed.
  16. 16. www.freelivedoctor.com Will the HPV vaccine replace cervical screening programme ? The vaccine protects against 70 per cent of cervical cancers that is caused by HPV-16 &18 and still there is chance of developing the cancer due to other HPV strains like 31,33,35,39,45,51,56,58,59,68,73 and 82. Therefore, for the moment, adult females should continue to rely on Pap smear tests and it seems probable that this will be so for at least the next 20 years because the majority of women already have HPV infection before the vaccines are induced.
  17. 17. www.freelivedoctor.com Developing countries: In many developing countries which lack organized screening programmes, cervical cancer is the leading cause of female cancer deaths. Such countries would benefit enormously from an effective HPV vaccine. The draw back of the vaccine is that it is expensive, 3 doses are needed and it is administered by injection. Therefore, a second generation HPV vaccines are required that can be produced more cheaply and to be administered as a single dose.
  18. 18. www.freelivedoctor.com Conclusion: Its really looks like that the use of HPV vaccines is the beginning of the end for HPV-associated diseases in women. Vaccines by themselves are safe and effective, however, the real benefit of a vaccination programme will take 10-20 years to be realized.