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Wednesday, April 18, 2012

Human Papilloma Virus - HPV ở người

Human Papilloma Virus (HPV)
May 29th, 2011
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Definition:
HPV, short for Human Papillomavirus, is a group of over 100 different kinds of viruses, some of which cause warts on the hands and feet and others which cause genital warts and cervical cancer. This health guide is about the sexually transmitted types of HPV. If you are sexually active, or thinking about becoming sexually active, your best protection is to learn the facts about how HPV is spread and how to prevent getting it.

HPV (Human Papillomavirus) is one of the most common sexually transmitted diseases. There are many different types of HPV and more than 30 are sexually transmitted. Researchers keep track of the different types of HPV by identifying them with numbers, such as 6, 11, 16, and 18.

Some sexually transmitted HPV types may cause genital warts. Persistent infection with “high-risk” HPV types—different from the ones that cause skin warts—may progress to precancerous lesions and invasive cancer. HPV infection is a cause of nearly all cases of cervical cancer. However, most infections with these types do not cause disease.

Some types (such as 6 and 11) cause genital warts, others (such as 16 and 18) cause pre-cancerous changes on the cervix that can later lead to cancer of the cervix. In rare cases, the virus can cause other types of cancers to the vulva, vagina, and anus in girls and the anus and penis in guys.

HPV is passed on through genital contact, usually during vaginal and anal sex, as well as during oral sex. People with weakened immune systems, such as those on chemotherapy or people with HIV are more susceptible to HPV infection.

At least 1 in every 2 sexually active young women has had a genital HPV infection. Any sexually active person—no matter what color, race, gender, or sexual orientation—can get HPV. HPV is mainly spread by sexual contact. Very rarely, a mother who is infected with the HPV virus can infect her newborn baby during the delivery.

Symptoms:
It’s estimated that by the age of 27, most sexually active people have been exposed to some strain of HPV, usually without them knowing, and very rarely do doctors know which strain.

Most people with HPV don’t develop symptoms or further health problems, as in around 90 per cent of cases the body’s immune system has naturally cleared it within two years.

However, certain types of HPV (most commonly strains 6, 11, 16 and 18) can cause genital warts in men and women, while other HPV strains (especially 16, 18 and 39) can cause cellular changes that lead to cancer of the cervix and possibly other less common but serious cancers including:

….………..

•vulval cancer
•cancer of the vagina
•cancer of the penis
•anal cancer
•head and neck (tongue, tonsils and throat) cancers
It’s possible to have HPV present years after sexual contact with an infected person, and it’s also possible to be exposed to more than one strain of HPV.

There is currently no easy way to spot which people affected by HPV exposure will go on to develop cancer or other serious health problems.

Very rarely, a pregnant woman can pass HPV to her baby during birth and the child can develop recurrent respiratory papillomatosis – a chronic lung condition where growths block the airways.

Causes:
*The infected area of your body remains totally normal (called latent or inactive infection). You may never know about it, but you may give the infection to others. Your body then usually clears the infection.

*Bumps, called genital warts, can be seen in your genital area. They almost never lead to cancer.

*Changes in the cells of your cervix can result in an abnormal Pap test. Most of the time, if you are a teenager, your body will clear the HPV and the Pap test will become normal again over several years. However, sometimes the HPV infection persists in your cervix which can lead to cervical cancer. This is why your doctor will want to see you for follow-up visits if you have had an abnormal Pap test.

Risk Factors:
*You had sexual contact at an early age.

*Either you or your sexual partners have had many different sexual partners at any time.

*You or any of your sexual partners have had a history of sexually transmitted diseases.

*Any of your sexual partners did not wear a condom.

HPV and cancer risks:
We don’t fully understand the way in which HPV affects cells. Both high-risk and low-risk strains of HPV can cause the growth of abnormal cells, but only the high-risk types of HPV appear to lead to cancer.

Several types of cancer (up to five per cent worldwide), while linked to other risk factors, are now also associated with HPV exposure:

•cervical cancer (the most common HPV-associated cancer)
•vulval and vaginal cancer (40 to 70 per cent linked to HPV)
•penile cancer (possibly 40 per cent linked)
•anal cancer (around 85 per cent linked)
•cancers of the head and neck (although most are linked to tobacco and alcohol use, it’s now thought about 25 per cent of mouth and 35 per cent of throat cancers may be linked to HPV exposure (in particular HPV strain 16)

Diagnosis:
Sometimes it’s hard to know if you have HPV. Although genital warts are usually seen on, around, or inside your vagina or anus, they may be small and hard to see. And you may not have any symptoms such as pain or bleeding.

In March 2003, the U.S. Food and Drug Administration (FDA) approved a test manufactured by Qiagen, which is a “hybrid-capture” test, as the primary screening tool for detecting HPV cervical infection as an adjunct to Pap testing. The test may be performed during a routine Pap smear. It can detect the DNA of the 18 HPV types that most commonly affect the cervix and distinguish between “low” and “high-risk” HPV types, but it cannot determine the specific HPV types.

According to the National Cancer Institute, “testing samples of cervical cells is an effective way to identify high-risk types of HPV that may be present. The FDA has approved an HPV test as a follow-up for women who have an ambiguous Pap test and, for women over the age of 30, for general cervical cancer screening. This HPV test can identify at least 13 of the high-risk types of HPV associated with the development of cervical cancer. The test can detect high-risk types of HPV even before there are any conclusive visible changes to the cervical cells.”

The recent outcomes in the identification of molecular pathways involved in cervical cancer provide helpful information about novel bio- or oncogenic markers that allow monitoring of these essential molecular events in cytological smears, histological or cytological specimens. These bio- or onco- markers are likely to improve the detection of lesions that have a high risk of progression in both primary screening and triage settings. E6 and E7 mRNA detection PreTect HPV-Proofer, (HPV OncoTect) or p16 cell-cycle protein levels are examples of these new molecular markers. According to published results these markers, which are highly sensitive and specific, allow to identify cells going through malignant transformation.

Other testing:
Although it is possible to test for HPV DNA in other kinds of infections, there are no FDA-approved tests for general screening in the United States or tests approved by the Canadian government, since the testing is inconclusive and considered medically unnecessary.

Genital warts are the only visible sign of low-risk genital HPV, and can be identified with a visual check. These visible growths, however, are the result of non-carcinogenic HPV types. 5% acetic acid (vinegar) is used to identify both warts and squamous intraepithelial neoplasia (SIL) lesions with limited success by causing abnormal tissue to appear white, but most doctors have found this technique helpful only in moist areas, such as the female genital tract. At this time, HPV test for males are only used in research.

Treatment:
There is currently no specific treatment for HPV infection. However, the viral infection, more often than not, clears by itself. According to the Centers for Disease Control and Prevention, the body’s immune system clears HPV naturally within two years for 90% of cases. However, experts do not agree on whether the virus is completely eliminated or reduced to undetectable levels, and it is difficult to know when it is contagious.

Health management is based on prevention, by advising condom use and vaccination.

There is treatment for some of the diseases that HPV can cause, including:

•Genital warts, which can be cauterised or treated chemically.
•Abnormal cervical cells, which can be removed by various techniques.

Treatments for genital warts range from acid medicines, to creams, to laser therapy. The treatment will remove visible warts and unwanted symptoms such as itchiness. The type of treatment your doctor recommends will depend on the number, location and size of the warts and the cost and side effects of the different treatments. It’s important to talk with your health care provider about treatment choices and what type of follow-up you will need. Tell your health care provider if you think you are pregnant so that the right therapy is chosen.

Do NOT use over-the-counter “wart medicine” on genital warts. (These medicines are not meant for the very sensitive skin around your genital area).

Prevention:
Condoms offer some protection against genital infection, but any exposed skin can transmit the virus. In short, condoms are not 100% effective in preventing HPV. Genital HPV infection is the most frequent sexually transmitted disease in the world.

Vaccines:
Two vaccines are available to prevent infection by some HPV types: Gardasil, marketed by Merck, and Cervarix, marketed by GlaxoSmithKline. Both protect against initial infection with HPV types 16 and 18, which cause most of the HPV associated cancer cases. Gardasil also protects against HPV types 6 and 11, which cause 90% of genital warts.

The vaccines provide little benefit to women who have already been infected with HPV types 16 and 18—which includes most sexually active females. For this reason the vaccine is recommended primarily for those women who have not yet been exposed to HPV during sex. The World Health Organization position paper on HPV vaccination clearly outlines appropriate, cost-effective strategies for using HPV vaccine in public sector programs.

Both vaccines are delivered in three shots over six months. In most countries they are approved only for female use, but are approved for male use in countries like USA and UK. The vaccine does not have any therapeutic effect on existing HPV infections or cervical lesions.

Women should continue to seek cervical screening, such as Pap smear testing, even after receiving the vaccine. Cervical cancer screening recommendations have not changed for females who receive HPV vaccine. Without continued screening, the number of cervical cancers preventable by vaccination alone is less than the number of cervical cancers prevented by regular screening alone.

Both men and women are carriers of HPV. Possible benefits and efficacy of vaccinating men are being studied. According to a study by Harvard University Medical School, to vaccinate boys may not be cost effective, especially if a widespread vaccination of girls continues.

No efficacy trials for children under 15 have been performed. Duration of vaccine efficacy is not yet answered by rigorous methodologic trials. Cervarix efficacy is proven for 7.4 years with published data through 6.4 years while Gardasil efficacy is proven for 5 years. Age of vaccination is less important than the duration of efficacy.

Condoms:-
The Centers for Disease Control and Prevention says that male “condom use may reduce the risk for genital human papillomavirus (HPV) infection” but provides a lesser degree of protection compared with other sexual transmitted diseases “because HPV also may be transmitted by exposure to areas (e.g., infected skin or mucosal surfaces) that are not covered or protected by the condom.”

Studies have suggested that regular condom use can effectively limit the ongoing persistence and spread of HPV to additional genital sites in individuals who are already infected. Thus, condom use reduces the risk that already infected individuals will progress to cervical cancer or develop genital warts.

Microbicides:-
Ongoing research has suggested that several inexpensive chemicals might serve to block HPV transmission if applied to the genitals prior to sexual contact. These candidate agents, known as topical microbicides, are currently undergoing clinical efficacy testing. A recent study indicates that some sexual lubricant brands that use a gelling agent called carrageenan prevent papillomavirus infection in animal model systems. Clinical trial results announced at the 2010 International Papillomavirus Conference indicate that a carrageenan-based personal lubricant called Carraguard is effective for preventing HPV infection in women. The results suggest that use of carrageenan-based personal lubricant products, such as Divine No 9, Bioglide and Oceanus Carrageenan may likewise be effective for preventing HPV infection.

Oral infection:
A review of scientific studies in healthy subjects has found carcinogenic HPV in 3.5% of the studies subjects and HPV16 in 1.3%. Men have higher prevalence of oral HPV than women.

Oral HPV infection is associated with HPV-positive oropharyngeal cancer. Odds of oral HPV infection increases with the number of recent oral sex partners or open-mouthed kissing partners. Nonsexual oral infection through salivary or cross transmission is also plausible

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose


Genital HPV Infection
What is genital HPV infection?
Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.
HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.
What are the signs, symptoms and potential health problems of HPV?
Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years. But, sometimes, HPV infections are not cleared and can cause:
Genital warts
Rarely, warts in the throat -- a condition called recurrent respiratory papillomatosis, or RRP. When this occurs in children it is called juvenile-onset RRP (JORRP).
Cervical cancer and other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils).
The types of HPV that can cause genital warts are not the same as the types that can cause cancers. There is no way to know which people who get HPV will go on to develop cancer or other health problems.
Signs and symptoms of HPV-related problems:
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.
Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.
Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils). For signs and symptoms of these cancers, see www.cancer.govExternal Web Site Icon.
RRP is a condition in which warts grow in the throat. These growths can sometimes block the airway, causing a hoarse voice or troubled breathing.
How do people get HPV?
HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.
A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.
Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP).
How does HPV cause genital warts and cancer?
HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.
How common are HPV and related diseases?
HPV (the virus). Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.
Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time.
Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated.
Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:
1,500 women who get HPV-associated vulvar cancer
500 women who get HPV-associated vaginal cancer
400 men who get HPV-associated penile cancer
2,700 women and 1,500 men who get HPV-associated anal cancer
1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.]
Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).
RRP is very rare. It is estimated that less than 2,000 children get juvenile-onset RRP every year in the U.S.
How can people prevent HPV?
There are several ways that people can lower their chances of getting HPV:
Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age.
Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Gardasil has also been shown to protect against anal, vaginal and vulvar cancers. Either vaccine is recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls beginning at 9 years of age. It is recommended to get the same vaccine brand for all three doses, whenever possible.
Boys and men: One available vaccine (Gardasil) protects males against most genital warts and anal cancers. This vaccine is available for boys and men, 9 through 26 years of age.
For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.
How can people prevent HPV-related diseases?
There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer.
Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above).
Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine protects against most, but not all, cervical cancers.
Preventing Anal Cancers: A vaccine (Gardasil) is available to protect against most anal cancers in males and females. Screening for anal cancer is not routinely recommended because more information is still needed to find out if screening and follow-up interventions prevent these cancers. However, some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men and in HIV-positive persons. This is because anal cancer is more common in those populations.
Preventing Penile Cancers: There is no approved screening test to find early signs of penile cancer.
Preventing Oropharyngeal Cancers: There is no approved test to find early signs of oropharyngeal cancer[see www.cancer.orgExternal Web Site Icon]
Preventing RRP: Cesarean delivery is not recommended for women with genital warts to prevent juvenile-onset RRP (JORRP) in their babies. This is because it is not clear that cesarean delivery prevents JORRP in infants and children.
Is there a test for HPV?
The HPV tests on the market are only used to help screen women at certain ages and with certain Pap test findings, for cervical cancer. There is no general test for men or women to check one’s overall "HPV status," nor is there an approved HPV test to find HPV on the genitals or in the mouth or throat.
Is there a treatment for HPV or related diseases?
There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause:
Visible genital warts can be removed by the patient him or herself with prescribed medications. They can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.
Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. [see www.cancer.orgExternal Web Site Icon]
Other HPV-related cancers are also more treatable when diagnosed and treated early. [see www.cancer.orgExternal Web Site Icon]
RRP can be treated with surgery or medicines. It can sometimes take many treatments or surgeries over a period of years.






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