From: jsmith@unixg.ubc.ca (JR Smith)
Newsgroups: sci.med
Subject: Re: Cervical Dysplasia Questions
Date: 25 Jan 93 04:59:39 GMT
Organization: The University of British Columbia
NNTP-Posting-Host: unixg.ubc.ca

In <1993Jan25.031443.28306@cs.rochester.edu> fulk@cs.rochester.edu (Mark Fulk) writes:

>In article <1993Jan22.193603.10478@ac.dal.ca> guruman@ac.dal.ca writes:
>>I have a few questions about cervical dysplasia, any help would be appreciated.

>I went through an experience with this with my SO several years ago;
>take the following cum grano salis.

>>1) Cervical dysplasia is a a)bacteria, b)virus c) a state of cells.

>c) a state of cells.  A pathologist makes the determination based on the
>appearance of cervical epithelial cells under the microscope; the cells
>come in the Pap smear.

>>2) CD is a communicable disease ?
>>
>>3) Venereal Warts are a majour cause of CD ?
>>      if yes, must HPV be present in infected person, or is exposure to HPV
>>      enough?
>>4) Cervical Dysplasia can be carried by men. ??

>It is believed that human papilloma virus, which causes warts, is responsible
>for most or all cases of CD.  Virgin women never, or at least almost never,
>get CD.  Women whose (male) partners have genital warts get CD more often.
>I don't believe that exclusively homosexual women get CD very often, so it
>probably depends on the introduction of HPV into the vagina.

>>5) It is totally treatable, and any re-occurrence is a new infection. ??


>It is impossible to tell a new occurrence from a relapse, but generally,
>this is thought to be true, at least if the CD is caught early enough.

>>6) If antibiotics are used to treat CD, then mustn't it be a bacteria?

>I'm not aware of antibiotics being used to treat CD.  On the other hand,
>I can imagine using antibiotics prophylactically if a surgical treatment
>was fairly extensive (a "conization", say).

HPV has been implicated as a possible cause of cervical cancer and is 
associated with upwards of 90% of cases of cervical dysplasia which is the
cancer precursor looked for by Pap smears. HPV DNA is commonly found in 
the nuclei of these dysplastic or cancerous cells. There are at least 50
subtypes of HPV and they are somewhat site specific. Types 6 and 11 cause
genital warts and are often associated with mild dysplasia while types 16,
18, 31, 33 and 35 are likely to be found in moderate or sever dysplasia or
cervical cancer itself. Other types of HPV cause common skin warts and other
lesions. HPV subtypes associated with cervical dysplasia have also been
implicated in vulvar, penile and perianal dysplasias and cancers. The 
evidence of a link is strong but be cautioned that 15 years or so ago HSV
was implicated in a somewhat similar fashion.

HPV is certainly common and the CDC suggests even more common than HSV.
Transmission is primarily but not exclusively through sexual contact.
Males certainly can be carriers of the virus without obvious evidence of
carriage.

Antibiotics are not used in the treatment of HPV infection. Flagyl is an
antibiotic used against anaerobic bacteria. Diagnosis of cervical dysplasia
and HPV infection can be made with Pap smears along with biopsys best directed
by an instrument known as a colposcope. Treatments include chemical agents
applied directly such as podophyllin or trichloroacetic acid, cryotherapy,
laser therapy, local excision, conization all the way to hysterectomy.
Relapse is not uncommon and follow-up is mandatory. It is very difficult to
eliminate this virus and reinfection is also possible.

Paps are essential for detection and early treatment but remember that an 
ounce of prevention...  If celibacy isn't an option then we're back to you 
know what. CONDOMS!! These won't absolutely eliminate the risk obviously
but they're a step in the right direction.

As for counselling/treating partners who aren't. Some areas have mandatory 
reporting and partner tracing for some STD's but HPV commonly does not make
these lists.
                                      JR