A 39-year-old female patient comes to the clinic for a pelvic exam and Pap smear. She reports that her partner is infected with condyloma acuminata. In her history, she always has her partner use a condom
The external genitalia, vagina, and cervix appear normal on pelvic exam, but the Pap smear shows dysplasia. The patient is worried that she could be infected with HPV. The clinician should:
A. Assure the patient that safe sexual practices protect against HPV infection
B. Explain that there is no condyloma present, so HPV infection is improbable
C. Explain that HPV infection can be transmitted in the presence of barrier contraception
D. Teach the patient about hysterectomy since she has cervical cancer
ANS: C
There is an increased incidence of cervical cancer in women infected with HPV, with neoplasias being associated with types 16 and 18. Visible manifestations of HPV occur in less than a dozen genotypes, estimated at only 1% of those infected. Of those who develop condylomas, the presentation is variable. Lesions are often very small, even microscopic, and the rugae of the vaginal mucosa may mask the lesion. If dysplasia is seen on the Pap smear, biopsies should be taken to rule out intraepithelial neoplasia because more than 90% of the cervical neoplasias are caused by HPV. Unfortunately, barrier contraceptives offer only limited protection against the spread of HPV infection.
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