1. Nursing Process
HPV

2. HPV infection is common among sexually active women and men, especially adolescents, regardless of ethnicity or socioeconomic status. Risk factors include early age at menarche and multiple sexual partners. The long incubation period (6 weeks to 8 months) makes it difficult to establish history of exposure. A strong association of HPV infection and abnormal cervical cytology exists (Jarvis, 2008).

3. Equipments
For women: gloves, protective clothing for examiner, goose-necked lamp with a strong light, vaginal speculum of appropriate size, graves’ speculum (useful for most adult women, available in varying lengths and widths, Pederson speculum, large cotton-tipped applicators, and materials for cytologic study: glass slide with frosted end, sterile cytobrush or cotton-tipped applicator, ayre’s spatula, spray fixative, specimen container for gonorrhea culture/Chlamydia, small bottle of normal saline, potassium hydroxide, and acetic acid, lubricant.
For men: gloves, glass slide for urethral specimen, materials for cytology, flash light (Jarvis, 2008).

4. Assessment
Genital warts: These appear as bumps or clusters of fleshy outgrowths around the anus or on the genitals. Some may grow into larger cauliflower-shaped masses.
Precancerous changes in the tissues of the female cervix: flat growths on the cervix that cannot be seen or felt by the infected woman.
Cancer: high-risk strains of HPV can cause cancers of the mouth and throat as well as cancers of the anal area and the male and female genitals. These typically take years to develop after infection. In men, symptoms of anal cancer may include bleeding, pain, or a discharge from the anus, or changes in bowel habits. Early signs of cancer of the penis may include thickening of the skin, tissue growths, or sores (NCP HPV Infection).

5. Diagnose
There is no general blood, urine, or imaging test for HPV infection. The diagnosis of genital warts is obvious based on their location and appearance. The doctor may, however, use a vinegar solution to identify HPV infected areas on the skin of the genitals. The vinegar solution may turn white if HPV is present.
Sexually active women should be screened periodically for the presence of changes in the tissues of the cervix. The most common test is the papanikolaou test or Pap smear, invented by a Greek physician in the 1940s.
To perform a Pap smear, the doctor takes a small spatula to obtain cells from the outer surface of the cervix and smears the collected cells on a slide that is then examined in a laboratory for signs of any abnormal cells. If abnormal or questionable cells are found, the doctor may order an HPV DNA test, which can identify the DNA of 13 high-risk types of HPV in cells taken from the cervix. There are no HPV screening tests for men (NCP HPV Infection).

6. Plan/ Treatment …
The prognosis of sexually transmitted HPV infections depends on the patient’s age, number of sexual partners, gender, and the condition of their immune system.
Women are significantly more likely than men to develop cancers following HPV infection.
However, most people of either sex with normally functioning immune systems who are infected with HPV will clear the infection from their bodies within two years.

7. …Plan/ Treatment…
Patients with genital warts should never use over the counter preparations designed to remove common or flat warts from the hands or face.
Doctors can treat genital warts with various medical or surgical techniques.

8. …Plan/ Treatment…
Cryotherapy: uses liquid nitrogen to freeze the warts. The dead tissue in the wart falls away from the skin beneath in about a week.
Imiquimod: is a topical cream that gets rid of genital warts by stimulating the body’s immune system to fight the virus that causes the warts.
Podofilox: is a topical medication available in liquid or gel form that destroys the wart tissue.

9. …Plan/ Treatment Surgery
The doctor can remove the wart by drying it out with an electric needle and then scraping the tissue with a sharp instrument called a curette.
Lasers can also be used to remove genital warts.
High-risk precancerous lesions are removed, usually by surgery, cryotherapy, or laser surgery (NCP HPV Infection).

10. Implementation
Preventive measures that people can take to lower their risk of HPV infection include:
Abstaining from sex, or having sex only with an uninfected partner who is faithful.
Reducing the number of sexual partners
Using condoms regularly during sexual intercourse.
Getting Gardasil vaccine. It is given as a series of three shots over a six-month period (NCP HPV Infection).

11. Evaluation Patient verbalizes the risk factors of HPV.
Patient verbalizes the preventive measures to lower the risk of HPV.
Patient asks for more information about the Gardasil vaccine.

12. References
Jarvis, C. (2008). Physical examination and health assessment (5th ed.). St. Louis, MO: Saunders Elsevier, Inc.
NCP HPV Infection. Retrieved from: