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Personal Perspectives

HPV and Molluscum

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I was diagnosed with both “low risk” and “high risk” HPV in October of last year. Previously, I had never had an abnormal Pap test. Five months later, I developed genital warts and immediately went to my gynecologist, who prescribed me a take-home cream for the warts.

A short time later I moved and changed doctors. During their initial exam with my new provider, I was told that all of my warts were not associated with HPV. Rather, I now had molluscum contagiosum as well. What joy. Not only did I have both types of HPV, but now I was diagnosed an ADDITIONAL sexually transmitted infection. I must admit this was an extreme hit to my self-confidence. I felt completely disgusted with my body. I was not promiscuous AND I used protection.  

About three months ago I noticed the patch that was molluscum contagiosum had disappeared.Thank God! I am now in the beginning stages of a better, outpatient treatment for the warts. Having the molluscum contagiosum go away was probably the biggest boost to my self-esteem in a year. Without feeling the physical symptoms of them, for once, this whole mess has not been in the forefront of my mind. I don’t need a constant reminder.  Now, as I await the results of my latest Pap, I’m keeping my fingers crossed that the will begin to resolve itself as well.

Most often HPV does self-resolve, so your Pap may return to normal without treatment. For this reason, many women with mild cervical abnormalities are managed with a “watch and wait” approach of frequent Pap tests, rather than immediate treatment. Molluscum contagiosum virus (MCV) can cause small lesions/bumps, and sometimes is confused with warts. MCV is generally a benign infection and symptoms may self-resolve. MCV was once a disease primarily of children, but it has evolved to become a sexually transmitted disease in adults. It is believed to be a member of the pox virus family. Lesions can be removed surgically and/or treated with a chemical agent such as podophyllin, cantharidin, phenol, silver nitrate, trichloracetic acid or iodine. Cryotherapy is an alternative method of removal – ed.

 

Spa Days Get a New Twist: Interview with Jane DeNight, M.S., ARNP

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You walk in and are greeted warmly. With hot tea in hand you’re led to a room that has fluffy pillows and high thread-count sheets.  Immersed in a swirl of calm music, flowers and pastels, you barely notice the exam table and gynecologic stirrups in the corner…

Spa or medical clinic? At SoBe Gyn of South Beach, Florida, the two concepts blend into what the clinic refers to as personalized boutique Jane DeNightgynecology. To learn more about the clinic that pampers patients in a setting more often associated with cold instruments, bright lights and stress, HPV News recently spoke with SoBe Gyn founder Jane DeNight, M.S., ARNP. A fellow of the American Society of Colposcopy and Cervical Pathology, Ms. DeNight’s clinical expertise includes diagnosis and treatment of HPV, abnormal Pap tests, colposcopy, and cervical cancer prevention. She and George Kovacevic, MD, started SoBe GYN in September 2006 with the aim of providing a unique healthcare experience for young, uninsured women in South Beach, Florida.

HPV News: How do you bring a “boutique” experience to health care?
Jane DeNight: It means mixing healthcare with what women like. Women enjoy going to a spa, of course, because it’s serene and tranquil. This environment is soothing and gives women a good chance to unwind and de-stress. We also took a couple concepts from shopping, which of course many women like, so our patients receive shopping bags when they come. They each get a gift with their basic exams and Pap tests. We provide a soothing environment, lots of white linen, comfy and fluffy couches, peaceful music and fresh orchids all over.

This sounds very different from a traditional gynecologic clinic setting.
Yes, clinics are usually much more sterile and not as focused on customer service. We want our patients to feel relaxed, which is why we utilize concepts from the spa. For example, our exam tables have down comforters and Hungarian down pillows, and the stirrups are covered with silk! The women wear chamois robes and spa socks, so it’s a very soothing experience where the woman feels genuinely cared for.

How does the staff dress? Do they wear traditional medical scrubs?
Right now we focus on white: I wear a white lab coat and my assistant Michelle Goodall wears scrubs, but we’re thinking of going with more of a healing outfit, that’s like a Chinese jacket with buttons down the front, and of course white because that promotes cleanliness; it looks clean, feels clean.

Besides spa components, are there other differences a patient might notice with your clinic? You mentioned customer service as a focus…
The cornerstone of our practice is patient education. From the moment they walk in to a warm reception, with “hi, thank you for coming, my name is so and so, would you like some hot tea?” we give them hot tea just like they would receive in a spa. We spend at least 25 minutes doing reviewing their health history and knowledge of cervical caner, HPV, and the Pap test. We teach patients what’s pertinent to their health at their stage of life. Cervical cancer affects young women and can cause loss of fertility. Since we mostly see young reproductive age women, we focus a lot of teaching on the importance of the Pap test and its role in preventing cervical cancer, as well as birth control and STD infections.
That’s very different from what’s going on in many places where the patients are in and out in five minutes. Patient teaching takes up a lot of our time, but  it’s an excellent investment for the patient and us. We feel we provide better service for the patient, better diagnosis and treatment, when we take our time and teach them about what’s important for their age group.

Many people reading this are in health care practice themselves. What are one or two things that will bring a more comfortable atmosphere to a clinic?
Some things don’t cost much money at all, and that’s important to remember. The number one thing is just kindness and empathy, and general good etiquette, which I think is lacking in medicine today. This includes how the patient is received, how well the clinician listens to the patient, thanking them and telling them you appreciate that they chose your facility.
Sobegyn Clinic
Next would be small things, like fresh flowers, a refreshing beverage when they come in, and comfortable seats. Those things don’t have to cost a lot. Women love flowers, they love the color pink, and we use very good exotic wood furniture that wasn’t too expensive but gives a polished look. The other important part is patient education, including verbal, written, and online resources such as HPV News, the ASHA website, and the NCCC website. Knowledge empowers patients and makes them feel more comfortable with their healthcare experience.

You mentioned that you largely work with uninsured patients. How do they afford clinical services?
We once thought about accepting some insurance plans, but after experiencing the exorbitant amount of time and stress we spent filing these claims, we decided not to. The cornerstone of our practice is patient education. When we educate our patients on the facts of the Pap and the statistics of cervical cancer worldwide, they are usually very receptive to paying the $220 annual exam fee which includes the consultation, the lab fee, and the complete gynecological and physical exam and health counseling. We also offer inexpensive options so people can experience this unique approach to healthcare. For example, for urinary tract infections and Vaginitis (yeast, bacterial vaginosis) it costs just $80. For a consultation it is also $80. We also advise women to have their partners share half the cost of birth control.

If a patient is truly unable to pay we offer free referral services to the public health hospital and clinics. We have a very strong referral network. Our typical patients are young reproductive age women and men who work hard and make a decent wage.  Most of them can afford to spend $200-$500 per year for their health. South Beach people often spend more money on less important services such as cable TV, cell phones, dining out, drinks at clubs and bars, hair styling and cuts, and nowadays waxing!

What sort of feedback have you received from your patients?
They often say “I feel like I just went shopping,” and we tell them they have, they’ve been shopping for their body and their health! We’re quite flattered because we get a great response and many people actually ask us if we’ll open clinics in other cities. 

Does your practice also see males?

Yes. Sometimes partners have infections that affect the male so we welcome them, too. Once we get men in, we do some general medicine as well. Men are similar to women in that they appreciate being treated well, with respect and kindness in a soothing environment. So our male population has grown tremendously and they actually feel good about coming to the clinic, a practice that too many men shun.

Visit SoBe Gyn online or contact them at 305.535.9907. For patients in South Florida the clinic offers yearly gynecology exams and Pap tests, birth control, treatment of vaginal infections, and general medicine.

 

This is all so anxiety provoking and stressful

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A little more than a year ago I had my regular annual Pap exam, which resulted in my first abnormal Pap test result. I was told I had a “high-risk” type of HPV, which had caused cell changes in my cervix. I didn’t even know what HPV was until I began to see the commercials for the vaccine! I was amazed at how little support there is for this, and am still upset that the vaccine is only for women ages 9 to 26. I’m 30 and wish I could receive it.

I had another Pap test a month ago, and this one also detected abnormal cells.  I know they say that HPV usually goes away within a few months or maybe a year or two, but this is all so anxiety provoking and stressful. I wish there was more research or ways in how to improve the immune system for those who have mild cervical dysplasia caused by HPV. I am now exercising, taking vitamins and trying to live my life as stress-free as possible, to see if I can get help my body clear HPV.

Stress, anxiety, and even relationship issues are not at all uncommon following abnormal Pap results and a diagnosis of HPV. ASHA has a support forum that might be ideal for you. Free and anonymous, you can log on 24/7 at http://www.ashastd.org/phpbb/index.php. Stop by, and we look forward to connecting with you online! – Ed.

 

I thought "It can't happen to me"

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Personal perspectives

I went for my routine yearly check up but this time I went to a different gynecologist, thinking that it will be just another boring consultation where they just make me uncomfortable.  

She started explaining about HPV and said that she only uses the liquid Pap test, as the lab gets a better sample, clearer and free of obscuring material. Lab technicians who read these slides say the difference is like night and day between the traditional Pap and the new liquid technology.

I just heard “blah-blah-blah” and couldn’t wait to leave.  The doctor looked at me and with a very strict voice said “women are not educated enough about these things and think ‘it cannot happen to me,’” which is exactly what I thought.

I went home waiting for the little piece of paper to arrive in the post saying “normal” but instead received a phone call from the clinic asking me to make an appointment for a biopsy, as there was pre-cancerous cells caused by HPV had been detected.  Suddenly everything stopped… my busy day at work did not matter anymore… nothing mattered anymore… My head was spinning with all these questions “what now and why is it that I don’t know about these things”?

I went back to the gynecologist, was strapped in like a horse while she performed the biopsy and promised myself never to complain again when going for a Pap test. The doctor phoned me a few days later and said the test results show that I have HPV type 16 and CIN III (the Pap only showed CIN II). However, it turns out that I am one lucky girl, as my doctor confirmed the operation was very successful. The end is almost here!!

 

"I'm glad I found your site"

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This morning my doctor called and told me that I had an abnormal Pap test and that I have HPV, “a genital warts virus that causes cervical cancer.” She said that I will have it for the rest of my life, will probably have warts that come and go for the rest of my life, there is no cure, and that if I ever have kids I will have to have a C-section so they won’t contract it.

Obviously distraught with the news we had an STD that one of us gave to the other (and ideas of infidelity in our minds), my boyfriend and I started looking up information about it online. We found your HPV resource center through Google.

I think that your website is great. I have worked in a pharmacology research lab for the past year, so it makes total sense to me that even healthcare providers can sometimes be misinformed (I know now that warts come from HPV types that aren’t associated with cancer).

Resources like yours seem so imperative to have available to women, because someone who didn’t know better would probably suffer emotionally from being told the things I heard at my clinic. I am really thankful for the information on your website, because without it I would still feel dirty, anxious, and sad, like I did all morning, until I go for my colposcopy.

We’re glad to hear from you, and that you found the ASHA site helpful. There is a great deal of misinformation about HPV, even among professionals, and your provider clearly has some old, misinformation about HPV infection. As you stated, the types of HPV that cause warts are different from those linked with cervical cancer.  It’s especially troubling you were told you wouldn’t be able to have a natural delivery; HPV is seldom a threat to either mother or baby, and C-sections are rarely indicated here.

If you’d like to connect with others, visit our HPV forum. -ed.

 


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