Nursing Considerations for Teenagers with a Positive HPV Diagnosis

While diagnosis and treatment of the human papillomavirus (HPV) is the same for patients of all age levels, nurses should approach teenaged patients with their age and maturity in mind, specifically when educating them about safe sex practices and limiting the spread of the virus.

Symptoms of HPV include genital warts or warts in the throat, cervical cancer or cancer in other parts of the body relating to sexual behavior. Some patients may live for years with few or no symptoms and then have a sudden onset of warts while others may live their entire lives without presenting any symptoms at all (Jones & Haynes, 2006).

HPV is diagnosed by a pap smear with a cytological screening and an HPV test that examines cell changes on the cervix (Jones & Haynes, 2006). While these tests must be done at a doctor’s office or clinic, there has been pilot testing of self-sampling studies; where women have been provided a test kit to collect vaginal fluid that is sent to a laboratory for synthesis (Gyllensten et al., 2011, p. 694). However, completing these tests at a clinic means that nurses can provide patients with information regarding care and preventing the spread of the virus.

There are several aspects of HPV that must be treated in women after a positive diagnosis has been made; treatment of genital warts or lesions; test for cervical and other cancers; and test for and treatment of Recurrent Respiratory Papillomatosis (RRP), if present. Treatment of apparent cervical intra-epithelial neoplasia (CIN) lesions is usually the first step after diagnosis of HPV. There are a variety of treatments available such as “cone biopsy, cryotherapy, laser vaporization, and loop electrosurgical excision procedure” (Aerssens et al., 2008, p. 382). While these treatments encourage the healing of the lesions, they are likely recurring and the patient remains infectious. Treatment of RRP usually begins with medication and, if needed, can also be treated with surgery to remove warts, although this is often a difficult to treat illness (Samkange-Zeeb, Pöttgen & Zeeb, 2013).

While it is less likely that men will show constant symptoms, there are cases where male patients have genital warts or RRP. However, it is still important to diagnose men with HPV and instruct them on health promotion so they can make healthy decisions with their sexual partners and get treatment if and when symptoms occur.

In the past ten years, HPV incidences have has gotten a great deal of attention because of the vaccination that is offered to pre-teen and teenaged girls. While many times the girl’s parents may be the driving force for receiving the vaccination, a study by Watson and Green (2012) argue that “Gaining an insight into the views and knowledge of children and young people can contribute to improvements in nursing practice” (Tearfund, 2004; Parahoo, 2006). Considering a young person’s perspective when talking to them about HPV prevention and condom use can be more effective because it provides the information from a level that the teenagers understand. This is especially important when explaining patient care since it places the responsibility to care for themselves and for future sexual partners. Since many teenagers become or are considering becoming sexually active, educating them in way that engages them can mean more successful avoidance of the illness or treatment for those who already have tested positive. A teen that has been recently diagnosed positive for HPV may also need resources for information, treatment or support (Watson & Green, 2012).

Although it is an expectation, maintaining confidentiality of the patient’s diagnosis and treatment is legally and ethically necessary; sharing information with the parent only if it is fitting to the age and guardianship status of the child. This can be a difficult topic to discuss with parents and their teenagers but, especially if the teen needs more treatment, the parents will need to provide support and care for their child. Since young people often become ineligible for health insurance or have lapses in insurance, it is also important to provide information regarding care and treatment options if they cannot afford care, either at present or in the future (Pichichero, 2007, p. 200). This information may not be needed immediately but the adolescents need to be aware that they have a continued responsibility to limit the spread of HPV by using protective measures.

Bearing in mind the needs and support a teenager may need after a positive HPV diagnosis, a nurse should consider the approach of educating the patient and informing the parents in a way that is accessible and mindful of the needs of this age group.

References

Aerssens, A. A., Claeys, P. P., Garcia, A. A., Sturtewagen, Y. Y., Velasquez, R. R., Vanden Broeck, D. D., & ... Cuvelier, C. A. (2008). Natural history and clearance of HPV after treatment of precancerous cervical lesions. Histopathology, 52(3), 381-386.doi:10.1111/j.1365-2559.2007.02956.x

Gyllensten, U. U., Sanner, K., Gustavsson, I., Lindell, M., Wikström, I., & Wilander, E. (2011). Short-time repeat high-risk HPV testing by self-sampling for screening of cervical cancer. British Journal Of Cancer, 105(5), 694-697. doi:10.1038/bjc.2011.277

Jones, N. R., & Haynes, R. (2006). The association between young people's knowledge of sexually transmitted diseases and their behaviour: A mixed methods study. Health, Risk & Society, 8(3), 293-303. doi:10.1080/13698570600871851

Pichichero, M. E. (2007). Who should get the HPV vaccine? (Cover story). Journal of Family Practice, 56(3), 197-202.

Samkange-Zeeb, F., Pöttgen, S., & Zeeb, H. (2013). Higher risk perception of HIV than of chlamydia and HPV among secondary school students in two German cities. Plos ONE, 8(4), 1-8. doi:10.1371/journal.pone.0061636

Watson, C., & Serrant-Green, L. (2012). Exploring HPV awareness and understanding before and after health education. British Journal of School Nursing, 7(5), 240-248.