An estimated 20million Americansare currentlyinfectedwith humanpapillomavirus (HPV). Assuch, HPV is now the mostprevalent sexually transmitteddisease (STD) in thiscountry. Answers to commonquestions like the onesabove are therefore of particularinterest to physicians.The issue of when and howto use testing for HPV hasbecome especially crucial.
A 32-year-old woman tells you that she has had generalized weakness;swelling of the face, arm, and legs; diffuse myalgias; and a facial rashfor several weeks. Her main concern is her inability to keep her arms elevatedor get out of bed. Her history is significant for cervical cancer.
A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.
An 83-year-old woman-who had not visited a physician for 20 years-presented to the emergency department with a 1-day history of urinary retention and a 1-month history of gross vaginal bleeding. The mass on the left side of her face was a secondary finding.
A 48-year-old woman was hospitalized following 10 days of rectal bleeding. One year earlier, she had undergone combined external-beam radiation and brachytherapy for stage IIIA carcinoma of the cervix. The patient was orthostatic and pale on admission, and her hemoglobin level was 6 g/dL. After receiving a transfusion of packed red cells, she underwent colonoscopy. Several telangiectases were seen in the rectum, the mucosa was friable, and blood oozed from one of the lesions.