Transmission of genital warts through the examination bed
Dr. Diana Hosseini
MashhadGynecological cancers fellowship, specialist in obstetrics and gynecology
Transmission of genital warts through the examination bed: scientific review and available evidence
Genital warts are one of the most common sexually transmitted infections (STI) caused by Human Papillomavirus (HPV) is created. The virus has more than 100 different types, some of which (such as types 6 and 11) are responsible for genital warts and others (such as types 16 and 18) with HPV-related cancers, including cervical cancer, are related.
HPV transmission usually occurs through direct skin-to-skin contact during sexual activity, but questions have been raised about the possibility of indirect transmission through surfaces such as medical examination beds. This article deals with the scientific investigation of this issue, the available evidence and prevention solutions.
How HPV is transmitted
HPV is a non-enveloped virus that depends on living host cells for survival. This virus is mainly transmitted through direct contact with infected skin or mucous membranes and is rarely transmitted through non-living surfaces (fomites) (Doorbar et al., 2012). Unlike viruses such as norovirus or bacteria such as Staphylococcus aureus that can survive on surfaces for long periods of time, HPV is rapidly inactivated in a dry, host-free environment.
A 2014 study by Bednarczyk et al showed that the persistence of HPV in the environment outside the body is very limited and its indirect transmission requires special conditions such as constant moisture and immediate contact. 700 style="font-weight: 700;">Examination bed as a potential medium for transmission of genital warts
Examination beds in clinics and hospitals are often covered with disposable covers and cleaned with disinfectants after each patient. Health standards of the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) recommend that high-contact surfaces in medical environments be cleaned using effective disinfectants such as 70% alcohol or sodium hypochlorite (WHO, 2020). These measures minimize the risk of transmission of any pathogen, including HPV.
However, in unsanitary conditions, such as failure to change bed covers or insufficient disinfection, there is a theoretical possibility of transmission. A 2016 study by Pao et al showed that transmission of cutaneous viruses can occur if there is an infected discharge on the surface and immediate contact with healthy skin, but this scenario is rare for HPV due to the need for the virus to enter deeper layers of the skin (such as a scratch or wound).
Scientific evidence and studies related to the transmission of genital warts from the examination bed
So far, no valid clinical study has confirmed the definitive transmission of HPV through the examination bed. In a 2019 systematic review published in the Journal of Infectious Diseases, researchers concluded that HPV transmission through fomites is not recognized as a major or significant route (Gravitt & Winer, 2019). Also, a 2021 study by a research team at Harvard University showed that even if viral particles are present on surfaces, the probability of their infection without direct contact with mucous or damaged skin is close to zero. John
The stability of viruses in the environment outside the host's body depends on several factors, including the structure of the virus (enveloped or unenveloped), temperature, humidity, pH, type of surface and the presence of organic substances. HPV is a non-enveloped virus that is generally more resistant to environmental factors than enveloped viruses. This resistance is due to its strong protein capsid structure that protects the viral genome.
Scientific evidence of HPV survival on inanimate surfaces
Various laboratory studies have investigated the survival of HPV on different surfaces. Due to the challenges of HPV culture in the laboratory environment, these studies often use PCR-based methods to detect viral DNA and not necessarily the infectious virus. However, the long-term detection of viral DNA on surfaces indicates the potential for virus survival and its potential importance in transmission.
Laboratory studies on the stability of the HPV virus on various surfaces:
Porous surfaces:
Research has shown that HPV DNA can remain on surfaces such as cloth, clothes and paper towels for several days to weeks. For example, a study showed that HPV DNA can be detected on cotton for up to 7 days and on plastic for up to 3 days. Stay longer, sometimes up to several weeks. These surfaces are less absorbent and the virus may remain in stable conditions for a longer time.
High-contact surfaces
: Due to its clinical importance, the survival of HPV on high-contact surfaces has also been investigated in medical and public environments. Doorknobs, sports equipment, and medical tools are among the things that have the potential to be infected with HPV.
The effect of environmental conditions on the persistence of HPV virus on surfaces:
Temperature and humidity
Lower temperature and moderate humidity generally increase the survival of viruses. On the other hand, high temperature and very low or very high humidity damage the capsid of the virus and reduce its survival.
The presence of organic substances:
Organic substances such as proteins and blood protect the virus and increase its survival on surfaces, which is of particular importance in clinical environments.
Infectivity:
While detection of viral DNA indicates the presence of the virus, it does not alone indicate its infectivity. Due to technical difficulties, few studies have directly investigated the infectivity of HPV remaining on surfaces. However, some studies have shown that the infectivity potential of the HPV virus, especially under favorable conditions, exists for some time after the virus has been exposed to the surface. John, their exact role in the epidemiology of HPV transmission is not yet fully understood. The main transmission of HPV is through direct skin-to-skin or mucosa-to-mucosal contact. However, transmission via fomites is a potential route, especially in environments with close contact or sharing of equipment.
Clinical settings:
Medical instruments, especially those used in genital examinations, must be thoroughly sterilized to prevent possible transmission of HPV.
Public environments:
Locker rooms, gyms, swimming pools and even common surfaces in homes have the potential to transmit HPV, although the risk is lower than direct transmission.
Scientific evidence and research related to transmission through the examination bed
Despite the high prevalence of HPV and the identification of its DNA on surfaces, there is no strong and direct scientific evidence of the usual transmission of HPV through inanimate surfaces (fomites) such as medical examination beds, clothes or towels. Internationally recognized health organizations, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), emphasize that the main and almost exclusive route of HPV transmission is direct skin-to-skin or mucous-to-mucous contact, especially during sexual activity.
Study findings:
Some research studies have found HPV DNA on instruments or environmental surfaces in medical offices. However, these studies have not been able to prove that these DNAs originated from live, infectious viruses and led to infection in humans. In general, reported cases of non-sexual transmission of HPV (including via fomites) are very rare and usually occur in specific circumstances such as mother-to-child transmission at birth, or autoinfection (transmission of the virus from one part of the body to another).
Health organizations' point of view:
None of the main public health institutions consider HPV transmission through examination beds as an important or common route of transmission and do not emphasize this in their preventive recommendations. The main focus is on prevention of sexual transmission.
Possible mechanisms of transmission of HPV from surfaces (if any)
In theory, if a surface comes into contact with another person's skin immediately after contact with infected skin and before drying or disinfecting, found, there is a very small chance of transmitting the virus. However, this scenario is highly unlikely due to several factors such as the need for the virus to enter living cells through microscopic skin scratches and its sensitivity to environmental conditions. In general, fomite transmission of HPV, if it occurs at all, is so rare that it is considered clinically insignificant.
Risk factors and special circumstances of genital wart transmission from the examination bed
Although transmission through the examination bed is unlikely, some factors can increase the risk:
Lack of hygiene:
If the examination bed is not cleaned after use by an infected patient, secretions containing the virus may remain on the surface.
Presence of wounds or scratches:
Damaged skin can act as a gateway for the virus to enter.
Timing: id="h2_898ddf0a">Prevention and recommendations regarding transmission of genital warts from the examination bed
To reduce any concern about HPV transmission in medical settings, the following measures are recommended:
Compliance with health standards:
Use of disposable covers and regular disinfection of beds.
Training of medical staff:
Awareness of the importance of cleaning surfaces to prevent the transmission of pathogens.
Vaccination:
HPV vaccine (such as Gardasil), which is effective against the main types of the virus, is the best way to prevent infection (CDC, 2023).
Reassurance to patients:
Doctors should address patients' concerns by explaining health protocols.
Transmission of genital warts through the examination bed, although theoretically debatable, but in practice and based on the available scientific evidence, is very unlikely and close to impossible. is HPV virus requires direct contact and special conditions for transmission, which are rarely provided in standard medical settings. By following health protocols, this risk is practically zero. Instead of worrying about such rare routes, it would be more effective to focus on prevention through public education.
Conclusion and main message
According to the available scientific evidence, the concern about the transmission of genital warts through the medical examination bed is very rare and unnecessary. is While viral DNA may be detected briefly on surfaces, its ability to cause infection outside the human body is greatly reduced, and there is no strong evidence for such transmission. The main and dominant way of HPV transmission is direct skin-to-skin contact during sexual activity. color: inherit;" href="https://scholar.google.com/citations?hl=en&user=xY_AVMwAAAAJ&view_op=list_works&gmla=AMpAcmTCCkr6ErndXXNUbGOG4J4vpd3i0qeoQVZ3K2hZgmtNe 2jaDb-JKJRGCk7hSwPDqchxPZzxMTjXIdTmQ66asO0PKnJX8yxSBEzqhyJoOqXzrJaY-TKfpQPb1xY_mgIBt5xNaGZZ3r0DLf0wqJc&iaan=seyyede+Diana+Hoseini+Farabadi" rel="noopener noreferrer" style="user-select: auto; color: inherit;" target="_blank">Dr. Diana Hosseini has been approved."
Resources
D'Souza, G., et al. (2020). "Long-term Persistence of Oral HPV Over 7 Years of Follow-up"
