# Situation: A nurse works in the pediatric ward and the adolescent health clinic of a city hospital during the rainy season. A sexually active 17-year-old girl is diagnosed with genital warts caused by human papillomavirus (HPV) types 6 and 11. Which points should the nurse include in her teaching plan? 1. These HPV types are low-risk types that rarely cause cancer 2. Treatment removes the warts but may not clear the virus 3. She no longer benefits from HPV vaccination because she is already infected 4. She will still need cervical cancer screening at the recommended age

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the pediatric ward and the adolescent health clinic of a city hospital during the rainy season.

A sexually active 17-year-old girl is diagnosed with genital warts caused by human papillomavirus (HPV) types 6 and 11. Which points should the nurse include in her teaching plan?
1. These HPV types are low-risk types that rarely cause cancer
2. Treatment removes the warts but may not clear the virus
3. She no longer benefits from HPV vaccination because she is already infected
4. She will still need cervical cancer screening at the recommended age

## 보기

1. 1 and 2
2. 1, 2 and 4 **✔ 정답**
3. 2, 3 and 4
4. 1, 2, 3 and 4

**정답: 2**

## 해설

HPV 6 and 11 are low-risk types that cause warts but rarely cancer, whereas high-risk types such as 16 and 18 cause most cervical cancers; she may carry more than one type, so screening under DOH guidance (women 30–65) still applies. Wart treatment removes lesions, not the virus. Infection with some types does not remove the benefit of vaccination, which still protects against types she has not acquired.

## 심화 해설

Clinical context

A 17-year-old sexually active adolescent presents with genital warts caused by HPV types 6 and 11. The teaching plan must address risk stratification, treatment expectations, vaccination, and future screening. The correct combination is 1, 2, and 4.

Why statement 1 is correct

HPV 6 and 11 are classified as low-risk HPV types. They are responsible for approximately 85% of all genital warts but are rarely associated with malignant transformation [2]. In contrast, high-risk types such as 16 and 18 account for about 70% of cervical cancers [2]. The presence of visible warts therefore does not by itself indicate a high oncogenic risk. However, rare cases of invasive carcinoma containing HPV 6 or 11 have been documented, so the term “low-risk” describes relative probability rather than absolute safety [3].

Why statement 2 is correct

Treatment for genital warts—whether topical, cryotherapy, or surgical excision—targets the visible lesion, not the underlying viral infection. Removing warts does not guarantee clearance of HPV from the surrounding epithelium. The virus can persist in a latent or subclinical state, which explains why recurrences occur even after successful lesion removal. This distinction is critical for patient education: the adolescent should understand that treatment improves symptoms and reduces transmission risk from visible lesions but does not equal cure.

Why statement 3 is incorrect

Infection with HPV 6 or 11 does not eliminate the benefit of vaccination. The quadrivalent vaccine covers 6/11/16/18, and the nonavalent vaccine covers 6/11/16/18/31/33/45/52/58 [2]. A patient already infected with one or two types can still receive protection against the other vaccine-covered types she has not yet acquired. Key point! Vaccination is not contraindicated by a history of genital warts; it remains a recommended preventive strategy for sexually active adolescents.

Why statement 4 is correct

Even though HPV 6 and 11 are low-risk, the adolescent may be co-infected with high-risk HPV types that are not visible as warts. A retrospective study of 407 women found that vulvar condyloma can serve as a marker for concurrent high-risk cervical HPV infection and abnormal cervical cytology [1]. The presence of genital warts should prompt continued adherence to age-appropriate cervical cancer screening, not early discontinuation. Screening recommendations remain applicable because the patient’s full HPV genotype profile is unknown without specific testing.

Integrated teaching plan

| Teaching point | Clinical rationale | Nursing implication |
| --- | --- | --- |
| Low-risk type explanation | HPV 6 and 11 cause warts but rarely cancer [2] | Reduce anxiety while avoiding false reassurance about all HPV |
| Treatment limitation | Lesion removal does not clear the virus | Set realistic expectations about recurrence |
| Vaccination still beneficial | Protects against types not yet acquired [2] | Offer vaccine regardless of current infection |
| Continued screening | Co-infection with high-risk types is possible [1] | Reinforce age-based cervical screening adherence |

Watch out! Do not equate “low-risk HPV” with “no screening needed.” The coexistence of high-risk types is clinically significant and supports ongoing surveillance [1].References (research sources)

- [1]Clinical Significance of Vulvar Condyloma as a Marker of Concurrent High-Risk Cervical HPV Infection and Abnormal Cervical Cytology.Research articleGüner Özen E, Özen S, Akbaş Ö, Kanmaz AG, Akpak YK. (2026) · DOI: 10.3390/diagnostics16152439

- [2]Vaccines against human papillomavirus infections: protection against cancer, genital warts or both?Research articleJoura EA, Pils S (2016) · DOI: 10.1016/j.cmi.2016.12.017

- [3]Low-risk human papillomavirus types 6 and 11 associated with carcinomas of the genital and upper aero-digestive tract.Research articleTurazza E, Lapeña A, Sprovieri O, Torres CP, Gurucharri C, Maciel A (1997)

## 임상 시나리오

HPV 6/11 Genital Warts: Adolescent Teaching PlanRisk, treatment limits, vaccination, and screening
HPV types 6 and 11 are low-risk types that cause genital warts but rarely lead to cancer. High-risk types such as 16 and 18 cause most cervical cancers, so co-infection with a high-risk type remains possible.

Wart treatment removes the visible lesion, not the underlying virus. HPV can persist in a latent or subclinical state, so recurrence is possible even after successful removal.

Infection with one HPV type does not eliminate the benefit of HPV vaccination. The vaccine still protects against other types she has not acquired.

Cervical cancer screening should still be performed at the recommended age, typically 30–65 years, because she may carry more than one HPV type.

CautionDo not tell the patient that treatment cures HPV. Emphasize that lesion removal reduces symptoms and visible-lesion transmission risk but does not guarantee viral clearance.

## 핵심 개념

- **Low-risk HPV** — HPV types such as 6 and 11 that cause genital warts but rarely lead to cancer.
- **High-risk HPV** — HPV types such as 16 and 18 that are responsible for most cervical cancers.
- **Genital warts** — Benign epithelial lesions caused primarily by HPV types 6 and 11.
- **HPV vaccination** — Immunization that protects against multiple HPV types, including those not yet acquired by the individual.
- **Cervical cancer screening** — Periodic testing recommended for women, typically ages 30-65, to detect precancerous or cancerous cervical changes.

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