By Carol A. Kemper, MD, FACP

HPV on that Ultrasound Probe?

SOURCE: Gallay C, et al. Human papillomavirus (HPV) contamination of gynaecological equipment. Sex Trans Infect 2015:1-5.

HPV has been identified from a variety of sources, including the underwear and under the fingernails of persons with genital HPV, as well as on medical equipment, such as vaginal probes and cryoguns. Because HPV (a non-enveloped capsid virus) can resist routine cleaning with such agents as glutaraldehyde and ethanol, it has been theorized that transmission other than sexual may occur.

In order to investigate the frequency of HPV contamination of gynecological equipment, these authors collected specimens from fomites twice a day for two days at two University Hospital and four private gynecology offices in Geneva and Lausanne, Switzerland, in 2013. In total, 179 samples were collected from glove boxes, lamps, tables, gel tubes, speculums, and colposcopic equipment from both colposcopic rooms and private examination rooms. Samples were processed, DNA was extracted and stored at -20 C, and then real-time amplification and genotyping was performed with the Anyplex II HPV28 test kit.

Overall, 32 (17.9%) of the fomite samples were contaminated with HPV DNA. Contamination was higher at private offices than at University facilities (27.5 vs 11.8%, p = .38). The two most frequently contaminated sites were the colposcopic handle (43.8%) and the lamp (37.5%) with the latter most likely because the operator reaches to adjust the lamp. Other sites of less frequent contamination included the glove box (9.4%), and gel tubes (6.2%). One of 24 speculums (3.1%) was contaminated. Speculums were sterilized between patients, so this speculum could have been contaminated from the tray table or contaminated gloved hands. There was no difference in the observed frequency of contamination between samples collected in the morning or the evening.

Twenty different HPV genotypes were detected, including 13 different high-risk genotypes found in 20 locations, and 7 lower-risk genoptypes found in 24 locations. The number and viability of virus detected using these techniques could not be determined.

These authors propose changes in procedures for gynecologic exam — including enhanced cleaning procedures. Once the exam begins, gloved hands of the examiner should not touch other equipment or surroundings; and lights should be adjusted by an assistant. The use of disposable speculums should further reduce the risk of contamination.

Saving Elephants from Herpesviruses

SOURCE: Akst J. A plague on pachyderms. The Scientist. June 1, 2015.

At least seven genetically distinct herpesviruses, called elephant endotheliotropic herpesvirus (EEHV), can infect elephants, resulting in a devastating hemorrhagic infection with a high rate of mortality, especially in non-immune calves. Between 1978 and 2008, nearly 20% of the United States-born Asian elephant calves died from EEHV. Since then, there’s been a considerable effort to save these youngsters.

Most recently, a 5-year-old Asian elephant named Sampson at the Maryland Zoo in Baltimore began behaving poorly, and his caretaker quickly initiated a diagnostic and therapeutic protocol developed at other centers including large volumes of oral fluids (15-20 gallons of Gatorade-spiked water), supplemental enemas as needed, anti-inflammatories, pain medications, and famciclovir at doses about 40 times the human dose (administered 15 mg/kg per day) for one month. Since Sampson weighs around 3500 pounds, it is estimated he took around 2500 tablets of Famvir during his treatment course. The Houston zoo protocol also includes the use of a single dose of ganciclovir 5 mg/kg in 1 liter of fluid.

Since 2005, steps have been taken to routinely screen zoo elephants for the viruses, which can be isolated from trunk washings (as well as genitals and eyes) of healthy elephants, using ELISA screening. Evidence suggests that, similar to human herpesviruses, EEHV can intermittently reactivate, causing a localized head and neck infection. Originally thought to cause a more benign infection in wild African elephants, these viruses appear to present a greater risk to non-immune elephants born in captivity and so contact between Asian and African elephants is discouraged. Further work is occurring, using DNA fingerprinting, to identify differences between the species/types which appear to have evolved as distinct viruses many years ago and to track transmission of infection between animals.