TOPIC: Human Papillomavirus (HPV) Vaccine

WHAT’S THE PROBLEM?

Genital human papillomavirus is a commonly sexually transmitted infection.  Most people who have HPV don’t show symptoms or health problems and therefore don’t know they have it.  In 90 percent of those infected with HPV, the body’s natural defenses can clear up an infection in two years.

There are more than 40 types of HPV that infect the genital areas of both men and women; these types can also infect the mouth and throat. Of these, two strains of HPV cause about 90 percent of genital warts in men and women. Two other HPV strains cause 70 percent of cervical cancers.  In rare cases, these strains also cause cancer of the vulva, vagina, penis, anus, head, and neck (tongue, tonsils, or throat).

Over 12,000 women are diagnosed with cervical cancer annually and over 4,000 die from this disease each year.  Most cases of cervical cancer and genital warts are caused by human papillomavirus.

WHO’S AT RISK?

HPV is sexually transmitted and is passed through vaginal, anal, and oral sex as well as genital-to-genital contact.  It can be passed between partners even when the infected person does not show any symptoms of infection. A person can be infected with HPV even if it has been years since they had sexual contact with a partner with HPV.  Most people who are infected with HPV don’t know they have it and unwittingly pass it on to their partners.

CAN IT BE RPEVENTED?

The only sure way to prevent HPV infection is to abstain from all sexual activity.  Although condoms and dental dams can limit the spread of HPV, the virus can be spread through contact with areas of the body not covered by condoms and dental dams; thus, these devices are not completely effective against HPV infection.

Two vaccines have been developed to prevent HPV. Both are currently given as a series of shots.  These vaccines are clinically shown to be safe and effective for preventing against the HPV strains that cause most cervical cancer infections:

• Gardasil protects against four strains of HPV, including the two strains implicated in cervical cancer.  It also protects against some strains of HPV that cause genital warts.  This vaccine is recommended for females and males ages 9 to 26 and is the most commonly used HPV vaccine in the U.S.
• Cervarix protects against the two strains of HPV implicated in most cervical cancers.  It is recommended for females ages 10 to 25 and is commonly used in countries outside of the U.S.

Ideally, the vaccines should be administered to people before they become sexually active, and hence before they are exposed to HPV. However, even sexually active people who have not received the vaccine before onset of sexual activity could benefit from taking the vaccine. Most large insurance plans cover the cost of the vaccine, but for those without health insurance, some states also offer low-cost or free vaccines at their public health department or clinics.

THE BOTTOM LINE

• HPV is sexually transmitted
• Some strains of HPV can cause genital warts; others can cause cancer
• There are two vaccines available that can prevent infection against some of the strains of HPV that cause genital warts and cervical cancer
• These vaccines are covered by many insurance plans and low-cost and free vaccines may be available for those without health insurance

CASE EXAMPLE

Laurel is a 12 year-old girl.  At her annual physical check up, her doctor recommends that she get the HPV vaccine because of her age.  Her mother refuses, saying the vaccine is too expensive, too troublesome, and she doesn’t believe in vaccines.  One day, her mother gets a phone call from the gynecologist, who tells her the Pap smear she had last week showed precancerous cells on her cervix.  She has HPV. She talks to her doctor about HPV and learns that it is sexually transmitted and anyone can have it and unknowingly pass it on to their partners.  She also learns that she has been infected by one of the strains of HPV that cause cervical cancer. The next week, Laurel’s mom takes Laurel to the pediatrician to get her the first in a series of shots against HPV.