Do You Want to Spare Your Daughter a Colposcopy and LEEP?

Between 50%- 75% of adults will acquire some type of human papilloma virus (HPV) if they are sexually active. This is particularly likely if they, or their partner, have had more than one partner. The FDA has recently approved the first vaccine (Gardasil ®) which prevents HPV infections linked to cervical cancer, abnormal PAP smears, and even genital warts. Here are some points to consider if you are thinking about immunizing your daughter - or yourself.

Who Should Get Vaccinated?

The FDA has approved Gardasil for females between the ages of 9 and 26. The greatest number of persons acquiring HPV are young women 15 to 24 years old. The vaccine is most protective for women who have not yet become sexually active. Thus, if a woman is virginal the vaccine might still be given if she over 26 years of age.

Acquiring the virus when a teenager is particularly worrisome. In a young woman there is a proportionally larger area of a more delicate, vulnerable tissue (glandular epithelium) on the face of the cervix. With time this tissue is replaced by squamous epithelium which provides a thicker protective layer—more like our external skin. Viruses are opportunists. The mild tissue trauma of intercourse coupled with a more fragile cervical skin could make it easier for the virus to gain entry.

One well done study by Ho and colleagues (1998) followed older adolescents over three years. At the end of the study some 43% became HPV positive. This confirms the ease with which HPV can be passed between sexual partners. Surprisingly, of this group of newly infected women, only 9% continued to show persisting evidence of HPV. In many cases, especially with the "low risk" subtypes of HPV, a competent immune system can appear to clear the evidences of viral infection. Yet HPV can be acquired and be "dormant". Then, in times of a lowered immune function (e.g., pregnancy, chronic illness, or use of immune suppression drugs), dormant viruses such as herpes and HPV can produce significant infections.

Which Vaccine Should You Choose?

There are more than 30 types of HPV which are sexually transmitted. These have been classified into "low risk" and "high risk" subtypes. HPV subtypes 6 and 11 are considered to be low risk. They are linked primarily to the cauliflower-appearing genital warts, and low grade cervical lesions (eg LGSIL, CIN 1). Subtypes 16 and 18 are considered to be high risk as they are linked with persisting HPV infections and severely abnormal PAP smears. These two high risk subtypes are the probable cause of about 70% of cervical cancers.

The currently available Gardasil vaccine provides protection for all four of the HPV subtypes mentioned above. Another vaccine, "Cervarix" will likely be available in the near future. The Cervarix vaccine has been shown to protect from HPV high risk subtypes 16 and 18. Both vaccines have been shown in large research studies to provide 100% protection for the high risk subtypes.

OK, What Are the Downsides to Getting an HPV Vaccine?

Both vaccine require a series of three injections spread over a six month period. Currently it is not known if a booster shot would be needed when the woman is older to help keep her immunity at a protective level. Studies are ongoing to try and answer this question

While most major insurance companies are hopefully going to cover the cost of this vaccine, paying for the series of injections would be $360.00 if paid out of pocket. If a low income young woman is covered by the Vaccines for Children Program, this vaccine is paid for by the program.

Gardasil is a non-live virus type of vaccine. It does not contain the controversial ingredients thimersol or mercury. There is not enough long term data to suggest that it can be given during pregnancy. There are several medical conditions (eg immune suppressed) where a vaccine may not be as effective.

Like many other immunizations where an injection is required there is the trauma of getting "a shot". The most common side effect of this injection was redness and swelling at the injection site—this was experienced by about 25% of subjects receiving the vaccine. Other less common side effects were soreness or itching at the injection site, or low grade fever.

Are You Going to Get This, Jane?

Alas, I am too old, and have had too many sexual partners over my early life. But if I had the opportunity I would certainly do this. My parents had me vaccinated against smallpox. This was considered routine at the time. Some countries routinely vaccinate for tuberculosis. I believe all parents have to consider the pluses and minuses of giving preventative vaccines to some pathogen their child may never encounter. HPV is an infection that a majority of persons will contract. In my professional opinion this vaccine offers advantages to women not yet sexually active.

For more in depth information consider reading this report from the Centers for Disease Control (CDC): Recommendations of the Advisory Committee on Immunization Practices.

Related Topics:

• HPV Vaccine vs. Vulvar, Vaginal Cancer
• WebMD Video: Diagnosing HPV - DNA Test

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