by The College of Physicians of Philadelphia
It seems like every channel you watch, every paper you pick up, every blog you read — HPV and a vaccine called Gardasil is being debated. It's everywhere — just like HPV! The Centers for Disease Control (CDC) estimates that as many as 20 million Americans are currently infected with HPV and another 6.2 million are newly infected each year. Youth isn't in your favor, either, since half of the people who get HPV are age 15 to 25.
HPV (Human Papillomavirus) is actually a group of more than 100 related viruses. Some are annoying but harmless, such as the common wart you find on your hands or feet. Others, called genital HPVs, are the most commonly sexually transmitted disease in the world. They can cause raised, flat or cauliflower-shaped warts on the genitals or anus of both men and women but rarely grow into cancer. Others can cause cell changes in the cervix, vagina and vulva and are the cause of 99 percent of cervical cancers. HPV is also linked to other genital cancers and some head and neck cancers.
HPV is transmitted from one person to another through genital skin-to-skin contact during vaginal, oral or anal sex, making it very easy to become infected. Most people who become infected don't even know it, sometimes for months or years. There is also no treatment for HPV, once you are infected. Luckily, the body's immune system is about 90 percent effective at ridding itself of most of these infections in one to two years. But it doesn't always happen that way, leading to HPV-related cancers, warts and other diseases.
The easiest way to prevent HPV is to not have any kind of sexual contact. (Try explaining that your date.) Condoms, since they do not cover the entire contact area, are helpful but not fully effective at preventing the spread of HPV. They leave the vulva, anus, perineal area, base of the penis, and scrotum uncovered, and contact between these areas can transmit HPV. Spermicides have also been shown to be ineffective against HPV. Oral sex? Not so fast. HPV virus can cause warts in the mouth and throat, and there is an increasing rate of tumors of the throat, tonsils and base of the tongue.
So how do you know if you've been exposed? You can't tell by physical examination of your partner's parts unless you see genital warts. For women, the DNA test for HPV can detect some types of HPV most commonly found in cervical cancer. This is used as a follow-up to an unclear Pap test or as a primary screening for women over 30. A Pap test, recommended routinely for women, checks for abnormal cells in the cervix which helps identify HPV disease and cervical cancer in its early stages. For men, there is no test. There is also no treatment for it. Unless he notices the appearance of warts, he may never know he has it.
This is why it is important to prevent the infection in the first place, and why Gardasil has been seen as such a vital new vaccination. Approved by the FDA in 2006, Gardasil (Merck Pharmaceuticals) has been championed as a preventive measure against the most common forms of HPV known to cause cervical cancer and those unsightly genital warts.
Gardasil is recommended by the CDC for vaccination of girls and women 11 to 26 years old. Research is currently being conducted to determine usefulness in men, boys and other age ranges of women. The vaccine is available only with a prescription and is not cheap. The vaccine is given in three shots over six months, and each injection can cost as much as $120. Some health insurance companies may cover all or part of it. Children age 18 and younger may be eligible to get the HPV vaccine for free through the Vaccines for Children program if they are uninsured or covered by Medicaid.
The vaccine is capturing the spotlight with questions and debate regarding its safety and effectiveness and whether its benefits outweigh its potential risks. The CDC, FDA and the manufacturer pay attention to all reported events that occur after a vaccine is given. A recent report from the Journal of the American Medical Association analyzed voluntary reports of post-vaccination adverse effects to prevent HPV. The authors concluded that most of the adverse affects were not any greater than rates compared with other vaccines, but that two complaints — fainting and serious blood clots — were more common than expected. The CDC and many physicians and medical organizations support the continued use of the vaccine, while some physicians are more cautious in recommending the vaccine to all individuals and encourage further research on its safety.
Current research shows that the vaccine is effective for five years. More research is being conducted to determine whether an additional shot or booster is needed. The bottom line is, we don't have all the answers.
The important thing is, if you have ever been sexually active, whether you have received an HPV vaccine or not, you should get annual gynecological checkups and routine Pap tests. Research the pros and cons of the HPV virus and discuss it with your health provider.
When talking with your partner, be direct. The presence of the virus means only that a person contracted the infection at some point in his or her life. Remember that the virus can remain latent in the body for weeks, years or longer.
For more information on HPV and cervical cancer or to find a vaccine provider in your area, visit the College of Physicians of Philadelphia's Web site, phillyhealthinfo.org, a comprehensive directory of health services, events and information for Bucks, Chester, Delaware, Montgomery and Philadelphia counties.
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