The human papilloma virus is unfortunately the most common sexually transmitted disease today. It is known to be present in 60-70% of the sexually active population. After over 20 years of research, it is clear that more than 100 subtypes of this virus can cause women to develop cancer of the cervix. Types 16 and 18 are present in more than 70% of cancer of the cervix cases. Types 6 and 11 are found in over 90% of genital warts cases. You can have the HPV virus without ever developing lesions, with the infection going through stages. Many people recover, clearing the virus with no consequence. Others however do not, and infection with other subtypes can occur.

The vaccine Gardasil was introduced in June of 2006, targeting the four subtypes noted-16, 18, 6 and 11. The CDC approved of this vaccine, to prevent high-grade premalignant lesions of the cervix, cancer of the cervix, and genital warts. The vaccine is not infectious, and does not predispose a patient to malignancy. It does however stimulate an immune response against those subtypes noted. Three doses over a six-month time span are recommended, the initial injection, a second dose at two months, and a final dose at six months after the initial one.
The cost for each dose is around $150, with almost all insurers now
covering this.

After more than four years in clinical trials, the vaccine was found to be almost 100% effective in preventing moderate to severe dysplasia, cancer of the cervix, as well as genital warts. It does not protect against the other subtypes less likely to cause these conditions, nor does it protect against any other sexually transmitted disease. Ongoing
studies will determine the potential need for a booster vaccine at
5-10 years later.

The primary indication for this vaccine is prevention of cancer of the cervix, with the initial focus on the female population. Prevention requires protection prior to exposure, the least comfortable part of the campaign promoting Gardasil - the vaccination of young females against a sexually transmitted disease prior to the onset of sexual activity. Current recommendations are for this vaccine to be administered to all females 9-12 years of age, in addition females 13-26 years of age not previously vaccinated. Any female not in a long-term mutually monogamous relationship and therefore at risk of exposure remains a candidate as well, even with previous removal of the uterus and/or cervix.

HPV 16 and 18 are present in more than 80% of all vaginal and vulvar cancers. The vaccine remains recommended even if the patient is currently undergoing treatment for an abnormal Pap smear. Protection against subtypes not already involved in the present condition is expected. The series currently is not advised during pregnancy, though no adverse outcomes have been reported. Vaccination is simply recommended deferred until after birth. Obviously the male population prior to sexual debut is another target, but this remains in study
phase only.

If indeed, over the next 20 years there is a widespread successful HPV vaccination program, with outcomes as predicted by the clinical trials, recommendations for routine Pap smears will change. This, however, will require some time, as this target group covers a large age span, with no other impact on sexually transmitted diseases. Any young female or male patient considering becoming or already sexually active is encouraged to limit the number of sexual partners for their lifetime, and to use condoms to help prevent exposure to sexually transmitted diseases, in conjunction with reliable birth control. For further information, you may contact Washington Women's Care, or visit www.HPV resource.org.

(252) 946-6544 • 1-800-675-5694