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Have you heard of HPV?

April 22, 2007

Matthew Vasey, MD



Every once in a while, there are landmark accomplishments made in the field of medical research. A recently developed vaccination for Human Papilloma Virus (HPV) is one of them. The medical literature gives the female public a "poor" grade when it comes to knowledge of the virus. (2) The HPV can lead to uncontrolled replication of cells yielding from what can be harmless, yet aesthetically unpleasing genital warts, pawned off as razor bumps to potentially life threatening metastatic cancer of the cervix, ergo, so many Papanicolaou tests, or "Pap smears". Not all types produce warts, so you may not even know you have it. The HPV has also been implicated in some types of oral cancers, particularly of the tonsils. (1) This vaccine is truly a great medical discovery.

Here are the facts from the U.S. Centers for Disease Control and Prevention and the Journal of the American Medical Association

General prevalence of HPV
Incidence of HPV in U.S. women: 26.8 percent
Incidence of HPV in U.S. men: As high as 50 percent (estimated)
HPV infections that clear up within two years: About 90 percent

Cancer and HPV
Number of U.S. women who develop cervical cancer each year: 9,600
Number of U.S. women who will die from the disease: 4,000
Types of HPV: More than 100, but only a few lead to cervical, anal and other genital cancers.
Discovery: High-risk types of HPV are detected in 99 percent of cervical cancer cases.
Most common: HPV types 16 and 18 are found in about 70 percent of cervical cancer cases.
Vanishing: Most high-risk viruses will go away rather than cause cancer.

The federally approved vaccine
Protection: The Gardasil vaccine guards against HPV types 6, 11, 16 and 18.
Prevention: This prevents about 70 percent of cervical cancer cases and about 90 percent of genital warts cases.
No side effects: The vaccine has been tested in 11,000 women, and no serious side effects have been found.
Expense: The retail cost of the vaccine starts around $120 per dose, three of which are required for a full series.
Who should have it: The vaccine is recommended for 11- to 12-year-old girls and can be given to girls as young as 9.
Further tests: It is unknown whether the vaccine is effective in boys or men. This is being studied. Other direct benefits: It is possible that vaccinating males will prevent genital warts and rare cancers, such as penile and anal cancer.
Indirect benefits: It also is possible that vaccinating males will have indirect health benefits for females by reducing the spread of HPV.

If you are a female, and have not received the vaccine, you should consider bringing it up with your doctor at your next visit, or even schedule a visit just for this. While the vaccine has not shown to be effective in treatment of existing infections of the virus, it can still protect you from acquiring the other variations in HPV types.

There are a range of treatments available for existing infections, all of which focus on controlling and eliminating the presentation of the wart. As with all things in medicine, an ounce of prevention can be worth a pound of cure.

In regard to a vaccination used to prevent a sexually transmitted disease, there are obvious moral issues confronted when deciding at what is the appropriate age for vaccination.

REFERENCES:

Scully C. Oral squamous cell carcinoma; from an hypothesis about a virus, to concern about possible sexual transmission. Oral Oncol. 2002 Apr;38(3):227-34.

Waller, J., McCaffery, k., Forrest, S., Szarewski, A., Cadman, L., Wardle, J. Awareness of human papillomavirus among women attending a well woman clinic. Sex Transm Infect 2003;79:320-322

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