By Mary Parman, D.O.

Human Papillomavirus (HPV) is the most common sexually transmitted infection in the Unites States, and studies have shown that women and men in their late teens to early 20s are at greatest risk. In fact, 40 percent of HPV infections occur in people who have only been sexually active for two years. HPV is transmitted through direct skin-to-skin contact and is strongly associated with cervical cancer and genital warts. There are approximately 40 HPV strains that can infect the genital tissues of men and women.

How does this relate to my child?
In 2006, the U.S. Food and Drug Administration (FDA) approved the vaccine Gardisil for the prevention of cervical cancer, precancerous genital lesions and genital warts. Experts on the vaccine recommend that it be given to girls/women between the ages of nine and 26 – with the target age being 11 to 12 years.

Why vaccinate so young?
Like all vaccines, Gardisil can only protect against disease if it is given before someone is exposed to HPV. Since HPV infection is most commonly acquired during the first several years of sexual activity, the vaccine is most effective when given to girls who are not yet sexually active. Studies have found that 7.4 percent of girls are sexually active by age 13 and 60 percent are sexually active by the end of high school. Sometimes parents are concerned that a doctor who recommends the vaccine may think their daughter is promiscuous or that getting the vaccine will encourage their daughter to become sexually active, but this is not the case. The recommendation to vaccinate young is based on broad national data and not on individual patients. In addition, no link has been found between getting the vaccine and early sexual activity.

How does the vaccination work?
The Gardisil vaccination covers four viral strains of HPV that cause 70 percent of cervical cancer and 90 percent of genital warts. It is made of noninfectious virus-like particles and is given as a series of three injections over six months. Studies have shown that the vaccination protects against complications caused by these four HPV strains in 98 percent of cases and that the protection lasts for at least five years. Researchers do not yet know if girls and women will need a booster shot after five years.

Is the vaccination safe?
The FDA approved the vaccination as safe and effective in 2006. In addition, clinical studies performed around the world have found no serious side effects. Mild injection site soreness is the most common side effect. The vaccine contains no thimerosal or mercury, but it is yeast-based and should not be given to those with a yeast allergy.

Is the HPV vaccination required?
There has been an ongoing debate in the United States and beyond as to whether or not this vaccination should be mandated for girls entering public schools. California does not require it, but this could change in the future.

Can the vaccination be given to boys/men?
Currently, the vaccination is not offered to boys/men because researchers are still studying if it is safe and effective in the male population. Boys/men often have no ill effects from HPV infections. However, by being vaccinated, they could possibly protect the health of their future sexual partners.

Will girls/women that receive the HPV vaccination still need Pap smear screening?
Yes. The vaccination does not protect against all HPV strains. Women should start Pap smear screening three years after first intercourse or at the age of 21 (whichever comes first), and then repeat the test annually until age 30.

Is the vaccination covered by insurance?
As of September 29, 2007, approximately 98 percent of private insurance plans covered the vaccination. Additionally, there are federally funded vaccination programs for children covered by Medicaid, uninsured children and other underserved populations.

Where can I find out more information?
www.cdc.gov

References:
www.cdc.gov

Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Kari P. Braaten, M.D., MPH, Marc R. Laufer, M.D. Reviews in Obstetrics & Gynecology. 2008;1(1):2-10.

Dr. Parman is a physician at the Palo Alto Center's Department of Obstetrics and Gynecology.