As a primary care physician, one of the best tools that I can offer my patients is immunization, as it helps to prevent disease before it happens by providing the immune system with a “home-court advantage,” or as I like to tell my patients, “the answers to the test before it has to take it.” August is National Immunization Awareness Month, so it is fitting to focus on vaccines, in this case the HPV vaccine.
What is HPV, how is it spread and why should I vaccinate myself and/or my children to protect them from it?
HPV stands for Human Papilloma Virus. Humans are the only known host for this virus and there are at least 150 different types in the environment, with 40 of them responsible for genital warts, throat cancer and anal cancer in both men and women; penile cancer in men (responsible for about 1/3 of cases); and cervical, vaginal and vulvar cancer in women. HPV is spread through intimate direct skin-to-skin contact, most commonly through vaginal or anal intercourse. Condoms can reduce transmission, but they don’t stop the spread of HPV entirely. HPV is the most common sexually transmitted infection and is second only to HIV in healthcare associated costs ($8 billion dollars annually).
Currently, the CDC estimates that 79 million people in the U.S. are infected with HPV, and an estimated 14 million new infections occur each year (80 percent of people will get an HPV infection in their lifetime). Once exposed to it, your immune system will typically clear the infection, but in some cases, it may not and if you have been exposed to a cancer-causing strain this is what leads to the development of the cancers previously listed above. HPV types 16 and 18 are responsible for about 66 percent of all cervical cancers, which are responsible for about 4,000 deaths each year in the U.S., 50 percent of high-grade and 25 percent of low-grade cervical lesions and/or abnormal cells on pap smear (which amounts to about 300,000 cases requiring treatment). Types 6 and 11 cause approximately 90 percent of all genital warts; type 16 is responsible for 95 percent of anal cancers. From 2011-2014 the prevalence of any type of oral HPV among adults aged 18-69 was 7.3 percent, with an estimated 3,400 new cases of throat cancer in women and 14,800 new cases in men each year.
How can you protect against HPV?
As of October 2018, Gardasil-9 is licensed to be given in both men and women aged 9-45. Typically, HPV vaccination is performed around age 11-12 as it is best to immunize prior to sexual activity (29 percent of ninth graders report being sexually active and that number grows to 60 percent by 12th grade; after three years of sexual activity, HPV is contracted in 44 percent of individuals). However, the odds of someone being exposed to all strains of HPV is low, so vaccination can still be performed after someone is sexually active. If you received your HPV vaccine prior to age 15, only 2 doses are required, but after age 15, three doses are given.
Is HPV vaccination safe?
More than 100 million doses of HPV vaccine have been distributed in the U.S. and monitored over at least a 10-year period with an excellent safety required. In fact, before the FDA licenses any vaccine, it undergoes years of research, development and testing, and benefits have to outweigh risks before they are brought to market, where continued monitoring occurs. There are three licensed HPV vaccines available, but as of late 2016, Gardasil-9 is the only one being distributed in the U.S. as it provides protection against the widest range of HPV viruses — types 6, 11, 16, 18, 31, 33, 45, 52 and 58. Gardasil-9 does not contain live viruses, is made from one protein that resembles the viral shell of an actual HPV virus and is noninfectious, meaning that it can’t actually infect you with HPV. Gardasil-9 was introduced into the market in 2014 and was studied in clinical trials with more than 15,000 males and females and found to be safe and effective.
Several myths that I have encountered in my practice include believing that HPV vaccination would lead to infertility, and believing that HPV vaccination is a “license to have sex.” There is no evidence to suggest that HPV vaccine causes infertility, and in fact, actually contracting HPV and either developing a cancer or a pre-cancer can affect a woman’s ability to conceive and carry a pregnancy to full term depending upon the type of treatment required (i.e. hysterectomy, chemo, radiation, etc.) HPV vaccination only protects against HPV and not against HIV, herpes, gonorrhea, chlamydia, trichomonas, hepatitis or syphilis, so it is not a free pass to have intercourse. The fact of the matter is that HPV vaccination is a cancer prevention shot.
Common side effects include: Injection site pain, swelling, redness and headaches. Passing out or syncope has been reported after administration, with rates higher in adolescents than adults. There is no increased risk for a serious adverse event after HPV vaccine administration.
Is HPV vaccination successful?
Yes. Studies have shown long-lasting protection in individuals who have received HPV vaccines with rates of infections with HPV types that cause most cervical cancers and genital warts dropping by 71 percent among teenage girls and 61 percent in young adult women. In vaccinated women, HPV types that cause cervical pre-cancers have dropped by over 40 percent.
Never be afraid to ask your doctor questions about any vaccine, including HPV. In fact, I encourage my patients to ask questions as it helps me to understand their perspective, and in turn I try to provide them with the most relevant information that I can. I also always encourage my patients to not just take my word for it, but to go look at the information for themselves on the CDC website, which contains a wealth of information on all vaccines.
Information provided by Andrew Bowers, MD, board-certified family medicine physician who cares for patients ages 5 and older at UT Health East Texas Physicians in Bullard. To schedule an appointment with Dr. Bowers, call 903-596-DOCS.