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March 21st, 2007

SOHO JOURNAL MEDICINE MAN: BE ONE LESS

by John J. Flanagan

Any of you who watch daytime TV have no doubt seen one of the “Tell Someone” or “Be One Less” commercials by pharmaceutical giant Merck for its new HPV vaccine, Gardasil. HPV, human papilloma virus, is the most common sexually transmitted infection in the United States and the cause of cervical cancer. This vaccine, targeted at girls ages 11-12, is not without controversy. We asked local women’s health expert Anne Miller, N.P. to shed some light on this issue.

SJ: Let’s start from the beginning: What is HPV and why do we care?
AM: HPV refers to a group of over 100 viruses. About 30 of these viruses are transmitted sexually, so HPV is often referred to as an STI (Sexually Transmitted Infection). These viruses can cause genital warts and cervical cancer.

SJ: So HPV only affects women?
AM: At least 75% of sexually active people will be infected with HPV-men and women.

SJ: That’s a scary number, could that possibly be right?
AM: Absolutely. The Centers for Disease Control estimates that 20 million people at any given time are infected with HPV. But many people are asymptomatic and do not know they have HPV.

SJ: What else contributes to HPV infection?
AM: Cigarette smoking, few or no screenings for cervical cancer, multiple sexual partners, immuno suppressed state, long term use of oral contraceptives (longer than 2 years), co-infection with another STI, pregnancy nutritional deficiencies, folate deficiency, increased exposure to ultraviolet radiation and early onset of sexual activity.

SJ: So HPV can cause cervical cancer?
AM: Yes. According to the American Cancer Society Over 9,000 women were expected to be diagnosed with cervical cancer and 3,700 will die.

SJ: So now we have a vaccine to prevent this?
AM: In June 2006, Gardasil, the first vaccine to prevent cervical cancer and genital warts, received F.D.A. approval. The vaccine is manufactured by Merck. The HPV vaccine protects against HPV types 6, 11, 16 and 18, which together account for about 70% of cervical cancer and 90% of genital warts. Women who already have been infected with HPV are still candidates for the vaccine. These women still may attain protection from an HPV virus type they have not been exposed to.

SJ: So how does the vaccine work?
AM: The HPV vaccine is given as a series of three injections over 6 months with the second and third dose given two and six months after the initial dose. The vaccine works by inducing the body to create antibodies to the 4 strains of HPV, which prevents initial infection. Current study results indicate that females who receive the vaccine are protected for at least five years.

SJ: Apparently this vaccine is controversial.
AM: Most vaccines tend to be controversial when they first come out.

SJ: So why Gardasil?
AM: The vaccine is recommended for girls age 11-12. The regimen may begin as early as 9 and can be given to women up until age 26. Some people have argued that giving a vaccine that targets an STI to a pre-teen might encourage that girl to become sexually active-if they are not already. Others think that it may encourage promiscuity due to a false sense of protection.

SJ: What do you think about that?
AM: If these girls receive proper counseling from their health care provider, and parents talk to their kids about sexual responsibility, this is not an issue. As the commercial says, if there can be one less case of cervical cancer, it’s worth it. I can’t overemphasize how important it is for parents or guardians to talk to their kids about their sexual health. Also, the state of Texas recently made this vaccination mandatory and New York and Connecticut are considering this also.

SJ: Now what about men?
AM: Even though men are susceptible to HPV and carry the high risk strains of HPV, they are less likely to develop cancer. According to 2006 figures, 989 new cases of penile cancer and 1453 new cases of anal cancer were reported for every 100,000 men compared with 12,085 new cases of invasive cervical cancer for every 100,000 women. At present, HPV screening or immunization is not recommended for males, although discussion and studies continue with regard to male immunization. Gay men who have receptive anal sex should talk to their doctor about HPV screening.

SJ: How much does the HPV vaccine cost?
AM: The CDC reports a private sector list price of $119.75 per injection. Many insurance carriers are reimbursing for the vaccine. The price may fall as other vaccines are developed. GlaxoSmithKline is working on a similar vaccine that may get approval this year.

SJ: So Anne, are there any parting messages for our readers?
AM: Yes-woman of all ages should continue to routinely schedule gynecologic care; this must always include pap smears. For more information on the HPV vaccine, visit the Centers for Disease Control website at: http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm

Anne Miller NP, MSN is a nurse practitioner in Greenwich Village and Director of Health Services at SUNY F.I.T.

Editors Note: We at the Soho Journal do not condone or recommend this vaccine. We simply deliver information to our readers from health care professionals. What we do suggest is an open and honest relationship with young adults who are nearing the ages where sex might become an issue and educate them about sexual practices. The more information they are armed with the better off they will be. Although it seems to have faded from the public eye, HIV is still very much alive and spreading along with a multitude of other sexually transmitted diseases. At the end of the day it’s going to be education and information that will save the greatest amount of lives.
–The Editors

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