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HPV, Cervical Cancer Vaccine: 15 Facts
Gardasil, the new vaccine against human papilloma virus (HPV) -- which causes cervical cancer and genital warts -- is now available nationwide.
Here is what you need to know now about this new vaccine.
1. What is Gardasil?
Gardasil is a vaccine, licensed for use in June 2006, by the FDA. It targets four strains of human papillomavirus (HPV) -- HPV-6, 11, 16, and 18. HPV-16 and HPV-18 account for about 70% of all cervical cancers. HPV-6 and -11 cause about 90% of genital warts. HPV is also linked to anal cancer.
2. How does HPV spread?
Sexual activity spreads the virus, a very common one. It's one of the most common sexually transmitted diseases (STDs) in the country, according to the CDC, with more than 20 million people currently infected and another 6.2 million contracting the virus each year.
About half of those with HPV are aged 15 to 24. Surveys suggest 3.7% of U.S. Girls have sex by age 13, and 62.4% have had sex by the 12th grade.
3. Who should get the vaccine?
Gardasil is approved by the FDA for girls and women ages 9 to 26. The CDC and the American Academy of Pediatrics recommend that the vaccine be given routinely to girls at age 11 to 12 years old, although doctors may choose to vaccinate girls as young as 9. The CDC also recommends the vaccine for women age 13 to 26 who did not receive the vaccine at an earlier age.
However, if a girl or woman is already infected with HPV, the vaccine will not prevent that strain of HPV from causing disease. It will protect against new infections with other strains of HPV included in the vaccine.
The vaccine is also being studied in women up to age 45, although that group may be targeted for the vaccine later.
The vaccine is being studied in males, too. Men can get HPV infections and can pass the virus to their sex partners. HPV causes genital warts and is associated with rare cases of cancer of the penis. Particularly in gay men, HPV is linked to anal cancers. Merck is currently testing Gardasil in men, including gay men.
4. What is the best way to talk to my daughter about this?
Emphasize that the primary goal is to help prevent cervical cancer. If you, as a parent, are worried this will give your child a false sense of security that they can't catch a sexually transmitted infection from sexual activity, you can also emphasize that the vaccine only protects against certain strains of HPV -- not against any of the many other types of sexually transmitted infections.
5. Does Gardasil protect against all cervical cancers?
No. The vaccine does protect against the strains of HPV most likely to cause cancer. But it does not protect against all HPV strains.
However, recent reports suggest that the vaccine may give wider protection than originally thought. There is preliminary evidence it may offer some protection against other HPV strains, which cause 8% or 9% of cervical cancers.
6. How effective is the new vaccine?
Studies have shown it is 100% effective in the prevention of cervical precancers and noninvasive cervical cancers caused by HPV-16 and 18 in those not already exposed to those strains, according to Merck & Co. Inc., which makes Gardasil. Merck is a WebMD sponsor.
7. If someone is already sexually active, will this vaccine still work?
If a person has been infected with any of the four strains the vaccine protects against, the vaccine won't provide protection against that type. But it will prevent infection from the other three.
8. How long is Gardasil effective?
Research suggests the vaccine lasts at least four years. Long-term results are not yet certain. The protection might last longer.
9. Does the vaccine actually contain HPV or any live virus?
No. It has a virus-like particle, but not the actual virus.
10. Is Gardasil safe?
Clinical trial data have found it is safe.
11. What does the vaccine cost? Will insurance cover it?
The "list" price is about $120 per dose, and three doses are needed. But that is the price your doctor pays to the manufacturer. It does not include the cost of an office visit or other charges, so the cost to individuals could be higher. The federal Vaccines for Children Program will provide free vaccines to those under age 19 who qualify. More information on that program is on the CDC web site, www.Cdc.Gov. A number of insurers say they plan to cover the costs.
12. Is it available everywhere in the U.S.?
Supplies have been shipped nationwide, according to Merck, although your individual doctor's office or clinic may not have ordered it.
13. Will the new vaccine make cervical cancer screens such as the Pap test passé?
No. Screening with a Pap test is still needed, since the vaccine does not protect against all cervical cancer.
14. Is this the only vaccine for cervical cancer?
There's a second vaccine in the works: Cervarix, from GlaxoSmithKline. Cervarix targets two HPV strains, HPV-16 and HPV-18. GSK says it plans to seek FDA approval for Cervarix by the end of the year. Early studies find that this vaccine, like Gardasil, is extremely safe and effective. GlaxoSmithKline is a WebMD sponsor.
15. How common is cervical cancer and how deadly?
The American Cancer Society predicts that in 2007, there will be about 11,150 new U.S. Cases of invasive cervical cancer, and 3,670 cervical-cancer deaths.
Cervical cancer is the second most common cancer in women worldwide. There are about 500,000 new cases, and 250,000 cervical-cancer deaths each year. According to the World Health Organization, nearly 80% of cases occur in low-income countries, where cervical cancer is the most common cancer in women
Asking For A Friend: Can I Have Sex If I Have HPV?
One in eight of us will contract HPV at some point in our lifetimes (Picture: Getty)Asking For A Friend is the series where we answer the questions you've always wanted to ask.
In the year of Our Lord 2023, you'd expect sex positivity to extend to people with sexually transmitted diseases – but why does contracting something like HPV feel like a dating death sentence?
Human papillomavirus is the name given to a group of sexually transmitted diseases that can – but don't always – cause symptoms like genital warts and abnormal cervical cells.
If you've shown symptoms of having HPV, or found out you have it through a cervical screening, navigating sex can be terrifying, but it's important to know that contracting HPV doesn't have to spell the end of your sex life.
Condoms only provide partial protection from HPV (Picture: Getty Images/iStockphoto)'It's all shame-based,' says Dr. Katherine Hertlein, world-renowned couples therapist and lead advisor at sex therapy app Blueheart. 'And that shame can cause a lack of confidence in dating where the person may feel like they don't know how to meet people and they don't want to explain it.'
She continues: 'It creates a negative cognition of "I am damaged and broken" which can lead to depression and anxiety, and this creates isolation, so it really is a vicious circle.'
But it doesn't have to be that way. While anyone with an STD might feel obligated to tell a potential partner about their infection, HPV is unlike other STDs, and it's likely the majority of people will have been in contact with it before.
HPV can only be detected via a cervical screening test (Picture: Getty Images/iStockphoto)While condoms work to protect people from many STDs, like chlamydia, though, HPV is different.
As Karen Hobbs, an expert working with The Eve Appeal, explains, condoms only partially protect from HPV, for example if the affected area is covered with the condom.
'But using condoms consistently doesn't mean that you won't ever get HPV, as HPV is also passed on through skin to skin contact and can infect areas that condoms don't cover, such as the scrotum,' she tells Metro.Co.Uk.
It's important to note that HPV can also be passed on through oral sex, anal sex, mutual masturbation and sharing sex toys.
Plus, you can pass HPV on to your partner whether you have symptoms or not, meaning it's likely that many people may contract HPV without ever finding out, especially since the only way to get tested for HPV is via a cervical screening test, which of course only applies to people who have a cervix.
Essentially, Karen continues: 'The only way to not get HPV or pass on HPV is to refrain from any type of sexual contact, which isn't realistic for most people,' which is why an estimated 80% of us are likely to get it in our lifetimes.
So, is it considered safe to have sex if you have HPV? In short, yes.
'Our immune system is designed to get rid of HPV, like it does with colds, for example,' explains Karen. Plus, ther NHS runs vaccination programmes against HPV for certain demographics.
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'Most HPV infections will go away on their own within two years, although it's difficult to know whether a strain of HPV has completely gone away or was lying dormant, as some people are shown to have the same type of HPV more than once.' She adds that most people with HPV won't get any complications or issues.
Of course, though, it's always a good idea to go for regular cervical screenings and wear condoms where applicable, especially with new or multiple partners.
Safe sex is good sex – that should go without saying.
Do you have a story to share?
Get in touch by emailing MetroLifestyleTeam@Metro.Co.Uk.
MORE : How to talk to your children about HPV
MORE : Who is eligible for the free HPV jab and how much does it cost for others?
MORE : 'It's incredibly easy to pick up': Experts explain why HPV is nothing to feel embarrassed or ashamed about
I Have HPV. What Should I Do?
Got an HPV diagnosis? Don't panic. Here's everything you need to know about the extremely common virus.
HPV stands for human papillomavirus. There are over 100 different types of HPV. (Cavallini/BSIP/picture alliance) What is HPV? HPV stands for human papillomavirus. There are over 100 different types of HPV. The majority are harmless, but around 14 strains can cause cancer, which is why so much focus has been placed on eradicating the virus over the past three decades. (Also read: India accounts for the highest number of cervical cancer cases. Watch out for these warning signs)
Estimates say around 11.3% of women and 21% of men have HPV globally. Around 604,000 people were diagnosed with cervical cancer linked to HPV in 2020 and 342,000 people died, according to the World Health Organization.
90% of these cases and deaths occurred in low-income countries, where screening capacity and vaccine supply is low.
According to the US government's Centers for Disease Control and Prevention, nearly everyone will get HPV at some point in their lives, so you can rest assured that you are not alone.
What are the symptoms of HPV?The vast majority of people with HPV won't experience any symptoms, but a minority will notice genital warts — small growths in the genital region or the mouth.
It's important to know that genital warts are the only clinical manifestation of HPV, and the strain that causes these warts is not the type that causes cancer, says Diane Harper, a professor of medicine at the University of Michigan who specializes in HPV and served as an investigator in the clinical trials of the HPV vaccines Gardasil and Cervavix.
"The high risk types that go into cancer really don't have any signs or symptoms at all," says Harper. "You have absolutely no idea that you're infected with it…That's what makes it really disturbing when you get the piece of information from your doctor that you tested positive because you're like, where did this come from?"
How do you get HPV?You can get HPV through skin-to-skin contact, generally during sex — even non penetrative. Although a condom helps prevent it, it doesn't fully protect you, because it doesn't cover all skin around the genitals.
With that said, the notion that you can only get HPV from sex is a misconception, Harper says, adding that between 10 and 15% of children are born with the virus. This happens when the mother carries the infection during pregnancy.
"If you've never had sex, it's highly likely you probably won't have had exposure, but it's not impossible," she says.
That's part of the reason people can never truly know the origin of their HPV infection. The other reason is the fact that HPV may not make itself visible immediately after a sexual encounter with an infected person. It is possible that a HPV infection only presents on a test years after exposure.
"For women to develop cervical cancer, they have to be exposed to HPV, but that exposure isn't just from the partner they were with," Harper says. "The partner's partners bring a lot to the bedroom. Men often have a lot of partners, especially early on as they're maturing and going through adolescence…every single one of those partners that they have they bring to the woman that they're now with."
What happens when I have HPV?In the vast majority of cases, HPV won't turn into anything.
"When a woman is infected with HPV, and it's the first time that she's been found to have HPV, I will tell my patients that 90% of women will clear it on their own, which is why we're not testing really young girls anymore," says Harper.
The older a woman gets, the more worrisome HPV can become, but the risk is still small. If you have genital warts, you will be prescribed medication or a cream to heal them, or you can get them removed using different types of therapies, like electrocautery, freezing or laser treatment.
Even when the warts go away, you will remain a carrier of the strain that caused them, which means you can still spread them and they can still come back in the future. Like other strains, warts can come shortly after exposure or months to years after. Or you can carry the strain without ever developing them at all.
But what about cancer?In a minority of cases, HPV can turn into cancer. Only a handful of HPV strains are cancerous.
If you have one of these strains, Harper says you will need to stay in screening to ensure it doesn't develop into cancer. In the rare case it does, it will take years to develop after the initial exposure, which is why screening is so important.
The most common type of cancer caused by HPV is cervical cancer, which occurs in the cells of the cervix, the lower part of the womb that connects the uterus to the vagina. The trademark sign of cervical cancer is abnormal vaginal bleeding, Harper says. But it's essential to get into screening before these symptoms develop, because by then, there's little doctors can do.
HPV is also thought to cause 70% of oropharyngeal cancers in the United States, according to the US Centers for Disease Control and Prevention, likely due to strains spread through oral sex. This number has been rising over the course of the past decades. However it's still unclear whether HPV is the only cause or if it's a mixture of HPV and something else, like smoking.
It can also cause other types of genital cancers in men, although this is very rare. The presence of these cancers is why men need to pay close attention when their female partners get an HPV diagnosis and get screened themselves.
Do I need to tell my partner? My past partners?Harper says she only advises people to tell their current partners about an HPV diagnosis, partly for the sake of supporting the woman as she goes through follow-up exams and partly because partners can choose to use condoms to prevent spreading the virus back and forth between each other.
Although condoms can stop the spread of some HPV, Harper says they are not necessary for monogamous couples in which both partners are already infected, and leaves it up to her patients to decide for themselves.
"Condoms will prevent about 60% of HPV transmission. So it's like, is that good enough for you? I think that's a personal decision," she says.
She doesn't advise patients to tell their past sex partners because "unlike something like syphilis or gonorrhea or chlamydia, we have no treatment for it."
If there was a treatment, she says, it would make sense to tell past partners, because they could tell their female partners, who could get tested and treated. But since that doesn't exist, she says it's not necessary.
What about the HPV vaccine?The best way to prevent HPV is by getting the vaccine, but the vaccine doesn't offer 100% protection against the virus, which Harper says is sometimes forgotten.
The HPV vaccine Gardasil 9 is only protective against seven — around half — of the cancer-causing types of HPV. These seven include the strains most likely to cause cancer, 16 and 18, as well as many of the strains that cause genital warts.
"[Patients] need to know that because HPV vaccination is a wonderful bridge to screening but we can't forget about screening because the vaccination isn't 100% coverage," she says, adding that if people think the vaccine they may think they don't need to screen, which is a problem.
With that said, Harper says that she always suggests that people get the vaccine if it's available to them.
I'm old. Should I get the vaccine?Harper says that although mass vaccination of women over 25 will do little to eliminate cervical cancer at a population level, she still suggests it on a personal level if a woman wants to invest in it.
"The way the vaccine works is it grabs onto that little HPV particle and won't let it go into the cell," Harper says. "And so it makes it so it doesn't fit into the receptors and so that part of it becomes very clear that it works to prevent that [spread]."
How do I know if the HPV is gone?By continuing screening, you can keep track of your HPV.
Does an STI test detect HPV?Traditional STI tests don't catch HPV, and although pap smears may detect it, they aren't nearly as accurate as actual HPV tests themselves. These tests are the most sensitive and will detect HPV if you have it.
Will the HPV live in me forever?In the vast majority of cases, the HPV is no longer detectable after a few years. This is when doctors say it has been "cleared". But there are rare situations in which the HPV reoccurs. Harper stresses these situations are seldom but do happen, which means it's impossible to say HPV goes away completely.
Edited by: Fred Schwaller
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