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Health & Wellness

The ABCs of HPV

Why men, as well as women, need to be vaccinated

Gardasil, HPV vaccine, sexually transmitted disease, STD, STI

Gardasil is the most common HPV vaccine and requires three doses to work. Photo by the Associated Press

Here’s a rather sobering statistic: at least half of sexually active people will contract the human papillomavirus (HPV) at some point in their lives, and most won’t even know it.

Currently, 20 million Americans are infected with HPV, and another 6 million become infected each year, making it the most common sexually transmitted infection, according to the Centers for Disease Control and Prevention. Most people who become infected never show any signs or symptoms, and in 90 percent of cases, the virus goes away of its own accord within two years. But in other cases, HPV can lead to genital warts and cervical and other rare cancers.

In 2006, a vaccine was introduced in the United States to prevent some forms of HPV. The initial recommendation was that girls and young women ages 11 to 26 (and as young as age 9) should receive the vaccine. Additional research has found that giving the vaccine to boys and young men—especially before they become sexually active—can reduce their risk of developing genital warts and some associated cancers. In October, the Federal Advisory Committee voted to urge that young men ages 9 to 26 be vaccinated against HPV.

The HPV vaccine (Gardasil is the most common) protects against the types of HPV that cause most cervical cancer, as well as anal, vaginal, and vulvar cancers and most genital warts.

At present, there is no test on the market that can check overall “HPV status.” Women can be screened for the virus with a normal Pap test, but there is no test at all for men. Condoms may lower the risk of HPV transmission and HPV-related diseases, just one of the reasons why using condoms is so important. Even people with only one lifetime partner can contract HPV if the partner has previously had sex with an infected person.

Rebecca Perkins, a School of Medicine assistant professor of obstetrics and gynecology, has done research at Boston Medical Center on the attitudes of parents and providers about young women being vaccinated for HPV. She is currently collecting data on young men.

Perkins spoke with BU Today about why doctors now recommend the HPV vaccine for men as well as women and the dangers associated with the STI.

BU Today: Why should young people get the HPV vaccine?

Perkins: HPV is the most common sexually transmitted virus, and about 80 percent of people will have it at some point during their lives. It’s also classified as a human carcinogen. There are more than 40 types of HPV that are transmitted through sex or genital contact. It causes cancers of the cervix, penis, oropharynx (base of the throat), vagina, vulva, and anus. Cervical cancer can be prevented through screenings, but we don’t really have good screening measures for any of these other cancers.

Certain cancers, like oral and vulva, have been rising significantly over the past couple of decades. An October 2011 study published in the Journal of Clinical Oncology found that between 1984 and 1989, about 16 percent of oropharyngeal cancers were linked to HPV, but between 2000 and 2004, 72 percent were linked to HPV. This reflects different social behaviors, specifically more oral sex with different partners among the population, combined with a lower amount of cigarette smoking, which is what used to cause those cancers. So with less smoking and more oral sex, you saw a dramatic shift from only 16 percent being HPV-related to 72 percent being HPV-related. We see about 7,000 new cases in the United States every year.

In the past, doctors gave this vaccine only to women, and now they are recommending that men get it as well. Why is it important for men to be inoculated?

It’s important for men to get vaccinated for two reasons. The first is because it’s a contagious disease, so it’s to prevent transmittance from partner to partner. The other reason is for men themselves. Oral cancers are much more common in men than in women. Of the about 7,000 oral cancers that are diagnosed in this country every year, 5,000 will be in men. And there is no screening or preventive measure for it other than the HPV vaccination. I think this is the most important reason why men should be vaccinated.

Why wasn’t the vaccination recommended for men initially?

The first trials were done in women, looking at the end point of cervical dysplasia, also known as precancer of the cervix. They then decided to also do the trials in men and found that the vaccine reduced the risk of genital warts. It’s important, but since no one ever died from a genital wart, it was not enough of an indication to give it the strong recommendation that it has more recently gotten. That recommendation was given because researchers were actually able to show a decrease in anal precancers, similar to what was seen in terms of the reduction of cervical dysplasia in women.

Studies have shown that the vaccine works best in those who haven’t already been exposed to HPV. So if you’re sexually active, is it still worth getting the shot?

That’s a very good question and the answer is—definitely. Most people will acquire HPV within the first two years of their first sexual experience. There are about 40 different types of HPV that can infect the genital area, and the vaccine covers 4 of those types. Since the vaccine is a preventive vaccine, if someone has already been exposed to the HPV types that the vaccine wards against, the vaccine won’t work. A study found that 90 percent of college-age students will probably still get some benefit from the vaccine because they will have been exposed to none of the four types or only one or two of them. It’s worth the chance.

The HPV vaccine actually requires three separate shots. Is it important for people to receive all three?

Some vaccines will work with only one injection. There is some evidence that the HPV vaccine Cervarix—which is approved in this country, but only for females—may be effective with only one or two doses. But Gardasil, the most common vaccine, seems to require all three doses to actually work.

Are as many people getting vaccinated as expected?

As of 2010, the National Immunization Survey showed that 49 percent of females between the ages of 13 and 17 had received at least one dose of the vaccine and only 32 percent had actually completed the series. It’s certainly lower than the goal, which would be 80 percent, similar to any other recommended vaccine. When you compare it to when the chicken pox vaccine was introduced, and when the hepatitis B vaccine was started, it’s probably on par with those, because it always takes vaccines a while to catch on. Now that boys are in the mix as well, we’ll have to see how that plays out. Hopefully it will become more normal as part of the standard adolescent vaccine, but if the uptake in boys isn’t very good, and they’re included in the statistics, those numbers could fall even farther.

Are there any side effects or risks associated with the vaccine?

As with many vaccines, arm pain is the most common side effect. Also, some young women seem to faint when they get the vaccine, which could be just a reaction to the pain of the shot or maybe they’re scared of needles. It’s something that happens within 15 minutes of getting vaccinated, not something that happens three days later. Rarely, people can be allergic to things in a vaccine, but the rates of any serious side effect seem to be low or lower compared to other vaccines that we commonly give, like hepatitis and tetanus. We’ll have to see when we start giving it to more men if the males are fainting more than the females.

There has been some controversy surrounding the vaccine. What’s behind that?

Parents have two main concerns about this vaccine. Any time you have something new, people are afraid of the side effects. A lot of parents and doctors wanted to wait to see what, if any, side effects there would be. We have data on over 25 million doses in the United States and more data coming from Australia, Canada, and throughout Europe. The vaccine first came out in 2006, and I think at this point if there were any serious side effects we would have heard of them by now.

The other controversy was about giving a vaccine against an STD. Some parents are concerned that it might send the wrong message, that they were condoning sexual activity, that their kids wouldn’t use a condom. But we have found that it is actually a minority of parents that feel that way. It’s something that’s gotten lots of media coverage because it’s attention-grabbing, but it is really a minority of parents who will decline the vaccine for that reason.

How did you became involved in HPV research?

In 2007 and 2008, I did research at Boston Medical Center looking at parents’ attitudes towards HPV vaccinations. The patient population was generally low-income, minority, and immigrants. These parents were actually very accepting of the HPV vaccine—90 percent said not only were they in favor of the vaccine, but they went ahead and followed through getting their daughters vaccinated. I also did a medical record review, which didn’t show quite such rosy numbers, sort of on par with the national average, showing that about only half of girls finish up with the dosing of the vaccine. I’ve also done a little bit of work with providers, asking them their impressions around this particular vaccine. Providers themselves have different opinions: some think it’s the most amazing thing because it is a vaccine designed to prevent cancer, but some people are scared to bring up a vaccine for a sexually transmitted infection with the parent of an 11-year-old girl. Our current research project involves interviewing parents of boys, and we are still collecting data.

At BU, students can receive HPV vaccinations at Student Health Services; the cost is $165 per dose, and insurance usually covers it. Planned Parenthood, at 1055 Commonwealth Ave., offers the vaccine free of charge for those who are 19 to 26, have no health insurance, and meet financial criteria.

Amy Laskowski

Amy Laskowski can be reached at amlaskow@bu.edu.

9 Comments on The ABCs of HPV

  • James Tompkins on 12.07.2011 at 9:13 am

    This is a total crock. This vaccination is dangerous like many of the other vaccinations the pharmaceutical companies push on the unwary public to bolster their products. The number of people permanently maimed and killed by this poison make it not wise to use. In none of these studies have i seen figures for how many people this virus kills yearly and until that number FAR exceeds the number of people injured by the cure it is not viable.

    • Terry Smith on 12.07.2011 at 10:10 am

      According to your statement, you’ve read over many of the studies regarding this vaccine. If that’s the case, could you please list the study and statistics that give figures for how many people are “permanently maimed and killed” by the HPV vaccine?

      Otherwise, your statement is likely just part of the anti-vaccination movement (a la Michele Bachmann and Jenny McCarthy), as there is no data whatsoever to support this stance, other than a study in which the researchers completely fabricated the data.

      • Jon Jensen on 12.07.2011 at 11:34 am

        I don’t have enough information to understand the risk vs. benefit equation for HPV vaccines, but I think the same questions that Terry asked to James should be asked of Rebecca (and maybe it was but not printed here) and asked of all of the doctors who give this (and other) vaccine(s) – namely please site the statistics of the side effects. The comment “…people can be allergic to things in a vaccine, but the rates of any serious side effect seem to be low…” is a very soft statement without any actual data.

        I think many vaccines are beneficial from a public health perspective, but once a lot of diseases are wiped out at some point the benefit vs. risk equation becomes less of a slam dunk. Let’s say they come out with a vaccine for strain A strep, which kills about 2,000 people a year in the US (compared to 4,000 women who die of cervical cancer each year in the US), but 0.x% of people who take the strep vaccine get a life threatening blood clot. How low does x have to be for you to consider giving it to your child? If a doctor tells you that the risk is lower than other vaccines, is s/he giving you enough info to make an informed decision? I don’t think so. But too many people inherently trust doctors to do that and so will go along with their suggestions without further research on their own.

        In my experience, doctors don’t provide patients (and parents of patients) with enough information to make an informed decision about the risks. My comments here are not intended to pass judgment on HPV vaccines, but to encourage a more honest dialogue about risk vs. benefit. A general anti-vaccine movement is not in our best interest, but neither is suppressing the facts of side effects for fear of over reaction.

  • Alee on 12.07.2011 at 11:00 am

    I was curious about the side-effect and death rates associated with these vaccines, seeing as the article does not include these statistics. According to the CDC (http://www.cdc.gov/vaccinesafety/vaccines/hpv/gardasil.html – last updated October 2011), it does not appear that there is anything to worry about. Seemingly all serious and non-serious side effects could not be wholly attributed to the vaccine and there is no increase in rates to suggest a connection.

    While it is near impossible to prove the profit intentions of the pharmaceutical companies, statistics like those mentioned in the article are quite shocking…and possibly a bit misleading. Many of the HPV strains are completely harmless and go away by itself. The vaccine is most useful because it prevents the worst of the strains (those that cause 70% of cervical cancer – 16 & 18). Since most health officials normally just stress condom use or regular check-ups, HPV (the non-wart strains) is the dangerous exception due to few to no symptoms and the inability to check males!

    Imagine the following hypothetical: You decide not to have your daughter not vaccinated. Years after her wedding to her only sexual partner (who has had previous partners and was tested for all other STDs), she finds out that she has HPV strain 16. It has progressed quickly into later stages of cancer and she needs treatment, which may include removal of the uterus or radiation. After treatment, she is unable to successfully carry a child.

    If all it takes to prevent the sadness that my daughter would have is 3 vaccine shots, I would do it.

  • Nick on 12.07.2011 at 3:35 pm

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  • Chris on 12.07.2011 at 9:23 pm

    You saying that the fact that there are no major studies which have linked these vaccinations to any problems is an indication that they are safe is about as misinformed as anything I have ever seen.

    Reality is that government testing procedures have complexity levels in their requirements that would eliminate virtually any small independently conducted study. The only people who have the resources to carry out these types of tests are Pharmaceutical companies. Logically this is a problem because the only companies which have the resources to actually sufficiently test these vaccines have ZERO motivation to do so. They are after all the same companies who sell the vaccines.

    The absence of evidence against these vaccines in no way shows that they don’t cause problems. This is simple logic.

    I for one would refuse vaccination based solely on the non-active ingredients they use as stabilizers along with the actual vaccine. In many vaccines, these stabilizers (example: formaldehyde) are dangerous enough that I would not put in my body under any circumstances.

  • Candy on 12.08.2011 at 12:38 am

    I had the first two doses of the HPV vaccine in high school and never could receive the third due to a whole slew of serious health problems I’ve acquired after nearly dying. My mother was uneasy about me having the vaccine in the first place, but my pediatrician was very eager for me to have to it. This was shortly afterthe vaccine first came out. After the first shot, I noticed that things in my body seemed off, and after the second I almost died. Years later, I still struggle with damage to my nervous system and other symptoms that puzzle doctors. It is difficult to confirm 100% that Gardasil was the culprit, but I, along with doctors, believe it to be. It’s the only thing that makes sense with the timing, type, and severity of my health issues. Now doctors are afraid to give me any vaccinations of any kind or even a flu shot.
    Basically, my point is that while the promise of a vaccine that can help prevent HPV sounds great, it lacks significant testing for safety. There have been a number of cases similar to my own reported to the CDC and even deaths. I do not believe it’s such a good idea to be encouraging people to get this vaccine when the safety of it has not been adequately confirmed.

  • toni bark on 12.12.2011 at 7:10 pm

    There is currently a class action suit in Australia by girls who have been severely damaged by this vaccine. THe same thing would be happening here if Merck wasn’t protected by the vaccine injury court and the defective design decision by the supreme court last feb. Like all vaccines, this one is listed as “unavoidably Unsafe” and contains the nano aluminum salt AAAS which is a know neuruotoxin. There are many articles on the dangers of aluminum nana salts.
    In addition, the antibodies triggered by the vaccine last, on average 3-5 years for girls and even less than that for boys. This vaccine has been heavily marketed by MErck and propaganda materials distributed to medical societies and academy meetings as “educational material”. It’s unfortunate that there is so little awareness of the big picture. I suspect Merck is funding the research the writer is involved in , or at least funds the department.

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