Recently, before our son went off to college, my wife and I debated how we could best protect his future health while living away from home for his studies. One of the more controversial issues we grappled with was whether he should be vaccinated against the human papilloma virus (HPV), a sexually transmitted virus that causes cancer. As you read this, you may be thinking, why a debate; why the controversy? Many parents we know worry that this uncomfortable discussion may promote the idea of promiscuity or speak to your moral compass when in reality this issue is about preventing cancer. The fact that HPV infection has serious consequences makes this an essential conversation that needs to happen in all households in the US. Here are 8 things you need to know about HPV.
1. HPV is the most commonly diagnosed sexually transmitted infection in the United States resulting in a number of medical conditions ranging from genital warts to cancer.
2. HPV is spread by skin to skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area. 75-80% of sexually active adults will acquire HPV infection before the age of 50, typically between the ages of 15 and 25 years — when many first become sexually active. The problem is that HPV exposure increases with the number of sexual partners that one has and the number of partners a partner has had.
3. Condoms help but do not provide complete protection from HPV infection because condoms do not cover all exposed genital skin. People do not become infected with HPV by touching an object such as a toilet seat.
4. Most people who are infected have no signs or symptoms. In 10-20 percent of women, however, the infection persists. In this situation there is a greater chance of developing cervical cancer, one of the most common types of cancer in women. It takes at least 20 years for HPV infection to cause cervical cancer. Thus, regular cervical cancer screening and Pap tests are important in detecting cervical abnormalities early before cancer develops.
5. Although 100 types of HPV have been identified, researchers divide HPV viruses into two types, high or low risk, for causing cervical cancer. Low risk HPV cause about 90 percent of genital warts and are considered low risk because they do not cause cervical cancer. It is important to know that persistent viral infection with high risk HPV types virtually cause all cancer (70-80 percent) of the cervix and most cases of anal cancer.
6. HPV has been linked to a number of other cancers as well, including anal cancer, and cancers of the mouth, or throat. This is seen in both sexes regardless of age. According to the 2013 Annual Report to the nation on the status of cancer, rates of preventable HPV related cancers including, cervical, anal and throat cancer are on the rise in the U.S.
7. CDC research shows that US Latino women have higher cervical cancer incidence rates than non-Hispanic Whites and African-Americans with lower rates of cervical cancer screening. High rates of HPV infection and low rates of screening in Latino women is the cause of Latino women’s high rates of cancer. Although HPV is common and consequences of infection can be severe, knowledge of HPV is low or nonexistent in the Latino community. This is particularly true in individuals who are of lower socioeconomic status and less educated. In fact, in one large 2009 study of Latinos living along the Texas and Mexico border, results showed very little understanding about HPV and the role it plays in causing cervical cancer.
8. There are two HPV vaccines. Gardasil® is administered in three doses at 0, 2, and 6 months of follow-up; whereas Cervarix® is given in three doses as well at at 0, 1 and 6 months of follow-up . HPV immunization is most effective among individuals who have not been infected with HPV which is before they have had any sexual contact. Large clinical studies have demonstrated effectiveness and safety of both vaccines against cervical HPV infection and the development of cervical cancer.
Vaccines should be offered to boys and girls 11-12 years of age but can be administered as early as 9 years. Catch-up vaccines should be offered for females aged 13-26 years and males between the ages of 13-21 who have not been previously vaccinated. Despite recommendations by numerous medical groups for routine immunization of adolescent girls, HPV vaccination rates continue to lag. The 2013 Annual Report to the nation on the status of cancer found that 48.7 percent of all adolescent girls had received only one dose of vaccine and 32 percent had completed all three vaccine doses. Most troubling, Latino girls had the lowest vaccination rates of all groups studied. Not surprisingly, the rates of HPV cancers have increased.
Keep in mind that HPV vaccination is about preventing cancer. This important decision to have the vaccine can save a life.
Dr. Joseph Sirven is a first-generation Cuban-American. He is Professor and Chairman of the Department of Neurology and was past Director of Education for Mayo Clinic Arizona. He is editor-in-chief of epilepsy.com and has served U.S. and global governmental agencies including the Institute of Medicine, NASA, FAA, NIH and CDC.