The discussion regarding sex and sexually transmitted infections should start early with our child, in an age appropriate way. In our office we start this discussion with the parents when their child is 14 years old, or sooner if requested.
What is the most common sexually transmitted infection?
What is human papillomavirus?
Human papillomavirus (HPV) is a virus that infects the skin, genital area and lining of the cervix. There are many different types of papillomaviruses (about 100). Some types of papillomaviruses cause warts on the skin, some types cause warts in the anal and genital areas, and some types cause cervical cancer.
Many different HPV types cause cervical cancer. Two types (16 and 18) are the most common, accounting for about 7 of every 10 cases of cervical cancer. Similarly, many types of HPV cause anal and genital warts; but only two types (6 and 11) account for about 9 of every 10 cases.
The HPV vaccine, known as GARDASIL®, protects against nine types of HPV that cause disease in people. The types in the vaccine are 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Other viruses can cause cancer, too. For example, hepatitis B virus can cause liver cancer, AIDS virus can cause sarcoma (cancer of skin and soft tissues), and Epstein-Barr virus (the virus that causes 'mono') can cause cancers of the head and neck and of the immune system. These types of cancers can also be caused by other things. For example, alcohol can cause liver cancer, the sun can cause skin cancer, and poisons can cause cancer of the immune system.
Cervical cancer is unique in that it has only one cause: HPV.
How common is HPV?
HPV is the most common sexually transmitted disease in the United States and in the world. Twenty million Americans are currently infected with HPV and an additional 6 million Americans are infected every year. Half of those newly infected with HPV are between 15 and 24 years of age.
Is HPV dangerous?
Yes. Although most HPV infections typically resolve on their own, some persist. Every year in the United States:
About 34,000 HPV-associated cancers occur:
More than 20,000 of these are in females
Almost 14,000 are in males
The most common types of cancer caused by HPV infections are cervical cancer and head and neck cancers:
About 10,800 cases of cervical cancer and 4,000 deaths occur annually
About 10,700 males and 2,200 females are diagnosed with cancers of the head and neck
Babies can also be infected when they pass through the birth canal of a mother infected with HPV. Some of these children go on to develop a long-term infection of their windpipe that is occasionally fatal. This disease is called recurrent respiratory papillomatosis.
How do you catch HPV?
HPV is transmitted from one person to another by genital contact. Although this most often occurs during sexual intercourse, it can also occur during oral or anal sex or through genital-to-genital contact in the absence of sexual intercourse, even with “french” kissing. HPV will not be transmitted with simple kissing (such as kissing your child on the cheek).
HPV infections are unique. First, most people never know they were infected. Unlike a cold in which symptoms develop a few days after exposure to the virus, HPV infections are typically not symptomatic. Second, HPV infections can last for long periods of time. The average length of infection is about eight months; however, for about 1 of every 10 women, the infection lasts longer than two years. It is in this group of women that there is an increased risk of developing cervical cancer. Cervical cancer often doesn’t occur until 20 years after the initial infection.
How can you avoid getting HPV?
Sometimes people can be infected with HPV and not know it. So HPV can be difficult to avoid. The best way to avoid genital infection with HPV is abstinence. You can also decrease your chance of getting HPV by having sex with only one other person who isn't infected with HPV. While condoms may also decrease the chance of getting HPV, they do not always work to prevent the spread of the infection. Because other than abstinence, none of these measures can completely protect someone from becoming infected or prevent the spread of this infection, the development of a vaccine was an important tool for preventing future generations from experiencing the devastation caused by HPV.
Can't I avoid cervical cancer by simply getting routine Pap testing?
No. At one time cervical cancer was the most common cause of cancer in the United States. One test changed that: the Papanicolaou (Pap) test. The Pap test is performed by scraping cells from the opening of the cervix and examining them under the microscope to see whether they have begun to show changes consistent with the early development of cancer (called pre-cancerous changes). Typically, the length of time from infection with HPV to development of cervical cancer is about 15-20 years. For this reason, although most HPV infections occur in teenagers and young adults, cervical cancer is more common in women in their 40s and 50s.
The Pap test is one of the most effective cancer screening tests available and has dramatically reduced the incidence of cervical cancer in the United States. But the test isn't perfect and not all women get tested as often as they should.
On the flip side, even if you have been vaccinated against HPV, you are still recommended to get the Pap test.
Can genital HPV infections be treated?
HPV infections cannot be treated; however, the symptoms of HPV can be treated, at least to some extent. For example, genital warts can be treated with medications or surgically removed; however, they may return, and the patient may still be infected with HPV and could, therefore, still transmit the infection.
How is the HPV vaccine made?
The HPV vaccine is made using a protein that resides on the surface of the virus. The protein is grown in the lab in yeast cells. Once the protein is grown, it assembles itself to look like the HPV virus; however, importantly, it does not contain HPV genetic material, so it can’t reproduce itself or cause illness. The vaccine is composed of the surface protein from nine different types of HPV.
Who should get the HPV vaccine?
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that all adolescents between 9 and 12 years of age receive the HPV vaccine.
The vaccine is given as two shots separated by 6 to 12 months if started before 15 years of age. For those 15 years and older, and teens of any age with a compromised immune system, three doses are recommended. The second shot should be given one to two months after the first, and the third shot, six months after the first. Recently, the HPV vaccine was licensed for use in people up to 45 years of age.
Does the HPV vaccine work?
Yes. The HPV vaccine was originally studied in about 30,000 girls and young women between 9 and 26 years of age. Studies determined that the vaccine prevented 9 of 10 HPV infections and was completely effective at preventing persistent infections and Pap smear changes that predict cervical cancer. Subsequent studies showed that HPV vaccine prevented HPV infection, anal and genital warts, and anal cancer in men.
In Australia, where a school-based immunization program was implemented, they have seen dramatic reductions in pre-cancerous cervical changes in young women as well as genital warts in both young men and young women.
Is the HPV vaccine safe?
Because the HPV vaccine is made using only the surface protein from the virus, it can't cause HPV and, therefore, can't cause cervical cancer. The vaccine may cause redness and tenderness at the site of injection. The vaccine may also cause a low-grade fever in a small number of recipients.
More than 100 million doses of HPV vaccine have been given to people in the United States, and safety networks have continued to monitor reactions to the HPV vaccine since its licensure. Despite concerns raised by the media and some citizen groups, no cause-effect links have been found between HPV vaccine and adverse events, including blood clots, allergic reactions, strokes, seizures, Guillain-Barré Syndrome (GBS, a rare cause of paralysis), birth defects, miscarriages, infertility or premature ovarian failure, or infant/fetal deaths. While fainting episodes following HPV vaccination have been reported, the rates have not been higher than those following receipt of other vaccines for teens. Because of the possibility of fainting, teens are recommended to remain at the office for about 15 minutes after getting immunized.