Pharmacists focused on positive patient outcomes. AppaGrapha is a blog by pharmacists and other healthcare professionals intended for patients who desire a fresh focus on health and wellness. AppaGrapha...Discovering Trends. Inspiring Wellness.

Thursday, October 16, 2014 10:00 am

What You Should Know About Human Papillomavirus (HPV)

What is HPV?

What You Should Know About Human Papillomavirus (HPV)
Human Papillomavirus (HPV) infection is preventable
(Photo credit: Kathleen Kvilhaug)

Human Papillomavirus, or HPV, is the most common sexually transmitted infection (STI). According to the Centers for Disease Control and Prevention (CDC), approximately 79 million people are infected with HPV in the United States. An additional 14 million new HPV infections are estimated to occur each year. Furthermore, it is estimated that 360,000 people will develop genital warts and 10,000 women will develop cervical cancer each year. These numbers all reflect HPV infections and HPV-related health problems in the United States as reported by the CDC in March 2014.   

Who is at risk?

Anyone who is sexually active is at risk for contracting HPV. Most people are unaware they have been infected and will clear the virus, never experiencing signs or symptoms of infection. Sometimes HPV infections go unnoticed for a long time until signs are detected during cervical screening or upon abnormal PAP test. It is important to note that HPV may be passed to a partner during sexual activity even if there are no signs or symptoms of infection.

Can HPV infection and HPV-related cancer be prevented?
What You Should Know About Human Papillomavirus (HPV)
37.6 % girls received the recommended three doses in 2013
(Photo credit: Kathleen Kvilhaug)

We have two HPV vaccines available in the U.S. which have been proven to be safe and effective when given as the recommended three doses prior to initiation of sexual activity. There are  several different types of HPV. The types of HPV that cause genital warts are not the same types that cause HPV-related cancers. The HPV vaccines are not identical or interchangeable, the differences are identified in the following paragraph.

 In June 2006, Gardasil, a quadrivalent HPV vaccine was approved for use in the United States in females aged 9-26 years; in October 2009, the use of this vaccine in males aged 9-26 years was also approved. This vaccine provides protection against HPV types 6, 11, 16, and 18. HPV 6 and 11 cause approximately 90% of anogenital (anus/genital area) wart infections, while HPV 16 and 18 are believed to cause 70% of cervical cancers. Another HPV vaccine was approved in October 2009, this one a bivalent HPV vaccine, Cervarix, provides protection against HPV types 16 and 18 in females aged 9-25 years.

Are we doing all we can?

What You Should Know About Human Papillomavirus (HPV)
Let’s get the word out
(Photo credit: Kathleen Kvilhaug)

In the United States we continue to see low HPV vaccination rates among adolescents age 13 through 17 years despite the potential of both vaccines to protect against the high-risk cancer causing HPV types 16 and 18. The 2013 National Immunization Survey-Teen (NIS-Teen) shows only a slight increase in vaccination rates among U.S. adolescents from 2012 to 2013, with the number of girls receiving HPV vaccine far out numbering the boys receiving the vaccine.

For adolescent girls age 13 through 17 years:
• 57.3% girls received at least one dose in 2013
• 37.6 % girls received the recommended three doses in 2013

For adolescent boys age 13 through 17 years:
• 34.6% boys received at least one dose in 2013
• 13.9% boys received the recommended three doses in 2013

What is responsible?

We need to look at the reasons HPV vaccination rates are lagging not only in males but also in the overall adolescent population. Are we failing to adequately protect our children from HPV infection  and HPV-related cancers due to lack of awareness, fear of side effects, or fear of implied permissiveness?

What You Should Know About Human Papillomavirus (HPV)
13.9% boys received the recommended three doses in 2013
(Photo credit: Kathleen Kvilhaug)

Education is a critical focus. Healthcare providers and pharmacists are focusing on educating parents and young adults on the availability, effectiveness and benefits of vaccination. The goal is to vaccinate everyone, male and female, regardless of sexual orientation beginning at age 11 or 12 years. This is the only way to prevent continued spread of HPV infection and HPV-related cancers.

Addressing side effect concerns is vitally important. While not very common, fainting (syncope) may be responsible for a small decrease in vaccination rates, as it is not recommended to continue the series in these patients. All patients should be monitored for 15 minutes following vaccination.  Initial concerns regarding a possible link to Guillian Barre syndrome fueled some parental reluctance to embrace yet another vaccine. However, data collected since the release of HPV vaccine does not support a causal link.

Protection is not permission. HPV presents an opportunity to begin a conversation with our children regarding sexual activity and health. The intention of this conversation is not to imply we condone permissiveness, early or casual sexual activity. An open and honest conversation with our children can let them know we are interested in doing all we can to ensure that they are aware and protected. The HPV conversation is an important one to have if we hope to close the gaps in the HPV vaccination rates.

What you can do…

What You Should Know About Human Papillomavirus (HPV)
Both genders should be vaccinated 
(Photo credit: Kathleen Kvilhaug)
…to protect yourself.

Vaccinate ~ It is equally important for both genders to receive HPV vaccine in order to effectively diminish the spread of HPV infection and HPV-related health problems in the total population. The recommendations advise HPV vaccine be given to girls and boys prior to becoming sexually active. The vaccines are given in three doses over a six month period. It is necessary to receive all three doses for complete protection. If you were not vaccinated when you were younger, catch-up vaccination may be advisable. Your healthcare provider will help you decide if HPV vaccine is right for you or your child.
• Latex condoms ~ If you are sexually active, always correctly use a latex condom during activity. This will minimize risk but may not fully prevent all exposure to HPV.
• Mutually monogamous relationships ~ If you are sexually active, have sex only with a partner who only has sex with you.
• Cervical screening ~ Routine cervical screening and PAP tests for females beginning at age 21. HPV tests are approved for cervical cancer screening and recommended for women age 30 and older.
• Education and awareness ~ Talk to your healthcare provider, your pharmacist, your school nurse, your parent or guardian, or check out the CDC for more information on HPV and other STIs. The more you know, the better you can protect yourself and those you care about.
  • A must read for teens and parents of teens! Our pediatrician really helped us make an informed decision on this important health issue.