The HPV Vaccine FAQ
According to the American Social Health Association, over 6 million people worldwide acquire a strain of human papillomavirus (HPV) every year. By age 50, at least 80 percent of women (defined in information about this issue as people with a vulva/vagina) will have acquired a genital HPV infection, most of which will never develop any visible symptoms.
Over 10,000 people in the United States are diagnosed with cervical cancer each year at this time. The majority of cervical cancer cases are believed to be due to certain strains of the HPV virus. The HPV virus has also been associated with cancers of the vulva, vagina, penis, anus, and, more rarely, a few head and neck cancers.
Most people in developed nations have been getting various vaccinations since you were little to protect you against many pervasive and dangerous diseases and infections. Those vaccinations have even also already included some STI protection: Hepatitis is largely sexually transmitted, and you've probably been vaccinated against it routinely, starting as early as your first few months of life.
A vaccine -- Gardasil -- is available to help prevent the spread of some types of HPV. The Centers for Disease Control report that clinical trials in over 11,000 women have shown the vaccine to be 100% effective for women in preventing cervical precancers caused by the targeted HPV types, and nearly 100% effective in preventing vulvar and vaginal precancers and genital warts caused by the targeted HPV types.
The HPV vaccine is optional: it's something you and your doctor (and potentially your parents or guardians as well, especially if you are a minor and/or don't have control over your healthcare or the ability to pay for vaccines yourself) may discuss and which you may decide to get or not.
There are different types of human papillomavirus, or HPV. Genital types/strains are almost entirely sexually transmitted via genital contact: vaginal or anal intercourse, other genital-to-genital contact (like grinding bare genitals directly together), and far more rarely, by oral or manual sex. One group of strains can cause genital warts (and not cervical cancer), and about 2 out of 3 people who have sexual contact with a person who has genital warts (even if they are internal and not visible, which is the case with the majority of cases) will get HPV. Another group of strains doesn't cause warts -- and often shows no symptoms -- but can cause cervical cancer. While both penile and anal cancers are rare, HPV may cause these for men.
HPV, like many STIs, is of particular concern for young adults. It's estimated that of those 6 million new cases of HPV in the U.S. each year, the vast majority of them -- close to 75% -- occur in young adults between the ages of 15 and 24. Because those in this age group often go without annual sexual healthcare, including the pap smears for young women which could find and address precancerous conditions from HPV, and because of lack of both safer sex practices and the high prevalence of rape and sexual coercion in this age group these concerns are even greater. The risks of HPV in younger sexually active people are also substantially greater than for their older counterparts because of the way cellular development occurs for the cervix during the teen years and very early twenties.
It's thought that for many people, the virus may clear up on its own after a few years of acquiring it, though at the present time, there's no test to show when it has if it has, so anyone who has contracted the HPV virus has a strong possibility of passing it to partners. As well, there is currently no test available for men for HPV who do not have a strain presenting visible, extrenal genital warts: men can be screened for all other STIs, but currently not for HPV.
There is also currently not a "cure" for HPV. Genital warts can be treated and removed, but that does not remove the virus itself, and in most cases of HPV, warts will not be present. For those who do not "shed" the virus, some strains of HPV may cause cervical cancer.
Who should consider it?
The vaccine is suggested for young people, of all genders, who have not yet become sexually active, because it is has the best chance of being 100% effective if given before someone has any exposure to the HPV virus. Because HOV is so common and widespread, it's very likely that once a person is sexually active, when it involves genital contact, they will be exposed to a strain of HPV. It is also recommended, however, for people even if sexual activity has already occurred.
Most health organizations right now who suggest the vaccine are suggesting it can be given as early as the age of 9, and should be given, to provide the best protection, before the ages of 11 or 12. Some lead researchers for the vaccine state that tthose younger than 9 probably should wait on the vaccine until further testing is done.
Balancing all of the information available, it's sage to suggest that young people -- and this includes boys and men -- who are considering soon becoming in any way sexually active, or who already are, and who have not been vaccinated for HPV, should talk to their doctor about the HPV vaccine to consider it.
If a strain of HPV has already been acquired, the vaccine won't make it go away, but it is unlikely that young people will have been infected with all four strains of HPV -- 6, 11, 16 and 18, all of which can cause 70% of cervical cancers and 90% of genital warts -- which the vaccine protects people from.
What's involved in being vaccinated?
Gardasil is administered with three injections over a six month period by your doctor, nurse or clinician. After the first dose is given, two months later you'll get the second, and four months after that, the last dose.
Just like any other vaccine, it's a shot, and as with many other vaccines, the possible side effects are similar: pain, swelling, itching and redness where the injection was given, or short term fever, nausea or dizziness. Dizziness, fainting and seizures are reactions reported in around 1/4 of all adverse reaction reports on the vaccine. Because some allergies (like an allergy to yeast, for instance), conditions and sensitivities may making getting the vaccine dangerous for some women, be sure your doctor is informed about your health history before administering the vaccine to you.
If you want to take a look at the adverse reaction reports, you can see them at the VAERS database here.
It has been found that some basic precautions can help prevent allergic or other dangerous reactions to the vaccine. If you're going to get it, again, first be sure your healthcare provider has a thorough medical history for you so that they can be sure it's safe to give you the vaccine. Your healthcare provider should not, at this time, according to several reports, administer other vaccines on the same day as they administer Gardasil. You should be lying down when you get the vaccine, and should have a ride home from someone else afterwards rather than driving yourself home or walking alone.
Where can you get it and what does it cost?
You can get the vaccine at your family doctor's office, through your gynecologist, or general and sexual health clinics.
It's very expensive, around $350 - $600 for all three injections, but if you are insured (in those countries without national health), your insurance will most likely cover the costs. If you are uninsured and using public health services, those may cover the costs of your immunization. You can also often get Gardasil via sexual health clinics and college health clinics at no to low cost. For information on these options, call your insurance provider, or your public or private health clinic.
What do you do about parents who have a problem with the vaccine?
Some parents are wary because of not understanding how prevalent HPV is, or knowing the facts about HPV and cervical cancer. Some may also be reticent because they think it only needs to be given when, rather than before sexual activity begins. What reticent parents may not understand is that this vaccine offers a lifelong preventative against HPV, and the earlier it is given, the more likely it is to offer the best protection it can. So, it will protect you now, but it will also protect you when you're 30. Because HPV is so prevalent, and so few people know when they have it -- especially men -- the risk of HPV exists whether someone is single or married, monogamous or nonmonogamous, 16 or 36.
Obviously, as is the case with most STI transmission, one way -- the best way -- of reducing the risk of HPV is forestalling sexual partnership (not just intercourse) until later ages, and limiting the number of sexual partners one has.
But while forestalling partnered sex -- though realistically, very few people will delay all sexual activity until their mid-twenties -- reduces the risk of HPV, it does not does not remove the risk of HPV. Hard and awkward as it is to address, it should also be taken into account that many young people are forced or coerced into sexual activity against their will. Rates of rape and coercion are far higher for younger people than older people: more than half of all rapes of women in the U.S. -- rapes which the Department of Justice state occur every two minutes stateside, with near a half a million women raped every year -- occur before the age of 18, and 22% before the age of 12 (Tjaden and Thoennes 2000). So, while it's important to address making sound choices for sex, it's unrealistic to rest sexual health protections for people solely on the ability to choose to be sexually active or not, when the risk also exists, and is very real, of exposure due to sexual assault or abuse.
It's likely that some parents who are not opposed to other vaccines, but who are opposed to this one, are either uninformed as to the high risk of HPV, unaware of sexual realities, and/or unaware that even if their daughter is able to choose not to sexually partner until after her teens the vaccine can potentially give her the best protection against cervical cancer the younger it is given.
However, some parents are opposed to all vaccines, or feel that the risk of HPV or cervical cancer is not so high as to warrant vaccinating against HPV, or worth possible risks the vaccine may present. Some parents are also simply waiting until the vaccine has been around for a longer period of time before supporting it, which is certainly valid.
If you are interested in the vaccine and have a parent who has a conflict, the best way to find out what their conflict is is to talk with them about it.
If you go to your doctor with your parent for checkups, you can ask your doctor or nurse to talk about the vaccine with your parent: often, information is powerful, and sometimes a parent responds best to a doctor or other healthcare professional giving them that information. Then you can all talk about it from an informed position. A doctor can also remind your parent about all the vaccinations you've probably gotten before, including vaccinations against Hepatitis B, which you'd be most likely to get via sexual contact or intravenous drug use. So, for parents who are being freaky about a vaccine only because they've got the idea it'll someone invite their teens to engage in sexual activity before they're ready, having a healthcare pro point out that they didn't have worries about their four-year-olds shooting up since they had a Hep B vaccine (which a doctor would like word far more tactfully than I have here) may be of help.
If, no matter what efforts are made, you're a minor or reliant on your parent's healthcare coverage, and a parent refuses to pay for or okay the vaccine when you want it for yourself, in many states and countries you still have the legal right to get it if you want it. Talk to your doctor or clinician about the conflict, or look into a sexual healthcare clinic with sliding scale fees, like Planned Parenthood clinics.
What else can I do to protect myself?
With or without the vaccine, if you're sexually active and have a vulva/vagina, yearly pap smears with your annual gynecological exam are a must.
Pap smears can detect cervical abnormalities, so if precancerous cells appear, they can be treated early and save your life and health. This is especially important in terms of HPV, because with the types that can cause cervical cancer, there is a "too late" when it comes to testing: the CDC states that within just two years, cervical HPV infection usually becomes undetectable.
If you are sexually active or over 21 and haven't started getting your yearly STI screenings, pelvic exams and pap smears, talk to your doctor, make an appointment with a private gynecologist, or get started at a sexual health clinic today. For people with a penis, not a vulva, regular STI screenings and visual genital exams are important once you become sexually active (and not just intercourse: if you're engaging in oral sex, for instance, especially unprotected, you have had STI risks, too).
If you are sexually active, remember that safer sex -- latex barriers, screening for you and partners and lifestyle adjustments -- protects you from sexually transmitted infections like HPV. Condom use does not prevent HPV to the same degree it prevents transmission of fluid-borne infections like HIV, but those who use condoms for all genital contact are around 70% less likely to contract HPV than those who do not use them or only use them sporadically, and that's a substantial level of protection. The vaccine is not meant to substitute for safer sex practices, but instead, only to supplement them. Obviously, too, choosing not to be sexually active when it is a choice is one other way to keep from acquiring HPV.
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