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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 will have acquired a genital HPV infection, most of which will never develop any visible symptoms.
Over 10,000 women in the United States are diagnosed with cervical cancer each year. It is the third most common cancer overall worldwide and the leading cause of death from cancer among women in developing countries: internationally, cervical cancer kills around 200,000 women a year. The majority of cervical cancer cases are believed to be due to the HPV virus.
Most of you in first-world countires 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 now available to help prevent the spread of HPV to help prevent cervical cancer, massively protecting women as well as public health. 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.
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, and often does, cause cervical cancer.
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 coerced sex in this age group these concerns are even greater. The risks of HPV in younger sexually active women 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. There is also currently not "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 can cause cervical cancer.
The vaccine is suggested for young women who have not yet become sexually active, because it is said to have the best chance of being 100% effective if given before a girl or young woman has any exposure to the HPV virus.
It is also recommended, however, for young women under 26, even if sexual activity has already occurred, but some lead researchers for the vaccine state that the youngest women probably should wait on the vaccine until further testing is done. Balancing all of the information available, it's sage to suggest that young women who are considering soon becoming in any way sexually active, or who already are, should talk to their doctor about the HPV vaccine.
If a strain of HPV has been transmitted, it won't make it go away, but it is unlikely that young women 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 women from.
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. Because some allergies, 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.
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, your insurance will most likely cover the costs. If you are uninsured and on public health, Medicare may cover the costs of your immunization. You can also 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.
Too, according to the Kaiser Foundation, for uninsured women, Merck -- the makers of the vaccine -- has announced that it will establish an assistance program to provide free vaccines, including Gardasil, to uninsured and low-income adults ages 19 and older who visit private practices that already provide Merck vaccines. The details of the program have not yet been released.
What reticent parents likely don't 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 as it is to address, it should also be taken into account that vast numbers of young women are forced or coerced into sexual activity against their will. Rates of rape and coercion are far higher for younger women than older women: 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 women solely on the ability to choose to be sexually active or not when it comes to young women, who are not always given a choice when it comes to sexual contact.
It's likely that many parents opposed to the vaccine for their daughters -- who are not opposed to other vaccines -- 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 give her the best protection against cervical cancer the younger it is given.
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. A doctor can also remind your parent about all the vaccinations you've 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 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) 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.
With or without the vaccine, if you're in any way sexually active, yearly pap smears with your annual gynecological exam are a must. Pap smears can detect cervical abnormalities early, 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 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.
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, to supplement them.
For more information:
On Gardasil: http://www.gardasil.com/
On cervical cancer: http://www.nlm.nih.gov/medlineplus/cervicalcancer.html
On HPV: http://www.cdc.gov/STD/HPV/STDFact-HPV.htm
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