Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STIs).
It is a virus that can be spread through skin-to-skin genital contact.
There are many different types of HPV. Some types cause genital warts and are called low-risk. And some types can lead to cervical, anal, or oral cancer and are called high-risk.
There is no known cure for HPV, but there is a vaccine that can protect against some types of the virus. Stephanie Joy, MD, is here to explaine HPV and the importance of the vaccine Gardasil for your teens.
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Importance of Vaccination Against Human Papilloma Virus
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Learn more about Dr. Stephanie Joy
Stephanie Joy, M.D., FAAP of MMP
Dr. Stephanie Joy is a graduate of the University of Vermont and completed her training at Maine Medical Center. She is a Board certified pediatrician and has been with Maine Medical Partners - South Portland Pediatrics since 2010.Learn more about Dr. Stephanie Joy
Transcription:
Importance of Vaccination Against Human Papilloma Virus
Melanie Cole (Host): Human papillomavirus is a common virus that’s spread through sexual contact and there is a vaccine for it now that we are giving our children in their teenage years. My guest today is Dr. Stephanie Joy. She’s a board certified pediatrician with the Maine Medical Partners South Portland Pediatrics. Welcome to the show, Dr. Joy. Tell us a little bit about HPV. First, the disease and how it’s contracted.
Dr. Stephanie Joy (Guest): Thanks for having me. HPV – a lot of people might not have heard of it but it’s very, very common. It stands for human papillomavirus. I tell people it’s like the warts that you get on your hands except you get this type of wart in different body parts, in your mouth, on your genitals. It’s very, very common. About 75-80% of adults have antibodies to HPV, meaning they’ve been infected at some point in their lifetime. Most people get infected first as younger, older teenagers, younger adults. Just like warts on your hands, you get infected with these warts and over 6-18 months often times your body realizes that they are there, mounts an immune response and you fight it off except sometimes you don’t. If you get infected with certain strains, those are the strains that go on to cause cancer. That’s why we care about HPV primarily.
Melanie: Which cancers are caused by HPV?
Dr. Joy: People call Gardasil--which is the vaccine for HPV--people call it a cervical cancer vaccine which is true so almost 100% of cervical cancer is caused by HPV. If you’ve ever had an abnormal pap smear, that’s HPV. So, it’s cervical cancer but also there’s increasing awareness that most anal cancer is caused by HPV, penile cancer, a lot of throat cancers, head and neck cancers, vaginal cancers--they are all caused by HPV.
Melanie: So, tell us about the HPV vaccine. Who can get it? We are giving it to both our boys and our girls right now?
Dr. Joy: That’s right. Initially, it was kind of designed and approved in girls but now we offer it to boys and girls. It’s actually approved for ages 9-26. The American Academy of Pediatrics, CDC and the Advisory Committee on Immunization Practices recommends giving it starting at 11. It’s a three dose series. You start at 11, you get one dose, one month later you get the second dose and six months later you get the third dose.
Melanie: How safe is this vaccine?
Dr. Joy: It is safe. We have been giving this vaccine in this country since 2006. We’ve given over 60 million doses. In terms of side effects that have shaken out, the only thing that has really shaken out in terms of increased side effects with this vaccine versus the other vaccines is that there’s some increased fainting. I’ve never seen anybody faint from this vaccine. I’ve seen people faint from other vaccines but that’s the only thing that has really kind of stood up over time. Oftentimes, we will watch kids for 15 minutes after getting the vaccine.
Melanie: If you are over the age of what, twenty something then, you cannot get the vaccine anymore?
Dr. Joy: Right. That’s something. I don’t see people over 26. It’s approved for ages 9-26. So, over 26 when I don’t see people anymore, it’s found to be less effective. I think it’s less effective immunologically and it’s less cost effective. Part of that is because most people are already infected at that age, so getting the vaccine once you’ve been infected is less helpful, although there are over 100 different serotypes of HPV. The vaccine that we have right now protects you against nine. The two most common that cause cancer, the two most common in general and five others. So, if you’re infected with a type that isn’t a cancer causing one at age 17, it’s still worth it to get the vaccine because we really want people protected against cancer. I’ve heard of older people who, say, at age 30 were in a relationship and got a divorce and wanted to get Gardasil to be protected against the other types. I think a lot of it is that insurance doesn’t cover it after a certain age.
Melanie: Dr. Joy, when we give our children vaccine, we tell them what vaccine that they are getting. If we are giving them the HPV vaccine, does that open up a discussion about sexual health and protection? Does it make them more likely to think about things involving sex?
Dr. Joy: That is a great question. We are not very great at giving this vaccine. In 2014, only 40% of girls age 13-17 had completed all three doses. Only 22% of boys in that age range had completed all three doses. I get more push back for this vaccine than any other vaccine. I think that part of it is that it’s sexually transmitted and that we offer it at 11. People don’t want to talk to their 11-year-old in detail about sexual activity. People don’t want to think about their 11-year-old being sexually active. I think there’s a lot of resistance. Sometimes when we start talking about it, and I’m pretty up front when I say this protects against genital warts. Everyone’s eyes get a little bit bigger. I think at 11, people are not ready to do this but you want people to be vaccinated before they are ever exposed. You don’t wait until you step on a rusty nail to think, “Oh, I never had a tetanus shot.” This is the time to do it. Again, we want kids to get vaccinated before they’re exposed. You mount a much stronger immune response at that age than you do when you are older. It does open up a little bit of a conversation, which I think is not a bad thing. I think some of the details, kids at 11 aren’t ready to hear and to learn about but I think it’s important to keep an open mind because I have seen kids who are not that much older than that who are sexually active. So, it is the biggest reason for people when I talk to them about not getting the vaccine is that they don’t think their kids are at risk. I also see moms of 17-year-olds who think their kids aren’t at risk.
Melanie: If we’ve given our girls this vaccination, do they then have to have pap smears as they get older or if they’ve been vaccinated against HPV, they don’t have to have a pap smear anymore?
Dr. Joy: That is also a great question. That one, I might have to defer to the gynecologists out there but I do know that the Pap smear guidelines have changed and it’s all because of HPV. We used to say everyone needed a pap smear within 3 years of the onset of sexual activity or by age 18. They were picking up so much HPV and people were getting so many procedures that they didn’t need. The new guidelines are that the Pap smears start at 21 and if you’ve had a number of normal, then you can go to pelvic exams and I think that’s a current change, too, is pelvic exams. That’s a good question. I think our immunization rates are not high enough that they’ll back away from Pap smears for a long time. Currently, the recommendations are if you’re over 26, the best thing you can do is get Pap smears. It seems a little bit like closing the barn door after the horse is out. You want to get the vaccine before you have to rely on Pap smears because nothing is perfect. A lot of people don’t voluntarily go for Pap smears at age 21 or 25. Even Pap smears, when they are done by people who are very good, nothing is perfect. I’m not sure. It will be interesting to see if we can get immunization rates up, if that changes the recommendations for Pap smears. They have changed a bit but no one is saying ‘no Pap smears’ yet.
Melanie: So, this vaccine is recommended at that early age, you said as young as nine years old. We are discussing this with our children, but why? Does it work better if it’s given to them at a certain age?
Dr. Joy: Yes. Definitely. Eleven to fifteen is when kids mount the strongest response. Older than 15, they still mount a response but it’s not as strong. I think part of it is, we’re giving kids other vaccines at 11. We give them a tetanus booster and a meningitis vaccine. So, we do all of them at the same time as adolescent vaccines and a big part of it is the immune response. That’s also part of why after 26 it doesn’t work as well.
Melanie: Does someone have to restart the HPV vaccine if too much time passes between those three shots?
Dr. Joy: No and I meant to say that when we talked about the three doses. You don’t. I see kids all the time who only come in once a year and they will get one dose at 11, one at 12 and one at 13. You don’t have to start over.
Melanie: That’s really good information. In just the last couple of minutes here, Dr. Joy, sum it up for us. Speak about the HPV vaccine for boys and for girls and why it’s so important and what you tell parents about this important vaccination and why they should come to Maine Medical Center for their care.
Dr. Joy: The most important thing to me is that people talk of this as a cancer vaccine and it’s true. If everybody was vaccinated against HPV, it’s reasonable to expect that we would have almost zero cervical cancer which is huge. Cervical cancer – there were 12,000 new cases in the United States in 2012. Four thousand people died in 2012 and worldwide there were 528,000 new cases and 266,000 deaths from just cervical cancer in 2012 worldwide. Those can all be prevented by a vaccine. The other thing that I always think about is the prevalence of HPV. This is not rare. The likelihood that you will be infected with HPV in your lifetime, unless you have a partner who has never, ever been with anybody else and you’ve never been with anybody else, the likelihood that you’re going to get infected is very high. Those two things together – very high rate of infection and a difficult cancer to treat-- is the best reason. It’s safe and it works. We don’t have a lot of long-term data to say in 50 years how much cervical cancer will we see but the short-term data is very promising that we’re seeing less rates of infection. I think that’s the most important thing and that’s what I talk to parents about. We know it works, we know it’s safe, we know this is an important vaccine and you can prevent cancer. It’s not even cervical cancer. It’s all the other types of cancers – head and neck cancer, anal cancer, penile cancer. It’s definitely something that, taking aside the mode of transmission, it’s kind of a no brainer that it’s an important vaccine.
Melanie: Thank you so much. It’s such important information. You’re listening to MMC Radio. For more information you can go to MaineMedicalCenter.org. That’s MaineMedicalCenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening.
Importance of Vaccination Against Human Papilloma Virus
Melanie Cole (Host): Human papillomavirus is a common virus that’s spread through sexual contact and there is a vaccine for it now that we are giving our children in their teenage years. My guest today is Dr. Stephanie Joy. She’s a board certified pediatrician with the Maine Medical Partners South Portland Pediatrics. Welcome to the show, Dr. Joy. Tell us a little bit about HPV. First, the disease and how it’s contracted.
Dr. Stephanie Joy (Guest): Thanks for having me. HPV – a lot of people might not have heard of it but it’s very, very common. It stands for human papillomavirus. I tell people it’s like the warts that you get on your hands except you get this type of wart in different body parts, in your mouth, on your genitals. It’s very, very common. About 75-80% of adults have antibodies to HPV, meaning they’ve been infected at some point in their lifetime. Most people get infected first as younger, older teenagers, younger adults. Just like warts on your hands, you get infected with these warts and over 6-18 months often times your body realizes that they are there, mounts an immune response and you fight it off except sometimes you don’t. If you get infected with certain strains, those are the strains that go on to cause cancer. That’s why we care about HPV primarily.
Melanie: Which cancers are caused by HPV?
Dr. Joy: People call Gardasil--which is the vaccine for HPV--people call it a cervical cancer vaccine which is true so almost 100% of cervical cancer is caused by HPV. If you’ve ever had an abnormal pap smear, that’s HPV. So, it’s cervical cancer but also there’s increasing awareness that most anal cancer is caused by HPV, penile cancer, a lot of throat cancers, head and neck cancers, vaginal cancers--they are all caused by HPV.
Melanie: So, tell us about the HPV vaccine. Who can get it? We are giving it to both our boys and our girls right now?
Dr. Joy: That’s right. Initially, it was kind of designed and approved in girls but now we offer it to boys and girls. It’s actually approved for ages 9-26. The American Academy of Pediatrics, CDC and the Advisory Committee on Immunization Practices recommends giving it starting at 11. It’s a three dose series. You start at 11, you get one dose, one month later you get the second dose and six months later you get the third dose.
Melanie: How safe is this vaccine?
Dr. Joy: It is safe. We have been giving this vaccine in this country since 2006. We’ve given over 60 million doses. In terms of side effects that have shaken out, the only thing that has really shaken out in terms of increased side effects with this vaccine versus the other vaccines is that there’s some increased fainting. I’ve never seen anybody faint from this vaccine. I’ve seen people faint from other vaccines but that’s the only thing that has really kind of stood up over time. Oftentimes, we will watch kids for 15 minutes after getting the vaccine.
Melanie: If you are over the age of what, twenty something then, you cannot get the vaccine anymore?
Dr. Joy: Right. That’s something. I don’t see people over 26. It’s approved for ages 9-26. So, over 26 when I don’t see people anymore, it’s found to be less effective. I think it’s less effective immunologically and it’s less cost effective. Part of that is because most people are already infected at that age, so getting the vaccine once you’ve been infected is less helpful, although there are over 100 different serotypes of HPV. The vaccine that we have right now protects you against nine. The two most common that cause cancer, the two most common in general and five others. So, if you’re infected with a type that isn’t a cancer causing one at age 17, it’s still worth it to get the vaccine because we really want people protected against cancer. I’ve heard of older people who, say, at age 30 were in a relationship and got a divorce and wanted to get Gardasil to be protected against the other types. I think a lot of it is that insurance doesn’t cover it after a certain age.
Melanie: Dr. Joy, when we give our children vaccine, we tell them what vaccine that they are getting. If we are giving them the HPV vaccine, does that open up a discussion about sexual health and protection? Does it make them more likely to think about things involving sex?
Dr. Joy: That is a great question. We are not very great at giving this vaccine. In 2014, only 40% of girls age 13-17 had completed all three doses. Only 22% of boys in that age range had completed all three doses. I get more push back for this vaccine than any other vaccine. I think that part of it is that it’s sexually transmitted and that we offer it at 11. People don’t want to talk to their 11-year-old in detail about sexual activity. People don’t want to think about their 11-year-old being sexually active. I think there’s a lot of resistance. Sometimes when we start talking about it, and I’m pretty up front when I say this protects against genital warts. Everyone’s eyes get a little bit bigger. I think at 11, people are not ready to do this but you want people to be vaccinated before they are ever exposed. You don’t wait until you step on a rusty nail to think, “Oh, I never had a tetanus shot.” This is the time to do it. Again, we want kids to get vaccinated before they’re exposed. You mount a much stronger immune response at that age than you do when you are older. It does open up a little bit of a conversation, which I think is not a bad thing. I think some of the details, kids at 11 aren’t ready to hear and to learn about but I think it’s important to keep an open mind because I have seen kids who are not that much older than that who are sexually active. So, it is the biggest reason for people when I talk to them about not getting the vaccine is that they don’t think their kids are at risk. I also see moms of 17-year-olds who think their kids aren’t at risk.
Melanie: If we’ve given our girls this vaccination, do they then have to have pap smears as they get older or if they’ve been vaccinated against HPV, they don’t have to have a pap smear anymore?
Dr. Joy: That is also a great question. That one, I might have to defer to the gynecologists out there but I do know that the Pap smear guidelines have changed and it’s all because of HPV. We used to say everyone needed a pap smear within 3 years of the onset of sexual activity or by age 18. They were picking up so much HPV and people were getting so many procedures that they didn’t need. The new guidelines are that the Pap smears start at 21 and if you’ve had a number of normal, then you can go to pelvic exams and I think that’s a current change, too, is pelvic exams. That’s a good question. I think our immunization rates are not high enough that they’ll back away from Pap smears for a long time. Currently, the recommendations are if you’re over 26, the best thing you can do is get Pap smears. It seems a little bit like closing the barn door after the horse is out. You want to get the vaccine before you have to rely on Pap smears because nothing is perfect. A lot of people don’t voluntarily go for Pap smears at age 21 or 25. Even Pap smears, when they are done by people who are very good, nothing is perfect. I’m not sure. It will be interesting to see if we can get immunization rates up, if that changes the recommendations for Pap smears. They have changed a bit but no one is saying ‘no Pap smears’ yet.
Melanie: So, this vaccine is recommended at that early age, you said as young as nine years old. We are discussing this with our children, but why? Does it work better if it’s given to them at a certain age?
Dr. Joy: Yes. Definitely. Eleven to fifteen is when kids mount the strongest response. Older than 15, they still mount a response but it’s not as strong. I think part of it is, we’re giving kids other vaccines at 11. We give them a tetanus booster and a meningitis vaccine. So, we do all of them at the same time as adolescent vaccines and a big part of it is the immune response. That’s also part of why after 26 it doesn’t work as well.
Melanie: Does someone have to restart the HPV vaccine if too much time passes between those three shots?
Dr. Joy: No and I meant to say that when we talked about the three doses. You don’t. I see kids all the time who only come in once a year and they will get one dose at 11, one at 12 and one at 13. You don’t have to start over.
Melanie: That’s really good information. In just the last couple of minutes here, Dr. Joy, sum it up for us. Speak about the HPV vaccine for boys and for girls and why it’s so important and what you tell parents about this important vaccination and why they should come to Maine Medical Center for their care.
Dr. Joy: The most important thing to me is that people talk of this as a cancer vaccine and it’s true. If everybody was vaccinated against HPV, it’s reasonable to expect that we would have almost zero cervical cancer which is huge. Cervical cancer – there were 12,000 new cases in the United States in 2012. Four thousand people died in 2012 and worldwide there were 528,000 new cases and 266,000 deaths from just cervical cancer in 2012 worldwide. Those can all be prevented by a vaccine. The other thing that I always think about is the prevalence of HPV. This is not rare. The likelihood that you will be infected with HPV in your lifetime, unless you have a partner who has never, ever been with anybody else and you’ve never been with anybody else, the likelihood that you’re going to get infected is very high. Those two things together – very high rate of infection and a difficult cancer to treat-- is the best reason. It’s safe and it works. We don’t have a lot of long-term data to say in 50 years how much cervical cancer will we see but the short-term data is very promising that we’re seeing less rates of infection. I think that’s the most important thing and that’s what I talk to parents about. We know it works, we know it’s safe, we know this is an important vaccine and you can prevent cancer. It’s not even cervical cancer. It’s all the other types of cancers – head and neck cancer, anal cancer, penile cancer. It’s definitely something that, taking aside the mode of transmission, it’s kind of a no brainer that it’s an important vaccine.
Melanie: Thank you so much. It’s such important information. You’re listening to MMC Radio. For more information you can go to MaineMedicalCenter.org. That’s MaineMedicalCenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening.