While the cure for some sexually transmitted infections (STI) remain elusive, research in the past few years has advanced to the point that we now have a vaccine for some strains of Human Papillomavirus (HPV). HPV is a common enough disease known as “warts” or in some strains of HPV, genital warts.
There are over 100 strains of HPV, and approximately 75% of sexually active adults will have at least one HPV infection in their lifetime. It is a disease which is easily acquired and is transmitted by any sexual contact. You don’t need to engage in intercourse as HPV can be transmitted via skin-to-skin contact – which includes hand-to-genital or oral-to-genital. It may take only one exposure and you can get it from someone who doesn’t have visible symptoms.
Treatment for anyone afflicted by the virus can be distressing, embarrassing and painful. Genital warts from HPV can be removed by surgical procedure, freezing or burning, or chemical treatments - but they can reappear.
However, if you still think it’s minor compared to other STIs, two strain of HPV (16 and 18) have been associated with a significantly elevated risk for the development of head, neck, throat, anal, cervical and penile cancers.
Pharmaceutical company Merck has developed the vaccine Gardasil to specifically combat both the cancer causing HPV strains (16 and 18) and the two strains (6 and 11) that cause 90% of genital warts. Canada-wide, these HPV vaccinations have been given to school age girls, usually around Grade 5, in the past few years.
The big change is we will soon see is the vaccine being administered to young boys.
The HPV vaccine has been in the news courtesy of religious groups in the United States who are afraid immunizing their girls against a sexual disease will magically turn them into sex-crazed nymphomaniacs. In Canada the response has been a bit more subdued, but health organizations do allow parents to opt out of vaccinating their children for religious or other reasons.
For “other reasons” this is usually a core group of people who take a look at the worst case scenario for vaccine side effects and blow it out of proportion. Dr. Kirk Barber, a practising dermatologist and Associate Clinical Professor of Dermatology at the University of Calgary, wants to allay any concerns people may have. The most common adverse effect hours after the injection was fever; or sometimes some itching/swelling/bruising at the injection spot. Occasionally there have been some instances of fainting. As Dr. Barber told us, people suffering some of the more severe side effects are few and far between. For the average person, “I like the word rare” he said, “...I’d even go as far to say very rare.”
As this vaccine is so beneficial, some people may wonder why it is specifically prescribed for school aged children (in fact, it’s usually not prescribed for people over 26). Regarding anyone over 26, as Dr. Barber told us, “statistically they are more likely to have seen the virus already,” as they were more likely to have been sexually active.
That’s not to say if you are older than 26 and have never had sex, you are ineligible to get the vaccine. Additionally if you’ve only been exposed to one of the types of HPV, the vaccine can still be effective in protecting you against the other 3 types.
As to how long the vaccine stays in the system after treatment, and whether boosters will be required, this was a grey area. Dr. Barber admitted, “we don’t know how long that immunity will last – we think it’s multiple years. But that’s going to be a question we’ll answer with time.”
Unfortunately, while the school-aged children will get the vaccine for free, anyone else who has a prescription from their doctor will have to pay for the 3 rounds of shots. It is expensive, running at $120 per shot.
Fortunately, you might be able to get this covered under a private health plan. Blue Cross told us their standard vaccine coverage currently lists Gardasil as indicated for treatment when it was first introduced. However, the new indication (for men) was still being reviewed, and this is probably similar to what other private health insurance companies are considering.
But getting back to the HPV/cancer connection, this illustrates how searching for the causes and risk factors of one cancer (cervical) led scientists to understand how HPV works. They realized if someone started his/her sexual activity at a younger age, had multiple sex partners, and a resultant exposure to HPV, the person had a higher chance of developing any number of cancers.
In fact, it’s believed strain 16 and 18 of HPV may be responsible for certain types of cancer which attack the hidden skin surfaces (throat, anus, cervix). So for women, the benefit to Gardasil is the reduction of instances of cervical cancer. For men?
“Anal cancer,” Dr. Barber mentioned. “That’s the issue in my mind as to why we should be aggressively vaccinating young people, because of the cancer risk.”
Especially in light of some of the numbers: greater than 500,000 cases of cervical cancer are diagnosed annually in women and a mortality rate around 200,000 a year. Head and neck cancer has about 640,000 new cases each year worldwide and is the sixth most common cancer among men and women. Anal cancer is still fairly rare, but its numbers are rising; the American Cancer Society for 2009 estimates anal cancer in the United States had about 5,290 new cases and about 710 deaths. This is why so many physicians push this as a public health issue.
Granted, Gardasil is not a magic bullet. As mentioned, it only targets the 4 most common, and most dangerous types of HPV. If you’ve already been exposed to a strain or strains of HPV, the vaccine may only then protect against the remaining strains to which you haven’t been exposed. Yet research is ongoing.
For the time being, adding men to the HPV vaccine regime will over time reduce the number of cancer cases and reduce the instances of pain and distress experienced by those suffering exposure to genital warts. It’s not a complete cure, but it will improve the health of the general public, and of the younger members of our community in the future. 