Breaking Ground With the HPV Vaccine

I was very excited in August when I scheduled my appointment to receive the recently arrived, newly approved HPV vaccine, Gardasil. I knew that I was going to be one of the first women to ever be vaccinated against four types of the human papillomavirus (HPV), which I later discovered is the cause 70% of cervical cancer cases and 90% of all genital warts cases (1). While I was thrilled to take part in a new era of women’s health care, one which ushered in previously unattainable levels of protection against the virus for women, I did not truly understand or appreciate the value of this new vaccine at the time of receiving it—I was enticed by the novelty and hype of the product, not necessarily enamored by its benefits or even aware of them as I should have been. I did not know how lucky I was to be getting this vaccine nor was I conscious of how important it is for all women and girls to do what they can to protect themselves and their sexual partners for life against contracting the HPV virus, which contains over 100 different strains, more than 30 of which are sexually transmitted (7). In my quest to better comprehend the medical advances that are affecting my body, our bodies, and our society, I learned much about HPV and the glory of Gardasil, and how fortunate we are to have this new vaccine.

Human papillomavirus is an all too common sexually transmitted virus, responsible for more than 3,700 deaths within the United States every year. About half of all sexually active men and women (6.2 million in the US alone) become infected with HPV at least once in their life time, with the consequences ranging from insignificant to life threatening in the form of cervical cancer (4). Carriers can transmit the virus without every being aware that they are infected, and anyone who has ever experiences sexual activity involving genital contact is potentially exposed to the more than 40 types of HPV that can infect the genital areas of both men and women (3). HPV poses a large threat to women as it is one of the main causes of cervical cancer, the second most common cancer in women provoking more than 233,000 annual deaths worldwide. On June 8, 2006, the United States Food & Drug Administration approved Gardasil, the first ever vaccine developed to immunize women against four of the most threatening types the virus that cause cervical cancer and genital warts (4).

While the HPV virus goes away on its own in most people who become infected, the virus can linger in the body, developing into cervical cancer, precancerous lesions, or genital warts. HPV can infect a woman’s cervix, the lower part of her womb, and then cause cells to change and grow abnormally. These changes in the cells, known as “precancers,” can develop into cervical cancer if not treated (3). Unfortunately, there is no cure for HPV, and often times treatment possibilities only exist for the health problems caused by HPV, such as genital warts, cervical cancer, or even cancer of the vulva, vagina and anus. HPV types 16 and 18 cause 70% of all cases of cervical cancer, while HPV types 6 and 11 cause 90% of genital warts cases—it is these four strains of the human papillomavirus that are contained in the vaccine Gardasil (1). Immunization against these four types of HPV effectively protects women against these strains who have not already been infected with HPV at the time of receiving the vaccine, and since we know that there is no cure for HPV, it is essential to get the vaccine before one ever becomes exposed to the virus, which generally means before one engages in sexual activity (3).

Gardasil is administered as a series of three injections given over a period of six months. I received my first vaccination in August, less than two months after it had been approved by the FDA; my second dose was given to me in October, two months after the date of the first injection, and I will receive my third and final injection in February of 2007, approximately six months after having received the first dose. For women who have not already been infected by one of the four strains of HPV contained in the vaccine, Gardasil is nearly 100% effective in preventing precancerous lesions of the cervix, vagina, vulva, as well as preventing genital warts (4). However, the vaccine does not protect women against less common types of HPV that can still harm the body, so in no way should women stop receiving their annual Pap test from their doctor. Regular Pap testing can detect cancerous and pre-cancerous cells of the cervix and thus is an essential weapon in the detection and treatment of cervical cancer (3).

There is a controversy surrounding Gardasil and the HPV vaccine; ideally, the vaccine should be administered in women before they ever have contracted any HPV. If a woman has contracted any of the four types of HPV in the vaccine, she will only be protected from those strains that she does not already have (1). Thus, the controversy: women and girls should get the vaccine before contracting HPV, and therefore, before they are likely to engage in sexual contact. Gardasil is approved for use in girls and women ages 9 to 26, with the hopes that the younger the patient is, the less likely she is to already be infected. This has many parents in an uproar: many say that immunizing their 9 or 11 year-old daughter against a sexually transmitted infection is jumping the gun and plunging young girls into the world of safe sex way before they should even be thinking about sex. Some say simply that that young are just too young to be concerned with sexual health and activity, and as one doctor stated, "It's almost an assault on their innocence to be talking about those things when they do not even know what I'm talking about" (5). Some also believe that vaccinating young girls will encourage sexual promiscuity, with the point that if girls know that they are safe from contracting a sexually transmitted infection they will start having sex earlier. I personally think that this is a totally bogus argument—no parent can ever protect their child from sexual assault even if she is not sexually active, thus I believe it is better to protect all women against the virus while they still have the chance, even if this morally compromises their innocence. What is innocence anyway and who decides whether or not innocence should interfere with health care and innovative, preventative medical technology?

While there is currently not a vaccine available for men and boys against HPV, studies are being done to see whether or not such a vaccine for males would be effective. If so, the vaccine could prevent men from contracting genital warts and rare cancers, such as penile and anal cancers. Vaccinating men may also protect women from then contracting HPV from their male sexual partners (3). Gardasil is here and Gardasil can change our lives, and as the spokesman for the American College of Obstetricians and Gynecologists said in relation to cervical cancer, “this is now a vaccine- preventable problem, we have a huge opportunity to make a significant improvement in the health care of women” (5). With knowledge available both about HPV and its new vaccine Gardasil, we can all protect ourselves before becoming victims of a virus that can ultimately take our life—this breakthrough in women’s healthcare is great progress to the overall attainment of good health and safe sex. I once again express my gratitude to the developers of Gardasil for their commitment to preserving women’s health, and as a newly informed member of society, I encourage everyone, especially al women, to see whether the vaccine is right for you, and if it is, good luck and congratulations for embracing Gardasil and kicking HPV to the curb.

Sources:
1) http://www.gardasil.com/index.html, the official website for Gardasil manufactured by Merck & Co., Inc.
2) “HPV Vaccine;” a statement released by Cecile Richards, president of the Planned Parenthood Federation of America, encouraging the FDA’s approval of
the new vaccine (http://www.plannedparenthood.org/news-articles-press/politics-policy-issues/HPV-Vaccine.htm).
3) “HPV Questions and Answers” from U.S. Department of Health and Human Services Centers for Disease Control and Prevention (http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm#hpvvac1).
4) “FDA News: FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus;” the 8 June 2006 statement released by the Food & Drug Administration following the unanimous approval of Gardasil (http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html).
5) “Vaccine for Girls Raises Thorny Issues” by Rob Stein; an article from the Washington Post about the HPV vaccine and concerns and benefits of immunizing younger girls (http://www.washingtonpost.com/wp-dyn/content/article/2006/11/03/AR2006110301966_pf.html).
6) “HPV Vaccine” from Wikepedia, the free encyclopedia; contains a host of information concerning all aspects of the development and issues surrounding the HPV vaccine (http://en.wikipedia.org/wiki/HPV_vaccine).
7) “Human Papillomavirus (HPV) Infection;” the Centers for Disease Control’s information center on HPV (http://www.cdc.gov/std/hpv/default.htm#fact).