Human papilloma virus (HPV) is a sexually transmitted illness that is responsible for causing a multitude of cancers, including cancer of the oropharynx, vulva, vagina, cervix, penis, rectum, and anus. Wherever the virus can live, it causes cancer.
HPV has been called the “hidden epidemic,” which is an accurate description. Initially, HPV infection is silent, not unlike HIV. Most people carrying the virus don’t realize they have it. Furthermore, intercourse is not required for transmission. Skin-to-skin physical contact and oral sex can easily spread the virus, which has contributed to its ubiquity. The CDC estimates that a whopping 80-90% of American women and men, respectively, will at some point be infected with HPV. Half of these individuals will acquire high-risk strains capable of causing recurrent disfiguring warts (either in the oropharynx or genitalia) or life-threatening cancer.
In total, HPV is directly responsible for causing nearly 32,000 cases of cancer each year in the US, plus an even larger number of precancerous conditions requiring invasive treatment. Although there are many strains of HPV (about 40 are sexually transmitted, and 60 cause common warts), a small subset is responsible for causing genital warts and cancer. Specifically, nine aggressive strains (6, 11, 16, 18, 31, 33, 45, 52, and 58) are targeted by the Gardasil vaccine. Gardasil is potentially capable of preventing more than 90% of cervical and anal cancer, along with high percentages of the other cancers mentioned above. It is important to recognize that the vaccine must be administered PRIOR to exposure, before a person is sexually active. Once a person becomes infected with a cancer-causing strain of HPV, the vaccine can no longer protect against that strain. In my opinion, the earlier the vaccine is administered, the better.
On a positive note, recent data from Australia indicate that the HPV vaccine is already having a significant impact on disease rates. The rate of JORPP (juvenile-onset recurrent respiratory papillomatosis), an incurable and potentially fatal respiratory illness in children caused by mother-to-child HPV transmission at birth, is declining for the first time ever. The Australia surveillance program detected a decline in incidence from .16 to .02 cases per 100,000 people from 2012 to 2016, the time frame corresponding to widespread vaccination with HPV. This improvement is only the beginning of the positive change we’ll see as vaccination against HPV becomes more routine. In Australia, the HPV vaccine is covered by insurance for people up to age 45. In the US, insurance pays for the vaccine between the ages of nine and 26. In my opinion, if an older adult is sexually active and not immune to HPV, then getting the vaccine is an excellent idea. Out of pocket, one Gardasil shot costs about $180, and three shots are required to vaccinate people who start the series later. Though it isn’t cheap, the vaccine series is much less expensive and invasive than cancer treatment.
An incredibly safe vaccination, Gardasil has been used clinically for more than a decade. Despite stories to the contrary on the web, Gardasil has never caused paralysis, sterility, or death in any patient. As a pediatrician who has been practicing medicine for nearly 20 years, I would strongly urge all parents to get the Gardasil vaccine for their children. It may someday save their lives.