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Women's Health

The HPV Vaccine: Current Information and Recommendations for Parents

What is HPV?

Why should I be concerned about HPV?

How common is HPV?

How can my child get HPV?

How can my child avoid getting HPV?

What HPV vaccines are available?

How does the HPV vaccine work?

How does the HPV vaccine prevent cervical cancer?

How can I get the HPV vaccine for my child?

What are the known safety concerns?

What controversies have arisen over the use of the HPV vaccine in girls?

If my child gets the vaccine, will she still need to have yearly PAP smear exams?

Recommendations

References

Introduction:

What is HPV?

HPV stands for human papilloma virus. It is the most common sexually transmitted infection in the United States and is found most commonly in young adults and sexually active teenagers. The majority of infections do not cause symptoms and go away within 1-2 years without treatment. Therefore, it is very likely that someone can have HPV and not know it.

Occasionally, HPV causes genital warts in girls around the vagina and can cause warts inside the vagina and on the cervix as well. HPV can also cause warts to form in the windpipe, but this is much less common than genital warts. If the HPV infection never clears, these warts can cause cancer by infecting the cells of the cervix with the HPV virus and causing the cells to grow continuously. When cancer cells grow continuously and spread throughout the body, they can cause death by blocking the function of vitally important body systems.

HPV has been found to cause 99% of all cervical cancers. Other risk factors for cervical cancer include: smoking, HIV infection, multiple pregnancies, and possibly long-term oral contraceptive pill use. HPV has also been found to cause penile cancer in Asia, Africa, and Latin America, but this is rare in the United States.

Why should I be concerned about HPV?

There are many different types of HPV (over 200 have been identified). The different types of HPV cause different symptoms and have different risks. Low-risk types of HPV can cause genital warts and some pre-cancerous cells on the cervix which are noted by pap-smear. High-risk types of HPV have a very high chance of causing cervical cancer.

How common is HPV?

According to the Centers for Disease Control (CDC), by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV. Most infections occur during sexual intercourse in women during their teens and early adulthood. All women older than 18 years and all teens that are sexually active are encouraged to get a yearly pap-smear solely to detect abnormalities in the cervix caused by HPV.

How can my child get HPV?

The only way that anyone can contract HPV is through skin-to-skin contact during sex. Infected skin of one person rubs against the skin of the other person and transfers the virus. Almost all infections are acquired through vaginal or anal intercourse, but rarely HPV may be transmitted by oral-genital sex. The male condom is not as effective at preventing HPV transmission as it is for the prevention of other STDs since the male condom does not prevent all skin-to-skin contact during sex.

Most infections do not have symptoms--no warts or Pap smear abnormalities-- but transmission of the virus is possible even though there are no visible signs of infection. Infants born to infected mothers may become infected, usually in the mouth or throat.

How can my child avoid getting HPV?

Abstinence is the only 100% way to avoid getting HPV. The next best method is to reduce sexual partners to those who have tested negative for HPV and to avoid sexual contact with any partner who has a visible genital wart or who has tested positive for HPV. Male condoms must be used such that genital skin-to-skin contact is reduced.

The HPV vaccine has been developed to immunize people against the high-risk types of HPV so that their body can fight the HPV if they contract HPV during sexual contact and so that the HPV infection can be prevented.

HPV Vaccine:

What HPV vaccines are available?

In June 2006, the FDA approved the HPV vaccine called Gardasil which is made by Merck & Co. Another vaccine called Cervarix, which is made by GlaxoSmithKline, is being reviewed by the FDA but has not yet been approved in the United States (as of July 2007).

The vaccine has been shown to work the best in girls that are 9 to 15 years old. The vaccine needs to be given in 3 doses over a 6 month period in a girl between the ages of 9 years and 12 years prior to becoming sexually active. Girls up to 26 years old can also get the vaccine, but it is not recommended for women older than 26 years as most women that are sexually active have already been exposed to HPV.

How does the HPV vaccine work?

In order to understand how the HPV vaccine works, you must first understand how the body fights HPV.

Normally, the body knows to fight infections and germs due to the signals on the viruses which send a message to the body that this is a bad germ and must be destroyed. This signaling takes several days and then several more days to make enough immune defenses to fight the virus or germ. During this time the virus is doing damage and you begin to feel sick.

Once the body has formed immune defenses against this germ or virus, anytime that the germ comes back, the body will be able to start fighting that germ immediately so that it doesn't have time to cause any damage and make you sick.

The vaccine contains the signals of the types of high-risk HPV viruses but does not contain the whole HPV virus particles. These bits and pieces of the high-risk HPV virus stimulate the immune system to attack any future HPV particles, thus causing them to die. Therefore, the vaccine allows you to make your defenses without actually getting infected by the virus and without you getting sick or damaged by the virus.

The vaccine does not contain any live virus DNA and is not infectious. Therefore, the HPV vaccine does not lead to a HPV infection.

You may find the National Cancer Institute's Understanding Cancer Series: HPV Vaccine helpful in understanding how the HPV vaccine works.

How does the HPV vaccine prevent cervical cancer?

The HPV vaccine helps the body to fight HPV without the body having been truly exposed to an HPV infection. Therefore, it tricks the body into fighting the HPV without actually getting the HPV infection and the HPV cancer risks. If your child were to obtain a HPV infection in the future, then your child would be able to fight the HPV virus before it was able to do any damage.

When the HPV dies after being attacked by the immune system, it is unable to cause cervical cancer. In this way, the HPV vaccine helps to prevent cervical cancer.

How can I get the HPV vaccine for my child?

Your child's pediatrician or family medicine doctor can give your child the vaccine. The retail price of the vaccine is $120 per dose ($360 for full series) and is covered by most health care insurances. Federal health programs such as Vaccines for Children (VFC) will cover the HPV vaccine for those without health care insurance. There are over 45,000 sites that provide VFC vaccines, including hospitals, private clinics, and public clinics. (See links below for more information)

What are the known safety concerns?

Immunization should be postponed in anyone with any moderate to severe illness at the time of the immunization so that the immune system can focus on fighting that illness. Women that are pregnant should not receive the vaccine as it could cause harm to the developing baby. If a woman becomes pregnant while receiving the vaccine, then that should be reported to a registry at: 1-800-986-8999. The vaccine should also not be given to someone with an allergy to yeast or to anyone with a past history of allergies to other vaccines as that person may have an allergy to some of the preservatives within the vaccine.

Occasionally, fainting has been noted when the vaccine has been given, thus vaccine recipients should lie down for 15 minutes after getting the vaccine. Only three reports of deaths were noted following HPV vaccination. These deaths were due to heart problems and/or blood clotting after receiving Gardasil and were most likely not related to the vaccine.

The vaccine should not be given to boys as the vaccine has not been fully studied in boys yet. However, current studies are underway to assure that the vaccine is safe and that it works well in boys, too.

What controversies have arisen over the use of the HPV vaccine in girls?

More than thirty-three U.S. states and the District of Columbia are considering making HPV vaccination mandatory for young girls entering middle school or high school which include the following: Arizona, Colorado, California, Connecticut, DC, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Minnesota, Mississippi, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, and West Virginia.

Texas Governor Rick Perry issued an executive order in February 2007 mandating that the HPV vaccine be given to all school girls entering sixth grade, beginning September 2008. However, the Texas legislature overruled Governor Perry's order and dismissed mandatory vaccinations.

Several conservative groups in the U.S. have publicly opposed the concept of making HPV vaccination mandatory for pre-adolescent girls, asserting that making the vaccine mandatory is a violation of parental rights. Some religious groups are concerned that the vaccine will encourage promiscuity by making it seem safer.

Others argue that the prevention of disease by vaccines is one of the shining achievements of healthcare and that the HPV vaccine should be mandated as a public health measure that would effectively help to make HPV extinct.

Preventive Medical Care: 

If my child gets the vaccine, will she still need to have yearly PAP smear exams?

Yes, annual PAP smear exams continue to be important as the vaccine does not protect against all strains of HPV. Therefore, there is still a risk for cervical cancer if your daughter is sexually active and contracts one of the strains of HPV not covered by the vaccine. Furthermore, annual exams are important to assess for other sexually transmitted diseases. 

Recommendations:

References:

For additional HPV vaccine information, the following websites are recommended:

HPV Vaccine Information For Young Women
Information for Parents about Pre-teen Vaccines
Understanding Cancer Series: HPV Vaccine
Vaccines for Children Program (VFC)

For more information:

Go to the Women's Health health topic, where you can:

This article is a NetWellness exclusive.

Last Reviewed: Oct 07, 2009

Jennifer Shine Dyer, MD, MPH Jennifer Shine Dyer, MD, MPH
Former Assistant Professor of Pediatrics
College of Medicine
The Ohio State University