How old should my daughter be before I get her immunized for HPV?
This is an excellent question and we commend you for you for keeping up on this important topic. HPV, human papilloma virus, is the virus responsible for all abnormal Pap smears and most cases of cervical cancer, as well as cancers of the vagina, vulva. It is a sexually transmitted infection for which there is no cure and is not completely preventable even with condoms. Every year about 12,000 women are diagnosed with cervical cancer in the U.S. and about 4,000 women die from it. (CDC). Fortunately, with regular Pap testing and treatment most women who are exposed to the virus (the majority of women) will not develop cervical cancer.
There are over 100 different strains of HPV some of which are considered high risk for cancer. Of the current approved HPV vaccinations, Gardasil helps to protect against 4 important strains of HPV and has been widely used and studied. This vaccination immunizes women against 2 high risk strains of HPV that cause 70% of cervical cancers and 2 strains that cause 90% of genital warts. Warts do not develop into cancer and are completely benign, but they are bothersome and this is why the vaccine includes protection from some strains. The vaccine is highly effective, but doesn’t protect against all strains of HPV or completely prevent cancer.
The HPV vaccine is currently approved for use in women age 9-26. (Studies are being done on the benefits of vaccinating men to minimize HPV in the population and whether women over 26 years old can benefit.) The key is to get immunized before contact with the virus, as is the case with all other immunizations. Typically around age 11-12 is a good time to think about immunizing your daughter, and I know our hope as parents and physicians is that kids are abstinent as long as possible. We find as gynecologists it is a good visit to talk to these teens about abstinence, avoiding tobacco and drugs, and the importance of Pap testing. (Age appropriately of course). Gynecologists will not perform a pelvic examination on these young girls unless they are sexually active, so this should not be a concern. If a young woman has a history of sexual activity or abnormal Paps, she may still get vaccinated as she might benefit from protection of the strains that she has not yet been exposed to. Fortunately, many insurance companies are now covering the vaccine.
Large trials on millions of women have been done on the risks of the vaccine and are ongoing. The majorities of the reactions have been mild and are similar to most other routine vaccinations; however there are more serious risks like seizures, fainting, anaphylaxis, and other rare complications. (Kuehn, BM. JAMA 2008; 300:2713.) This is not a live virus vaccine, so there is no risk of getting HPV from the immunization.
We do want to emphasize that despite the benefits of the vaccine, regular Pap testing still needs to be performed. In addition, preventive measures such as avoiding tobacco, encouraging abstinence, avoiding multiple sexual partners, and using condoms are all important measures to help prevent HPV, cervical cancer, and sexually transmitted infections. Most women have had to deal with the stress and discomfort of abnormal Pap smears; it is exciting to think about the future and that our young girls may not have to endure all of this.
Mona Saint M.D., M.P.H. is a board certified Ob/Gyn and a mother of two young boys. She has won awards of excellence in gynecologic surgery and teaching, and she continually receives the highest ratings in patient satisfaction surveys. Most of all, she is appreciated for her down to earth and easy to understand explanations of complex medical questions and her empathetic style.
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