Stephen R. Wells MD

Undoubtedly you have heard or read about the newest vaccine available to the public: Gardasil, manufactured by Merck, is the first vaccine developed to prevent cervical cancer, pre-cancerous genital lesions, and genital warts caused by the HPV virus. The following contains information useful to decide if the vaccine is right for you. We do offer and administer the vaccine in our office upon request.

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HOW COMMON IS HPV?

It is THE most common sexually transmitted infection in the U.S. More than 20 million men and women are currently infected in the U.S., and it is estimated that 6 million more will become infected in the next year. By age 50, at least 80% of all sexually active women will have acquired an HPV infection.

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HOW SERIOUS IS DISEASE CAUSED BY HPV?

Almost all cervical cancers are caused by HPV. In the U.S., 9,700 women each year are diagnosed with cervical cancer, and each year 3,700 will die of the disease. More commonly in my office, however, I see the effects of the virus in genital lesions like warts inside and outside the vagina. I also evaluate and treat abnormal PAP smears caused by the viral infection. Luckily, we live in an area where follow-up is excellent. As a result, progression from a pre-cancerous lesion found on PAP smear to cervical cancer is extremely rare. Nevertheless, to be able to prevent the virus from causing pre-cancerous changes in the first place is much better.

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SO WHAT ABOUT THE VACCINE?

Gardisil is manufactured by Merck. The vaccine is highly effective against four types of the HPV virus (thus called a quadravalent vaccine). This is important to understand. There are many subtypes or “strains” of the HPV virus. Over 60 have been identified to date. However, only a few are responsible for the vast majority of cancers or warts. The vaccine is highly effective against four types of the HPV virus, including two (types 16 & 18) that cause about 70 percent of cervical cancer and severe precancerous changes of the cervix and vagina, and another two (types 6 & 11) that cause up to 90% of genital warts and mild precancerous lesions of the cervix. The vaccine does not protect against EVERY type of HPV, but does an excellent job in protecting against the ones that cause the majority of problems.

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The vaccine contains other chemicals in addition to the viral-like particles (VLP’s – the part of the vaccine that elicits the immune response), but does not contain preservatives such as mercury-containing thimerosal.

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WHO SHOULD RECEIVE THE VACCINE?

The Advisory Committee on Immunization Practices (ACIP) voted to recommend that it be routinely given to girls ages 11-12, though it can be given to girls as young as 9 years. ACIP also voted to recommend that girls and women ages 13 through 26 receive the vaccine. Ideally the vaccine should be administered before the onset of sexual activity, but sexually active females should still be vaccinated.

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The question often comes up as to recommendations for women who have already been diagnosed with HPV. Although the vaccine would not alter the course of the current infection, women would still benefit from protection against the other virus types in the vaccine.

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HOW IS IT ADMINISTERED?

The vaccine is licensed as a 3-dose intramuscular injection series, with dose #2 given 2 months after the first dose, and dose #3 given 4 months after the second dose.

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Side effects may occur with the vaccine, as with any other vaccine. Common reactions include fever (13% of patients), pain at the injection site (63.4%), swelling at the injection site (10.2%) and erythema / redness at the injection site (9.2%).

The total cost is about $360 plus administration fees. Insurance may or may not cover the vaccine, and it is up to patients to work out those details with their insurance company. If you are interested in receiving the vaccine, please call to let us know.