Forms and Instructions
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The FDA approved the Gardasil vaccine in June 2006, and now all of us are learning more about HPV and cervical cancer. HPV stands for the human papillomavirus. There are over 40 strains of genital HPV, and some subtypes (low risk types) cause genital warts and some (high-risk types) cause cervical cancer. Gardasil is 100% effective in preventing the development of lesions caused by HPV types 6, 11, 16, and 18; which cause 90% of the genital warts and 70% of the cervical cancers. It seems difficult to believe that a viral infection can cause cancer, but in the case of cervical cancer, this is true. HPV is transmitted through genital contact. Risk factors for transmission of HPV and developing cervical cancer include early age at initiation of sexual activity, having multiple sexual partners, having partners with multiple sexual partners, immunosuppression and cigarette smoking.
Genital HPV is the most common sexually transmitted infection in the United States. Approximately 20 million Americans are currently infected with HPV, and another 6.2 million people become newly infected each year. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives. HPV can infect areas that are not covered by a condom — so condoms may not fully protect against HPV. So the only sure way to prevent HPV is to avoid all sexual activity. Currently, Gardasil is approved for use in females 9 to 26 years old. The Advisory Committee on Immunization Practices (ACIP) 2007–2008 guidelines recommend HPV vaccination for all females 26 or younger who have not completed the vaccine series.
It is almost without question that women present annually for a Pap smear — many without truly comprehending that the Pap test is a screen for cervical cancer. Recent HPV testing has made us even more sophisticated in our approach to abnormal Pap results. Going forward, although it may take an entire generation to do so, implementation of the HPV vaccine to all girls and young women will dramatically change the need for Pap testing. The American College of Obstetricians and Gynecologists is recommending that girls have a "getting to know your OB/GYN" visit between the ages of 13 and 15. However, instead of meeting young girls for this friendly type of a visit, I find myself meeting teenagers for the very first time to explain their abnormal Pap test and recent infection with HPV. We all need to face the reality that HPV has become the most common newly acquired sexually transmitted infection in the U.S., and furthermore, that the infection can be acquired on a first encounter, despite the use of condoms.
Dr. Jalpa (Jenny) Kim is a board certified OB/GYN at Longmont Clinic. She joined the Clinic in July 2006. She can be reached at 720-494-3130.
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