Human papillomavirus (HPV) is the most common newly acquired sexually transmitted infection (STI) in the United States. Furthermore, the incidence of HPV infection has increased during the past two decades, with approximately 6.2 million newly diagnosed cases annually. HPV infection has a very high prevalence rate in sexually active adolescent girls and young women. One study showed that 36% of women 25 years of age or younger are HPV-positive. Although HPV can cause genital warts, cervix dysplasia (a precursor to cervical cancer) and cervical cancer, most HPV infections do not cause symptoms.
Transmission typically occurs at the time of sexual intercourse. Increased risk for contracting HPV has been associated with multiple sex partners, younger age of sexual debut and failure to use condoms. One study reported that 20% of women became infected with only one lifetime sex partner, suggesting that both partners must be sexually naïve to prevent infection. The risk of infection increases substantially when initiating a new sexual relationship. The transmission of HPV infection can be blocked by latex condoms if the infected area is physically covered. However, HPV lesions often occur on external genital sites not covered by a condom, and so the latter does not prevent all infections.
The currently available HPV vaccine is effective in preventing infection with HPV types 16 and 18, the types that cause abnormal Pap smears and are related to cervical dysplasia and 70% of cervical cancer. The vaccine also prevents infection due to types 6 and 11, the types responsible for 90% of genital warts. Since other HPV types are not covered by the vaccine you should continue to have regular Pap smears.
Girls and women aged 9 to 26 years old are candidates for the vaccine. The vaccine is administered in three separate doses with an initial dose followed by additional doses at 2 months and again at 6 months.
Women with a history of an abnormal Pap smear are still candidates for the vaccine. Most abnormal Pap smears are due to infection with a single type of HPV. Since the vaccine covers 4 different types of HPV (types 6, 11, 16, and 18) it will offer protection against the types of HPV not causing the prior abnormal Pap smear.
by: David Soper, M.D.
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