Gynecology FAQs

What is the HPV vaccine?

The FDA has recently approved Gardasil by Merck. It is the HPV vaccine developed from purified inactive proteins for four different HPV subtypes (6,11,16,18). The purpose of the vaccine is to prevent cervical cancer & genital warts and other rarer cancers of the vagina and vulva. Notably, there are >100 subtypes of HPV and this vaccine is designed to prevent infection from four. These are four of the most troublesome and the vaccine could prevent 70% of cervical cancers and 90% of genital warts. The take home point is that the vaccine will not cover 100% of the HPV viruses. Patients who are sexually active are still at risk for infection with HPV and other viruses as well as bacterial STIs. Patients who get the vaccine should continue cervical cancer screening with pap smears per established guidelines.

It is best when given before HPV infection. Thus, before a woman becomes sexually active. There is currently, no clear cut mandate on when to initiate the vaccine. There is some evidence that it may be advantageous even in women who are already sexually active. It is being targeted for patients 9-12 years old. Should be considered in women through their 20’s.

The vaccine is given over 3 injections:

  • 1st dose
  • 2nd dose 2 months after first dose
  • 3rd dose 6 months after 1st dose.

There are minimal risks associated with the virus for example, it will not cause the patient to have an HPV infection. Some side effects and issues:

  1. Potential injection site side effects: pain, swelling, redness
  2. Fever
  3. Risk of allergic response
  4. Doesn't protect against all HPV types
  5. Doesn't protect against other causes of STI (sexually transmitted infections) such as herpes, hepatitis, HIV, chlamydia and gonorrhea to name a few.

This vaccine is not free of controversy. Many parents are concerned that it will encourage promiscuity. My opinion is it can only decrease promiscuity. I reason this because I believe the threat of HPV is not currently a deterrent to promiscuity because most people are not educated on the risks of viral STIs, particularly HPV. The discussions regarding this vaccine will enhance most patients' knowledge of viral STIs and will likely encourage consideration of uncovered HPV subtypes as well as other STIs such as HSV, HIV and Hepatitis. I reason that the resultant discussion and knowledge is more likely to result in abstinence than promiscuity especially in light of the fact that HPV is not currently a deterrent.