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Sexually Transmitted Infections

Preventing Cervical Cancer: A Guide to Pap Tests and HPV Vaccines

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. According to the Centers for Disease Control and Prevention (CDC), “nearly all sexually-active men and women will get at least one type of HPV at some point in their lives.”

But the virus usually clears on its own, without causing any damage -- and often without showing any symptoms.

The HPV vaccine can prevent infection, but it’s not for everyone. We'll tell you what you need to know about the virus and the vaccine.

What are the risks from HPV?

In both men and women, HPV infection can lead to warts or cancer in the person’s genitals, mouth, or throat. There are more than 150 types of HPV, but two (types 16 and 18) are thought to cause almost two-thirds of all cervical cancer, and close to half of all vaginal, vulvar, and penile cancers.

What are the current recommendations for cervical cancer screening?

The U.S. Preventive Services Task Force (USPSTF) recommends that women who have a cervix have a Pap test (which looks for pre-cancerous cells to screen for cervical cancer) every three years between ages 21 - 65.

Every five years, starting at age 30 and until age 65, women are advised to get a Pap test plus HPV DNA testing to screen cells for certain high-risk types of HPV.

The USPSTF does not recommend cervical cancer screening for women under 21 (i.e., neither Pap nor HPV DNA tests), because the tests are unlikely to find any problems. Similarly, the USPSTF does not recommend HPV DNA tests for women under 30, because almost everyone will test positive for the virus at least once. Even though the virus almost always goes away on its own, a positive HPV test increases people’s health care costs and anxieties. Some clinicians may order a HPV test as follow-up to an abnormal Pap test, but HPV DNA test is not meant for general screening or simply to determine HPV status.

Can HPV be prevented?

There are two vaccines -- Cervarix and Gardasil -- that prevent infection with the most common types of HPV, thereby reducing the risk of cervical and other cancers that are associated with high-risk strains of HPV.

Cervarix protects against HPV types 16 and 18, the highest-risk strains of HPV, and is approved for girls ages 9 - 26. Gardasil protects against HPV types 16 and 18, as well as types 6 and 11, which provides additional protection against genital warts and anal cancer; it is approved for both girls and boys ages 9 - 26.

While studies have shown vaccine efficacy over five to six years, longer-term data is not yet available to determine exactly how long the vaccines work to protect people.

How safe are the vaccines? What side effects can they cause?

The CDC notes that the United States “currently has the safest, most effective vaccine supply in history. Years of testing are required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and efficacy.”

The HPV vaccines are considered to be very safe, although reactions like dizziness, fainting, and soreness around the injection may occur.

More information is available about Gardasil than Cervarix because it was approved first, but on-going safety studies are being done on both vaccines. As with any vaccine, patients should carefully review whether they have allergies to any of the ingredients before getting the vaccine. (The CDC has also published a guide to vaccine safety, written especially for parents.)

When should vaccines occur?

For greatest protection, the CDC recommends vaccination around age 11-12, so it has time to become effective before sexual activity begins. (There is no evidence that having the HPV vaccine encourages a person to become sexually active.)

For people under age 26 who are already sexually active, the HPV vaccine won’t affect any existing HPV infections, but it may prevent infection from a different HPV type if it’s also covered by that vaccine. Likewise, the vaccine doesn't mean you no longer need cervical cancer screening; if you have a cervix, you should still follow the USPSTF’s screening recommendations.

Can pregnant women get vaccinated?

There have not yet been adequate studies to establish the vaccine’s safety for use by pregnant women, and neither vaccine is recommended for use by pregnant women. Women who got the vaccine and then find out they were pregnant at the time of vaccination should call the manufacturer’s “HPV in pregnancy registry” to contribute to efforts to learn more about pregnant women’s response to the vaccine (800-986-8999 for Gardasil; 888-452-9622 for Cervarix).

Where can I get the vaccine, and how much does it cost?

The vaccine is available from pediatricians, family doctors, ob/gyns, public health clinics, and family planning clinics. It is given in a three-dose series that may cost more than $500 in total. Insurance may cover the vaccine’s cost; uninsured children and young adults may be eligible to get it at low cost from public health departments and clinics.

Do I need my parents’ permission to get vaccinated?

The rules vary from state to state. In many states, teens are explicitly allowed to get reproductive health care (like family planning and STI treatment and prevention services) without a parent’s or guardian’s knowledge or consent. These laws are in place to reduce barriers to young people getting sensitive health care services.

If you get the vaccine from your provider using your parent’s insurance, keep in mind that they will get an “Explanation of Benefits” form that describes the services received.

Scarleteen has published an excellent HPV Vaccine FAQ with advice for talking with parents who have concerns about the vaccine.

For more information:

Written by: Rachel Walden. Adapted from an article from the July/August 2013 edition of NWHN's The Women's Health Activist.
Last revised: Aug 2013

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