Posts tagged ‘cervarix’

HPV Vaccination – Protection for you and your daughters

What if there was a vaccine that offered you protection against the second most common and fifth deadliest cancer in the world.  

Would you take the vaccine? 

Would you give it to your daughter? 

 These aren’t rhetorical questions.  Because that vaccine exists.  Its  was approved by the Food and Drug Administration (FDA) in 2006 and is intended to prevent cervical cancer. 

The human papilloma virus (HPV) can be linked to the development of almost all cases of cervical cancer.  Although there are over 60 different types of the HPV virus, approximately 70% of all cases of cervical cancer can be linked to only two specific, high-risk types.  These HPV types are known as HPV type 16 and 18.    So, vaccines preventing high-risk HPV can significantly reduce the risk of cervical cancer in women receiving the vaccine.

hpvdiagram-afp

The first vaccine against HPV, Gardasil, was developed to target types 16 and 18.  It also targets HPV types 6 and 11, which are linked to the development of genital warts (but not cervical cancer).  It was approved in 2006 for girls and women ages 9 to 26.   Gardasil is also approved for use in boys and young men aged 9 to 26, but that’s beyond the scope of this post.

Another HPV vaccine was approved in 209. This vaccine, Cervarix, is designed to prevent infection from HPV types 16 and 18, and offers some protection against HPV types 45 and 31.  Cervarix also contains an ingredient believed to boost immune system response to the vaccine.  It is given to girls and women ages 10-25.

Both vaccines are most effective at preventing HPV disease when given before a young woman becomes sexually active.  That’s because vaccines are designed to prevent infection, but don’t treat infection once it has occurred.  Both vaccines are given as a series of 3 injections over a course of 6 months.

Some people ask whether the HPV vaccine can be given to women who are already sexually active.  Yes!  It can even be given to women who have already been diagnosed with an HPV-related condition (such as an abnormal pap smear or genital warts).  While an individual who has been diagnosed with an HPV-related condition has probably been exposed to at least one strain of the HPV virus, that doesn’t mean she’s been exposed to all of them.  So the vaccine may protect against one or more strains of the HPV virus to which she is currently vulnerable.

Studies have shown that both Gardasil and Cervarix prevent nearly 100 percent of the precancerous cervical cell changes caused by the types of HPV targeted by the vaccine for up to 4 years after vaccination among women who were not infected at the time of vaccination

That’s some pretty dramatic stuff.  And If I’m gonna make a statement like that, I’m gonna cite a source (“Human Papillomavirus (HPV) Vaccines”. National Cancer Institute (NCI). 2009-10-22. Retrieved 2009-11-11.). 

Most health insurance companies cover one or both HPV vaccines for women and girls within the recommended age range (9-26 for Gardasil, 10-25 for Cervarix).  Some health care providers will administer the vaccine to women over the age of 26, but that can be discussed with the individual provider and won’t be discussed here.  Women without insurance, or those whose insurance doesn’t cover the vaccine, can pay for it out of pocket, but the cost is often prohibitive.  A doctor’s office or clinic can give an estimate of cost.

The Vaccine Information Statement for Gardasil gives a tremendous amount of useful information.

So does this HPV Vaccine FAQ sheet from the American College of Obstetrics and Gynecology.

For more information and individual advice, speak to your healthcare provider.

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May 24, 2013 at 7:55 pm 1 comment

HPV 411: The scoop on Human Papillomavirus

HPV (human papillomavirus) is a big topic nowadays. Patients are asking about it because it has been addressed as a topic in popular media (The HBO series ‘Girls’), because of commercials for the HPV vaccines (Gardasil and Cervarix), and because the have heard about it in the context of an abnormal Pap smears.  There’s a lot of misinformation out there (particularly in the media) and I’d like to combat it with some facts.

First, let’s review what the virus is and what it does. HPV is not just one virus. It’s a family of viruses, of which over 30 different types (identified by numbers such as ‘Type 16’) infect the anogenital area and can be transmitted by sexual activity. 

**Barrier contraception (such as condoms or dental dams) can prevent most HPV transmission between partners.** 

Some types of HPV cause genital warts. These types are typically described as ‘low-risk’ for subsequent development of precancerous or cancerous lesions. Genital warts are visible on the skin and mucous membranes. They are often noticed by patients on self-examination. They can also be diagnosed by a doctor at the time of an annual visit during a visual inspection of the genital area.

Some HPV types are described as ‘high-risk’ for the development of precancerous or cancerous lesions. That’s these types of HPV infection are the cause of nearly all cases of cervical cancer and may be linked to rarer cancers of the vulva (female external genitalia), vagina, anus, penis, and oral region. Most infections with even these ‘high-risk’ types resolve spontaneously (i.e. without treatment) and do not cause disease.

HPV screening in women is done indirectly through the use of Pap smears or Pap tests. A Pap smear is a microscopic evaluation of cells obtained by swabbing the cervix. These cells are examined for the types of cellular changes typical of HPV infection. A Pap smear is often performed by a doctor or other health care provider at the time of a woman’s routine annual visit.  An abnormal Pap test requires further evaluation, usually with colposcopy (see below).

HPV testing can be performed directly by a laboratory. A sampling of cervical cells (obtained by a healthcare provider at the time of a Pap smear) is sent to a lab to detect the presence of DNA from the HPV virus. This test is usually reserved for women over 30 or those who have already had an abnormal pap smear. HPV testing is not routinely performed on men, nor is it routinely performed in the anal or oral region. That’s because cancers of these other organs are rare in comparison to cervical cancer.

Most HPV infections in young women are self-limited (i.e. they resolve on their own and without treatment) and have no long-term health consequences.  Up to seventy percent of HPV infections resolve in 1 year and ninety percent may resolve in 2 years.  However, when the infection persists — in 5% to 10% of infected women — there is a significant risk of developing precancerous lesions of the cervix.  Over 10-15 years, these lesions can progress to invasive cervical cancer.  The long interval between precancerous lesions and their development into cancer allows ample opportunity for detection and treatment of the pre-cancerous lesion. Progression to invasive cancer can be almost always prevented when regular screening detects precancerous lesions and treatment is provided in a timely fasion. 

A colposcopy (from the Greek kolpos “hollow, womb, vagina” + skopos “look at”) is done to evaluate the cervix after an abnormal Pap result.  The colposcope itself is just a microscope with a light allowing a doctor to examine an illuminated, magnified view of the cervix, vagina and vulva.  Many premalignant and malignant lesions have specific characteristics which make them look ‘suspicious’ when examined in this fashion.  These areas can then be targeted for biopsy (taking a piece of tissue to be evaluated by a Pathologist). The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early so that they can be treated before they become malignant. 

Treatment of precancerous or premalignant lesiosn usually involves minor surgical procedures (a LEEP or a cone biopsy) in which uses a cauterizing loop or other small cutting instrument to remove the affected part of the cervix.   Patients are usually advised to avoid sexual intercourse for at least 6 weeks to allow complete healing.  Cryotherapy (freezing the affected portion of the cervix with liquid nitrogen) is also used in some areas where the aforementioned procedures are not feasible (i.e. in the developing world).  Cryotherapy is not usually used for premalignant lesions because it is less likely to remove the entire lesion and  because there is no way to reliably identify the extent of tissue destroyed.  Therefore, it is considered a less effective therapy and is used only for lesions which are not precancerous or in situations in which a LEEP, LETZ or cone biopsy cannot safely be performed.

There is some increased risk of reduction or loss of fertility and an increased risk of certain pregnancy complications (including preterm birth) with some of these procedures, especially if they need to be repeated several times.  A doctor who performs these types of procedures can go into greater detail about the risks of a specific procedure he or she recommends.

**In summary: HPV can cause cervical cancer.  The best defense against cervical cancer is to get reguar screening with Pap smears and HPV tests as recommended by your healthcare provider.  An abnormal screening test deserves prompt follow-up and may require colposcopy.  Medical procedures (LEEP, cone biopsy) which are performed on individuals with HPV infection at the time they are diagnosed with precancerous lesions are effecive at preventing cervical cancer.   These procedures may carry a risk of pregnancy-related complications and should be discussed with your healthcare provdier.  Condom use and HPV vaccination may prevent some HPV infections.**

I’ll be blogging about HPV vaccination next.

July 23, 2012 at 8:02 pm 6 comments

What happens in Vegas stays in Vegas (Sometimes)

I recently went to Las Vegas for a medical conference.  Everywhere I went, I saw signs with the slogan “What happens in Vegas stays in Vegas!”.  This led me to joke to one of my gynecologist friends– “Sure.  Except if it’s herpes.” 

I guess I thought that was funny at the time.  But it occurred to me that it’s dangerous to propagate the idea that acting out (sexually or otherwise) is without consequences.  

It’s not that there’s anything wrong with Vegas.  And I’m not one to knock bachelor/bachelorette parties and a night of cocktails.  But if being forewarned is being forearmed, then using a condom is some food for thought you won’t find at the $19.99 dinner buffet.  And I’d like to give you, gentle reader, the skinny on a few souvenirs you don’t want to bring home with you.

Some sexually transmitted diseases can be cured with antibiotics.  These include gonorrhea, chlamydia, syphillis and trichomonas.  All of these can be diagnosed with simple tests available in your doctor’s office. Treatment of sexual contacts is important, and should occur for both partners at the same time.  All can be prevented with the use of latex condoms.

Gonorrhea and chlamydia are often lumped together when discussing sexually transmitted diseased (STD’s).  They are distinct diseases caused by different microbes, but are often found together in co-infections.  Both can be asymptomatic.  When symptoms occur, they often show up 2 to 3 weeks after infection.  Common complaints include

  • A yellow vaginal discharge
  • Painful or frequent urination
  • Burning or itching in the vaginal area
  • Redness, swelling, or soreness of the vulva
  • Pain in the pelvis or abdomen during sex
  • Abnormal vaginal bleeding
  • Rectal bleeding, discharge, or pain 

Gonorrhea and chlamydia are diagnosed by laboratory analysis of samples taken from the cervix using a cotten swab.  Timely treatment of gonorrhea and chlamydia can prevent infertility, which can be a complication of advanced infection.  Treatment is usually oral medication or a combination of oral medication and a shot (like a flu shot) given in the arm.  Advanced infections may need to be treated in a hospital with intravenous medication.

  

 

Syphilis first appears as a painless genital sore called a chancre (pronounced like “shank-er”). It lasts 10 days to 6 weeks after contact with an infected partner. Swollen lymph nodes in the groin m ay also occur.  A rash on the palms and soles (of hands and feet) occurs durng a second stage of infection 1 week to 3 months later.  Flat warts or a flu-like illness may occur at this time.  Syphillis can be diagnosed with a combination of physical exam and blood tests.  Early treatment is important to prevent long-term problems including birth defects in children of infected mothers.  Treatment usually consists of antibiotics given as a shot (in the arm or buttocks) and may need to be given more than once. 

Trichomonas vaginitis is a microscopic parasite that is spread through sex. Many people have no symptoms of trichomonas. When symptoms do occur, they include discharge from the vagina and vaginal itching and redness.  Trichomonas can be diagnosed on a vaginal exam (sometimes in combination with testing samples of vaginal fluid). Treatment usually consists of oral antibiotics or an antibiotic gel which is placed in the vagina. 

Some sexually transmitted diseases can’t be cured.  Usually, these are due to viruses. 

Human Immunodeficiency Virus (HIV), Human Papilloma Virus (HPV), Herpes Simplex Virus (HSV), and Hepatitis B and C can all be sexually transmitted.  All can be treated with medication, but none can be cured.

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). Transmission can occur during intercourse.  It is possible for transmission can occur through orogenital (oral) sex too.  Anal sex is particularly risky.    Transmission rates can be significantly decreased with the use of a latex condom.  It can be diagnosed with a blood test and is treated with antiviral medications.  Untreated, it can cause compromise of the immune system, illness, and death.

Human papillomavirus (HPV) is one of the most common STDs in the United States.   There often are no signs of genital HPV. However, a few types of HPV cause warts. These can appear on the vulva, vagina, cervix, and anus. In male partners, they may occur on the penis, scrotum, or anus.

Sometimes warts go away on their own. If they do not, there are several treatments for warts available at your doctor’s office. Treating yourself with over-the-counter wart medications (compound W etc.) is NOT recommended.

Even after the warts have cleared up, the virus may be present. The virus can remain in the body for weeks or years without any symptoms.

Certain types  of the HPV virus are associated with an increased risk of cervical cancer.  HPV also may be linked to cancer of the anus, vulva, vagina, penis, head, and neck. 

Some types of HPV infection and pre-cancerous changes in the cervix are detected with a Pap Smear or Pap Test.  So while your Pap Smear doesn’t test for sexually transmitted diseases per se, it can diagnose HPV-related conditions. 

If abnormalities associated with HPV are found on your Pap Smear, your doctor will discuss diagnosis and treatment options with you.  You may also want to discuss the HPV vaccine, which prevents several types of HPV infections, and can be given to most girls and women aged 9-26 regardless of whether they have had an HPV infection in the past.

Herpes Simplex Virus (HSV) causes herpes.  It also causes “cold sores” on the face and mouth.  Although people sometimes refer to the HSV 1 virus as “oral herpes” and the HSV 2 virus as “genital herpes”, both viruses can cause lesions in both areas, so this distinction  isn’t particularly useful.  The best description is to say that genital herpes is any herpes ocurring on the genitals, regardless of virus subtype (1 or 2).

The most common symptom of genital herpes is a sore on or around the genitals. These sores are often multiple, usually red or blister-like, and may be itchy or exquisitely painful.  The sores can last from a few days to a few weeks.  Herpes can be diagnosed by a combination of physical exam, viral culture of open sores, and blood tests.

The symptoms go away by themselves, but the virus remains in your body. The sores may come back at any time, usually in the same place they first occurred. Treatment can help heal the sores and reduce the number of future outbreaks, but it cannot kill the virus. 

A person who has herpes can transmit the virus even in the absence of symptoms.  If you or your partner have oral or genital herpes, avoid sex from the time of first symptoms until a few days after the scabs have gone away.

The Hepatitis B and C viruses can also be transmitted by sexual intercourse. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise.  Hepatitis is acute when it lasts less than six months and chronic when it persists longer.  Chronic hepatitis may be asymptomatic, but can cause cirrhosis (scarring of the liver), liver failure, liver cancer, and death.  Hepatitis B and C can be diagnosed by blood tests.  Treatment is directed at reducing symptoms and slowing the progression of the disease. 

The Hepatitis B vaccine reduces the risk of contracting hepatits and is widely available.  It is recommended to all children and to high-risk adults (those with multiple sexual partners, who use intravenous drugs, or who are in occupations which may involve exposure to blood or other bodily fluids).  There is no hepatitis C vaccine. 

Hepatitis A, by the way, is not sexually transmitted.  It is food-borne and does not result in chronic infection. It causes an acute gastrointestinal illness and is often contracted by eating undercooked shellfish.  So, You can still get it in Vegas.  You’re welcome.

So, remember, there are some souvenirs nobody wants to bring home from vacation (or any other encounter).  If you have a new sexual partner or have any other reason to think you may be at risk for sexually transmitted infection, visit your heathcare provider for simple tests. 

And since I started this post with a poorly conceived joke, I’ll end with one.  Practice safe sex: Use your head (and use protection when giving it)!

November 18, 2010 at 9:03 pm 4 comments


Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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