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Gardasil-9: The Facts

What is Gardasil-9?

Gardasil-9 is the newest HPV vaccination on the market. It now provides protection against 9 high-risk types of Human Papilloma Virus (16, 18, 6, 11, 31, 33, 45, 52, and 58).

What is Human Papilloma Virus?

HPV is the most common sexually transmitted infection in the U.S. 75-80% of males and females will be exposed to HPV during their lifetime. Many people clear this virus on their own, however, in certain people, the virus is not cleared and can lead to certain types of cancers (cervical, vaginal, vulvar, and anal) and can also cause genital warts. While there are over 40 different strains of HPV, only about 12 are considered high-risk.

Wasn’t there already a vaccine for HPV?

Yes! The previous vaccination, Gardasil, has helped provide protection against 4 high risk types of HPV (16, 18, 6, and 11). While this has been very helpful at decreasing people’s risk for cervical, vaginal, vulvar, and anal cancers, the newest vaccination now provides protection against an additional 5 strains!

So what’s the big deal about 5 more strains?

The new vaccination provides protection against 20% of cervical cancers not covered by the previous vaccine.

So how can I get the vaccination?

The Gardasil-9 is now being offered at MacArthur Medical Center. It has been approved for females AND males ages 9-26. It is given in 3 doses with the second and third 2 and 6 months out, respectively. Come in today and ask your doctor about protecting yourself against cervical cancer!

Gardasil (The HPV Vaccine): For Your Information

Most of you have probably heard something about HPV (Human Papillomavirus). The importance of being well informed about the HPV virus and Gardasil cannot be understated. I encourage all my patients to be an active participant when it comes to their body, especially on topics of preventive medicine like HPV and Gardasil. The HPV/Gardasil topic touches on many important issues like adolescent/young female gynecologic care, disease prevention, and future long-term health that you as a patient can really take charge of and dictate.

HPV (Human Papillomavirus) is a common virus that is spread by skin-to-skin contact during sexual activity. Unlike other sexually transmitted infections, HPV-infected individuals are almost always without symptoms, so most who are infected don’t even know they have it! In fact, according to the CDC (Center for Disease Control and Prevention), the most common newly diagnosed sexually transmitted disease is genital HPV. Over 14 million new cases of HPV were diagnosed during the last year. To compare, the second most common newly diagnosed STD was Chlamydia with only 2.8 million new cases. In fact, newly diagnosed HPV was more common than Chlamydia, Trichomonas, Gonorrhea, Herpes, Syphilis, HIV, and Hepatitis B combined! The risk of acquiring HPV by age 50 for women is over 80%, and the most susceptible females are from ages 18-24 with infectivity rates more than 40%! In short, most women will be infected with HPV at some point in their lives.

So what’s the big deal you might ask? Well now we know that HPV is a known cause of certain cancers as well as non-cancerous conditions in both females and males. In females, these include cervical cancer, vaginal cancer, vulvar cancer, anal cancer, as well as genital warts. In males, penile cancer and genital warts have been linked to HPV. Even certain oropharyngeal cancers have been associated with the virus. The virus has the ability to actually infect body cells and change them in such a way that they transform into cancer.

Specific HPV genotypes are more dangerous than others. For example, HPV types 16 and 18 are known to cause ~70% of all cervical cancers and 50% of precancerous cervical lesions. In addition, 90% of all genital warts are linked to HPV types 6 and 11.

Luckily, a vaccine against HPV was created to combat these specific HPV genotypes. It is called Gardasil. The Gardasil vaccine is a powerful preventive tool in the fight to stop the spread of HPV. It is effective against the specific types of HPV that are known to cause majority of cervical cancer and genital warts, specifically HPV types 16, 18, 6, and 11.

Here are some important points that will hopefully answer any remaining questions you have about Gardasil.

Who can get the Gardasil vaccine?

Gardasil is a licensed, safe, and effective vaccine for all young women and men aged 9-26. Why those specific ages you might ask? Well, all of the original Gardasil trials were performed on thousands of people worldwide between these ages. Therefore, it has been approved for this age range only.

What is the recommended schedule for the vaccine?

3 injections are recommended over the course of 6 months. The first dose is given, then the second dose is given 1-2 months after. Lastly, a third dose is given 6 months after the first dose.

When is the absolute best time to get the vaccine?

The optimal time to get the vaccine is actually around 11 or 12 years old because the potential benefit is the greatest at that age. The reason for this is that the HPV vaccine works best before any sexual activity has begun. Higher antibody titers are produced in this age group too. Also remember, it IS possible to get infected during your first sexual contact.

How effective is Gardasil?

Gardasil is very effective as evidenced by its nearly 100% efficacy in prevention of primary infection from HPV types 16 and 18. In fact, a recent study by the CDC has shown a 56% decrease in the HPV strains covered by the vaccine in the first four years after the vaccine’s introduction in 2006. The vaccine is highly immunogenic and has shown maintenance of protection for at least 5 years after vaccination. It also has great immune memory with great potential benefit lasting even beyond 5 years.

What if I already have an abnormal Pap smear, genital warts, or tested positive for HPV?

Gardasil does not treat or get rid of an already established HPV infection or any cervical abnormality that has already occurred. However, even if you have been infected with the virus, you can still obtain some benefit from the vaccine. Plus, most of the time you don’t know exactly which HPV type you may have and most of the time young women tend to clear the HPV infection all by themselves anyway! So evidence of prior HPV infection does not preclude you from getting the vaccine or deriving any benefit from it.

Is Gardasil safe? Are there any side effects?

The FDA has licensed the HPV vaccine as safe. Thousands of people worldwide were tested and no major side effects were seen. Minor side effects do include pain at the injection site, headache, and nausea.

Do I still need Pap smears?

YES! You still need regularly scheduled Pap smears. Getting the Gardasil vaccine does not mean you can skip your cervical cancer screening (which should begin at age 21). Again, the vaccine does not treat pre-existing HPV infection. Plus, there are a small number of other HPV types can also cause cervical cancer that Gardasil does not cover.

What other things can I do in addition to vaccination to prevent HPV infection?

There are other ways to prevent or decrease the risk of transmission of HPV infection. First of all, protecting yourself is the most important thing and avoiding high risk behaviors is key. These include trying to limit your number of sexual partners and avoiding sex during early ages (13-18 years of age) when one is most susceptible to HPV. Using condoms whenever possible has also been shown to help prevent transmission (although not all skin-to-skin contact can be prevented by condoms).

Hopefully, this information has been helpful and informative. HPV is an incredibly prevalent disease, but we have the unique opportunity to still control its spread with the Gardasil vaccine. I encourage everyone to pass this information along to your family and friends (especially teens and their parents). Prevention of any disease involves action and self-motivation by patients, but even more importantly, it requires education and knowledge. So spread the word about Gardasil because HPV is spreading fast as well.

What Exactly is a Pap Smear Checking For?

As gynecologists, we help our patients through some very personal experiences: the dreaded pelvic exam, birth control, miscarriage, pregnancy, menopause, sexually transmitted infections, and so on. Discussing your cholesterol with a stranger just isn’t the same as discussing a first pregnancy or starting birth control. It is a very special part of our job. The pap is something I talk about everyday. Most women understand that they need to “get a pap to get checked down there.” But what exactly is a pap checking for? And why do you have to keep getting them?

The pap is a screening test for cervical cancer. The cervix is at the top of your vagina, and it is part of the outer uterus. We use a small brush (imagine a small toothbrush) to collect some cells from your cervix. It goes to a lab, and a specialist looks at your cells under a microscope. If the cells look abnormal, we do more tests because we are trying to prevent or detect the worse case scenario – cancer. But most times the result is simply normal or abnormal cells, which isn’t as serious but still very important. These abnormal cells can persist and ultimately develop into cancer. We can surgically remove these abnormal cells to help prevent cervical cancer. This is the gist of the pap test, and this part is fairly clear to most women.

Explaining the role of HPV testing casts a fog on all of the above, and this is usually the turning point in the discussion. Recent research has linked the human papilloma virus (HPV) to cervical cancer. We now know that certain types of this virus is what causes the abnormal cells found on paps. More importantly, the HPV virus also causes most types of cervical cancer. This is very important for two reasons: the HPV test effects the way paps are managed by health care providers and it also stresses the importance of the HPV vaccine.

But before I can even answer why it is so important for the patient’s future, I am often confronted with a question regarding the patient’s past. How did I get this virus? The virus is passed from one person to another during sexual contact, i.e. genital skin-to-skin contact. This type of contact can include vaginal, anal and oral sex. This virus is so prevalent that if you have ever had sex, the chances of having this virus is over 80% for your lifetime. In contrast, less than 10% of American women have chlamydia per year. HPV is the most common sexually transmitted infection. It’s like “the common cold” of sexual activity. Almost everyone you know has had the common cold right? The kicker about HPV is that it is a completely asymptomatic infection; there are no sniffles or sore throat, no discharge or pain. This means you will never know who gave it to you (because almost everyone has had it!). That part is not important, so it is not worth interrogating your partner over it.

It can overstay its welcome, and hang around for years. You may have gotten it on prom night five years ago, or you may have picked it up from your fiancé. And unfortunately there is no treatment for it. No pills, no shot. We just have to wait for the body to naturally clear the infection, which it usually does in about 90% of young people within two years of acquiring the infection.

But all of this, while important, is a bit irrelevant to what we are going to do about your abnormal pap smear. That’s our job, to figure out what to do next. Your job? With regards to HPV and your pap smears, here are the take home points:

  • Don’t stress about a positive HPV test. There is no treatment for it, and unlike an acute gonorrhea infection, it doesn’t mean that you or your current partner have been unfaithful.
  • Most women who have or have had HPV do not actually develop cervical cancer. But most women who have cervical cancer have the HPV virus.
  • Stop smoking. Smoking is like a power bar for the HPV virus, it helps it grow, which is not what we want.
  • Use condoms, but remember that a condom does not cover the entire genital area, and HPV can still be transmitted through contact of the exposed skin.
  • Keep your follow-up appointments with us. Even if your abnormal cells are not severe enough to warrant a surgical procedure to remove them today, the cells may become more abnormal in 6 months, or they may be completely normal next year. And wouldn’t that be a relief?
  • If you are under the age of 26, get the Gardasil vaccine. It’s a vaccine that can prevent a cancer. How fascinating and amazing is that!