Human Papillomavirus Lafayette Medical Education Foundation June 19, 2018 Katherine McHugh, MD Indiana University Dept. of OB/GYN kwmchugh@iupui.edu Take Home Points: - Risk factors for HPV infection: early age of sexual activity, high number sex partners - Risk factors for HPV cancer development: persistent HPV infection, early age of sexual activity, high number lifetime sex partners, tobacco smoking, immunosuppression, rare screening, history of HPV related neoplasia - 80% of people are exposed to HPV in their lifetime, often resolves in initial 12 months - High risk oncogenic serotypes: 16 and 18 - Most common serotype to cause anogenital warts: 6 and 11 - Prevention: HPV 9 valent vaccine is very effective and safe! - Screening: Only useful and approved for cervical cytologic screening - Cervical dysplasia: American Society for Colposcopy and Cervical Pathology (ASCCP) algorithm and app ($10) - HIV: more serious infection, higher persistence of HPV infection Details: - Diseases associated with HPV infection: o Genital and non-genital warts o Oral mucosal lesions o Respiratory papillomatosis o Head and neck cancer, anogenital cancer, Bowen s disease - Vaccine: o 9 valent: 6, 11, 16, 18, 31, 33, 45, 52, 58 o Seroconversion: Female 93-100%, Male 97-100% o VAERS: most common serious AE cellulitis, same-day syncope o Overall decrease in persistent HR-HPV infections by 70% - HIV: o HPV more commonly persistent with more serotypes present o Requires increased screening and surveillance - Further references: ACOG.org, CDC.gov - Patient resources: HPV.com
f AQ FREQUENTLY ASKED QUESTIONS FAQ191 WOMEN S HEALTH Human Papillomavirus (HPV) Vaccination What is human papillomavirus (HPV)? How many types of HPV are there? How common is HPV infection? What are the signs and symptoms of HPV infection? What diseases are caused by HPV? Does being infected with HPV mean a person will get genital warts or cancer? What happens if the immune system does not fight HPV infection? What is the best way to protect against HPV infection? Who should get the HPV vaccine and when? What if my child does not get all doses of the HPV vaccine on time? How effective is the HPV vaccine? Does the HPV vaccine cause any side effects? Do I still need regular cervical cancer screening if I have gotten the HPV vaccine? In addition to the HPV vaccine, how can I protect myself against HPV infection? Glossary What is human papillomavirus (HPV)? Human papillomavirus (HPV) is a virus. Like all viruses, HPV causes infection by entering cells. Once inside a cell, HPV takes control of the cell s internal machinery and uses it to make copies of itself. These copies then infect other nearby cells. How many types of HPV are there? There are more than 150 types of HPV. About 40 types infect the genital area of men and women and are spread by skin-toskin contact during vaginal, anal, or oral sex. Genital HPV infection can occur even if you do not have sexual intercourse. How common is HPV infection? HPV infection is the most common sexually transmitted infection (STI) in the United States. Almost everyone who is sexually active will get an HPV infection at some point during their life. What are the signs and symptoms of HPV infection? Like many other STIs, genital HPV infection often has no signs or symptoms. The infected person usually is not aware that he or she has been infected and can unknowingly pass the infection to others. What diseases are caused by HPV? HPV can cause the following diseases: Genital warts About a dozen types of HPV cause genital warts. These types are called low-risk types. Most cases of genital warts are caused by just two low-risk types of HPV: 1) type 6 and 2) type 11. Genital warts are growths that can appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix. Genital warts are not cancer and do not turn into cancer. Warts can be removed with medication or surgery.
Cancer At least 13 types of HPV are linked to cancer of the cervix, anus, vagina, penis, mouth, and throat. Types of HPV that cause cancer are known as high-risk types. Most cases of HPV-related cancer are caused by just two high-risk types of HPV: 1) type 16 and 2) type 18. Does being infected with HPV mean a person will get genital warts or cancer? No. In most people, the immune system fights most high-risk and low-risk HPV infections and clears them from the body. What happens if the immune system does not fight HPV infection? Infections that are not cleared from the body are called persistent infections. A persistent infection with a high-risk HPV type can cause cells to become abnormal and can lead to a condition called precancer. It usually takes years for this to happen. Cervical cancer screening can detect signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer. What is the best way to protect against HPV infection? A vaccine is available that can prevent infection with HPV. The vaccine protects against the HPV types that are the most common cause of cancer, precancer, and genital warts. Who should get the HPV vaccine and when? Girls and boys should get the HPV vaccine as a series of shots. Vaccination works best when it is done before a person is sexually active and exposed to HPV, but it still can reduce the risk of getting HPV if given after a person has become sexually active. The ideal age for HPV vaccination is age 11 years or 12 years, but it can be given starting at age 9 years and through age 26 years. For those aged 9 14 years, two shots of vaccine are recommended. The second shot should be given 6 12 months after the first one. For those aged 15 years through 26 years, three shots of vaccine are recommended. What if my child does not get all doses of the HPV vaccine on time? If your child has not gotten all of the recommended shots, he or she does not need to start over. He or she can get the next shot that is due even if the time between them is longer than recommended. This is also true for you if you have not completed the recommended number of shots through age 26 years. How effective is the HPV vaccine? Studies show that getting all doses of the HPV vaccine before you are sexually active can reduce your risk of getting certain types of HPV-related cancer by up to 99%. If you have had sex, you may already be infected with one or more types of HPV, but you can still get the vaccine if you are younger than 26 years. The vaccine may help protect you against the other types of HPV included in the vaccine that you are not infected with. Does the HPV vaccine cause any side effects? Millions of people have been vaccinated against HPV since the vaccine came out. There have been no reports of severe side effects or bad reactions to the vaccine. The most common side effect of the HPV vaccine is soreness and redness where the shot is given. Do I still need regular cervical cancer screening if I have gotten the HPV vaccine? Yes. HPV vaccination helps prevent HPV infection. It is not a cure for an HPV infection that has already occurred. Women who have been vaccinated still need to have regular cervical cancer screening as recommended for their age group and health history (see FAQ085 Cervical Cancer Screening). In addition to the HPV vaccine, how can I protect myself against HPV infection? Even if you get the HPV vaccine, it still is important to take other steps to protect yourself against HPV and other STIs: Limit your number of sexual partners. The more partners you have over the course of your life, the greater your risk of infection. Use a male or female condom to reduce your risk of infection when you have vaginal, anal, or oral sex. But be aware that condoms cover only a small percentage of skin and do not completely protect against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas. Glossary Anus: The opening of the digestive tract through which bowel movements leave the body. Cells: The smallest units of a structure in the body; the building blocks for all parts of the body. Cervix: The lower, narrow end of the uterus at the top of the vagina. Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth, and throat. Immune System: The body s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease.
Penis: An external male sex organ. Sexual Intercourse: The act of the penis of the male entering the vagina of the female (also called having sex or making love ). Sexually Transmitted Infection (STI): An infection that is spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]). Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body. Virus: An agent that causes certain types of infections. Vulva: The external female genital area. If you have further questions, contact your obstetrician gynecologist. FAQ191: Designed as an aid to patients, this document sets forth current information and opinions related to women s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate. Copyright June 2017 by the American College of Obstetricians and Gynecologists
INFORMATION FOR PARENTS DISEASES and the VACCINES THAT PREVENT THEM HPV Vaccines Are Safe For Your Child 09/09/2015 CS256663B HPV vaccines are very safe. CDC has carefully studied the risks of HPV vaccination. The benefits of HPV vaccination, such as prevention of cancer, far outweigh the risks of possible side effects. HPV vaccines are safe and recommended for girls and boys at age 11 or 12 Human papillomavirus (HPV) is a common virus that affects men and women. HPV can cause cancers of the cervix, vagina, and vulva in women; cancer of the penis in men, and cancers of the anus and throat in men and women. Like any vaccine or medicine, HPV vaccines can cause side effects Some people have mild side effects after getting the HPV vaccine. Common side effects include: Pain, swelling, or redness in the arm where the shot was given Fever Headache or feeling tired Nausea, vomiting, diarrhea, or stomach pain Muscle or joint pain HPV vaccination is recommended for girls and boys at ages 11 or 12.There are three HPV vaccines approved by the Food and Drug Administration (FDA) and recommended by the Centers for Disease Control and Prevention (CDC) to protect against HPV and the cancers it can cause. Like all vaccines used in the United States, HPV vaccines are required to go through years of safety testing before they are approved by the FDA. CDC and FDA closely monitor vaccines to make sure they are safe even after they are available to the public. HPV vaccines have good safety records. Studies have shown that each HPV vaccine is very safe, and careful safety monitoring has not shown any problems. The safety of HPV vaccines was tested in thousands of volunteers before the vaccines were approved Gardasil Cervarix Gardasil 9 How many people was it tested in? More than 29,000 volunteers More than 30,000 volunteers More than 15,000 volunteers When was it approved? 2006 Who is it recommended for? Girls and boys at age 11 or 12 2009 Girls age 11 or 12 2014 Girls and boys at age 11 or 12 years Talk with your doctor about any health concerns before vaccination If your child is scheduled for HPV vaccination, tell your doctor about any severe allergies. Some children should not get some HPV vaccines, including: Children who have ever had a life-threatening allergic reaction to any ingredient of an HPV vaccine, or to a previous dose of HPV vaccine Children who have an allergy to yeast (Gardasil and Gardasil 9) Children who have an allergy to latex (Cervarix) HPV vaccines are safe for children who are mildly ill for example, with a low-grade fever of less than 101 degrees, a cold, runny nose, or cough. Children with a moderate or severe illness should wait until they are better.
HPV vaccines don t cause HPV infection or cancer HPV vaccines cannot cause HPV infection or cancer. In fact, HPV vaccines are very effective at protecting against HPV types that cause cancers. HPV vaccines don t cause any fertility problems Some parents have been concerned that HPV vaccines might make their child unable to have children in the future. However, HPV vaccines do not cause any fertility problems. In fact, not getting HPV vaccination leaves boys and girls at risk for cancers caused by HPV. A girl who develops cervical cancer later in life due to HPV infection may require serious treatments that could leave her unable to have children. HPV vaccination can prevent these complications. Fainting can happen after any medical procedure, including HPV vaccination Some people, especially teens, faint after getting vaccinated. To prevent fainting and related injuries, people receiving HPV vaccines should sit or lie down during vaccination, then remain seated for 15 minutes after the shot. People should tell the doctor or nurse if they re feeling dizzy, faint, or light-headed. Seek medical care if your child has a reaction If your child is having a severe allergic reaction or other health emergency, call 9-1-1 or go to the nearest hospital. Look for any signs or symptoms that concern you, like signs of a severe allergic reaction, very high fever, or behavior changes. These would start a few minutes to a few hours after the shot is given. Signs of a severe allergic reaction can include: Hives Swelling of the face and throat Difficulty breathing A fast heartbeat Dizziness Weakness After seeing a doctor, you should report the reaction to the Vaccine Adverse Event Reporting System (VAERS). CDC and FDA use this system to track possible vaccine side effects. Your doctor can file this report, or you can do it yourself through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967. The Centers for Disease Control and Prevention, American Academy of Family Physicians, and American Academy of Pediatrics strongly recommend children receive all vaccines according to the recommended schedule.