Lois Ramondetta: Most of the time our immune system fights the infection and it goes away. However, sometimes it does not. If it does not go away, it can cause warts, precancers, and cancer to develop. We do know that men are less likely to get rid of oral infections than women.
LR: ABSOLUTELY! All boys and girls should get the vaccine. It's best to start early and administer all three shots by age 13 for best protection; without the vaccine, they cannot be protected!
Administering the vaccine early (before sex or contact from any other way) is the best way to be protected. You ideally want to give the vaccine before any exposure, but, if the patient is already active, he or she should still get it if they're under the age of 27.
Even if there's a mild illness on doctor visit day, they should still get it.
LR: To protect them from anal and oropharyngeal cancer, and to protect their partners and to avoid warts. Men will probably be the most affected by HPV by the year 2020; the oropharyngeal cancers in men are the fastest growing cancers. We believe the vaccine will prevent these cancers as well.
Protect your sons.
LR: Pap tests are recommended every three years for women aged 21–29, and a pap test with HPV DNA testing is recommended every five years for those aged 30 and over. We don't test earlier than age 30 because many women have already been exposed to HPV, and they will clear it on their own.
There is no recommended testing for men, though there is a lot of research going on about testing the anus and oral cavity for HPV.
LR: Most people's bodies clear the infection themselves; that’s why we don’t check young women because they probably already have it, and we don’t want to overtreat these young women. So, it can go away, but you can get reinfected with another type.
Also you can get exposed and never see the precancerous changes until much later in life. Cervical cancer patients are usually diagnosed around age 45, but they can [get HPV-caused cancers] in their twenties until very late in life. Oropharyngeal cancer patients are usually in their mid-fifties, and anal cancer patients are usually in their sixties.
LR: Almost everyone gets it at some point; about 80% of people, or 8 out of 10, will get exposed at some point in their life. Condoms help, but not 100%. You can get it from sex/intercourse, oral sex, and probably even from kissing.
LR: Yes, more than 100 types! Around 40 of them preferentially infect areas of our body including the mouth, anus, and genitals and can lead to cancers and warts. Other types only infect areas of the skin like the hands and feet and can cause warts but don't lead to cancer.
LR: Almost all cervix and anal cancers, 70% of back-of-tongue and tonsil cancers, as well as 60% of vaginal, vulvar, and penile cancers.
LR: The vaccine does not work against the HPV type you have already been exposed to, but it will work against those types you haven’t been exposed to. The main point is give all three shots to the children before age 13 for best effectiveness. The vaccine can be given as early as age 9 and as late as age 26. Even if you already have been exposed to HPV you could still benefit from vaccination, but giving the vaccine series early is best and most effective. The vaccine will be less effective if you already have HPV, but you still get some protection. It is important that for women, even if they are vaccinated, they still need Pap tests (and HPV co-test over the age of 30) on the regular recommended schedule.
LR: At this time, most people should be getting the Gardasil 9 vaccine (HPV 9); it prevents infections from two HPV types (16 and 18) that cause most of the cancers as well as five other types that can lead to cancer, and lastly, the two types that cause warts (6 and 11).
Yes, some other HPV strains can cause cancer, but about 85% of cervical cancers, 90% of anal cancers, and almost all warts should be prevented with this vaccine. Most penile, vaginal, and vulvar cancers should also be prevented with this vaccine, and we think (but don’t know for sure) that most back-of-the-tongue and tonsil cancers will be prevented with this vaccine as well.
The older vaccines all prevented infections from the two HPV types (16 and 18) that cause most of the cancers as well as the two types that cause warts (6 and 11). Though the HPV 9 offers more coverage and should be given as we go forward, choosing whether to get revaccinated is up to the individual and parent.
For women, I highly recommend they pay close attention to screening recommendations and get Pap tests or co-test HPV as recommended. You must continue to get screened even if vaccinated, as there are a few HPV types that cause cancer that are not covered by the vaccine.
LR: No way — earlier is better! The vaccine needs to be administered before the child is exposed to HPV for it to work, and, unfortunately many tweens and teens are sexually active or exposed through contact. Also, the immune system responds better if the vaccine is given before age 15; plus, it lasts at least 10 years and is suspected to last even longer (we only have 10 years of data). The vaccine can be given as early as age 9 and as late as age 26.
Starting early gives you the best chance of full protection when it really counts, so don’t miss the chance to protect your children and yourself!
LR: At least 10 years, but we suspect it could be lifelong. The CDC is following this yearly and will let us know if a booster is needed. At the present time, there is no evidence that a booster is necessary.
- Always use a condom
- Limit number of sexual partners
- Recognize that close genital contact, oral sex, and even kissing can lead to HPV infections
- Get screening per recommendations above for cervical cancer
- See a doctor regularly
These are the professional opinions of Dr. Lois Ramondetta. You should consult your personal physician/OB-GYN with your own HPV-related questions.
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