GU: human papillomavirus vaccination

human papillomavirus (HPV)

• the most common STI in the US

  • 79 million currently infected

  • 14 million new infections per year

  • 26,000 attributed cancers per year

• approximately 80% of adults will be infected within their lifetime

• transmitted through genital contact

  • abstaining from intercourse is the only 100% effective protection

  • condoms do NOT provide full protection but are still beneficial!!

• multiple virus types

• typically self-resolving within 2-3 years

  • most cases self-resolve with no symptoms

  • potential for clinical sequelae:

    • exposure to low risk types → genital warts

    • exposure to high risk types → cervical cancers

most common high risk HPV types

• HPV 16 and 18

  • associated with cervical cancer

  • may take up to 10 years to progress to cervical cancer

most common low risk HPV types

• HPV 6 and 11

  • associated with 90% of genital warts

  • clinical presentation of genital warts can vary from patient to patient

possible treatment approaches to genital warts

• topical treatments

  • Podofilox 0.5% solution or gel

  • imiquimod 2.5%, 3.75%, or 5% cream

• cryotherapy

• surgical removal

possible treatment approaches to cervical cancer

• cryotherapy

• laser therapy/conization

• surgery (eg. hysterectomy)

• radiation/chemotherapy

primary diagnostic tests

• visual inspection (for genital warts)

• cervical cellular changes via Pap smear

goals of HPV education

• HPV prevention

cervical cancer screening recommendations

• American Cancer Society (ACS):

  • start at age 25

  • every 5 years → HPV DNA testing ± pap smear

  • every 3 years → Pap smear alone

• US Preventative Services Task Force (USPTF):

  • stage at age 21

  • ages 21-29 → recommends Pap smear every 3 years

  • age > 30

    • every 5 years → HPV DNA testing ± pap smear

    • every 3 years → Pap smear alone

HPV vaccine

• Gardasil 9-valent (Merck)

  • note: the Gardasil Quadrivalent and Cervarix Bivalent have been phased out

• IM injection

efficacy of the Gardasil 9-valent vaccine

• provides protection against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58

  • essentially against the most common low and high risk types!

• aids in prevention against:

  • cervical cancer

  • vulvar cancer

  • vaginal cancer

  • a n a l cancer

  • genital warts

• > 90% decrease in infections with the HPV types mentioned above

• overall, highly effective

side effects of the Gardasil 9-valent vaccine

• injection site reactions

  • redness

  • erythema

  • swelling

• fever

• headache

• syncope

contraindications to the Gardasil 9-valent vaccine

• hypersensitivity to yeast products

recommended immunization practices for the Gardasil vaccine

• routine vaccination in ages 9-12 years old

  • typically done in patients 11-12 years old, but can start in patients as young as 9 years old

• “catch up” vaccination in ages 13-26 years old

• expanded age approval

  • the FDA approved an expanded use of the vaccine to include individuals aged 27-45

  • ACIP recommends shared clinical decision making regarding vaccination of patients in this age group

recommendations for the 2-dose Gardasil series

• patients who received their first dose at ages 9-14 years old can receive this series

  • vaccination at baseline and 6-12 months later

recommendations for the 3-dose Gardasil series

• patients who received their first dose at ages 15-26 years old (and 27-45) can receive this series

  • vaccination at baseline, at 1-2 months, and then at 6 months