HPV Vaccine: A Preventive Approach

We often see on a number of advertisements that a healthy female sexuality has a great influence on her emotional and psychological well-being. The obstetrician-gynecologists should establish a good rapport along with mutual trust and respect with their patients. A good clinician relationship will lead to an open and non-judgemental assessment of the patient's sexual history. This confidential and supportive approach is vital in eliciting proper assessment and effective management.

Human Papillomavirus Infection. The most common sexually transmitted viral infection is HPV infection of the genital tract. It was identified among the young sexually active men and women and occurs 80% on sexually active women by age 50. This increasing awareness of HPV infections suggests that vaccination is a good advise. Two HPV vaccines have been developed: (1) Quadrivalent vaccine with HPV 6/11/16/18 Gardasil (Merck) and (2) Bivalent HPV 16/18 Cervarix TM (Glaxo Smithkline - GSK). The protection they provide after an intramuscular (IM) administration of these vaccines is the production of immunoglobulin (IgG) serum neutralizing antibody. The GSK vaccine containing HPV types 16 and 18 cover approximately 70% of the high grade cervical lesions. The Merck vaccine contains types 16 and 18 as well as types 6 and 11, which are the most common HPV that leads to the induction of genital warts (benign). In June,2006 the FDA licensed for use in the United States the first vaccine shown to be effective at preventing infection with some genotypes of HPV, the quadrivalent Merck vaccine. However, the GSK vaccine is still under review by the FDA. The American College of Obstetricians and Gynecologist (ACOG) Committee on Adolescent Health Care and the ACOG Working Group on Immunization recommended the vaccination of females ages 9 - 26 years old against HPV. The Advisory Committee on Immunization Practices (ACIP) has recommended that the age for initial vaccination is 11 - 12 years old. Catch-up vaccination is recommended by the American College of Obstetricians and Gynecologists for females between ages 13 years and 15 years. This age range should be the first adolescent reproductive health care visit. On the other hand, the reasons for visiting obstetricians-gynecologists among adolescents and young women (ages 16 - 26) are for primary care, contraceptive or other gynecologic needs and for consultation of pregnancy concerns. The above mentioned doctor's visit is the best time to discuss the benefits of HPV vaccination and to offer vaccines to patients who have not yet been vaccinated. It will then follow proper documentation in the patient's medical record. It should be noted that quadrivalent HPV vaccine only provides the opportunity to prevent and is not intended to treat patients with cervical cytologic abnormalities or genital warts. Finally, it is recommended for the sexually active individuals to use latex condoms inorder to reduce the risk of acquiring HPV infections.

For more information visit www.ahrq.gov/clinic/uspsf07/hiv/hiovrevup.pdf.

www.ucsf.edu/hivcntr/PEPline/.

On CDC & Prevention www.cdc.gov/hiv/dhap.htm.

On partner therapy in management of STD www.cdc.gov/std/treatment/EPTFinalReport2006.pdf.