I know a little boy whose sweet voice slowly became hoarse and rough. At first it was blamed on viral illnesses and treated with throat lozenges, but it didn’t get better. Finally, an ENT discovered the real problem—he had HPV on his vocal cords. Yes, HPV, the virus that causes genital warts and cervical cancer, was growing on his vocal cords. We don’t know how he got it, but there was no evidence of sexual abuse, and his mother was HPV negative.
Given sad stories like this, it’s no surprise that many people pushed hard for the development of the HPV vaccines Gardasil and Cervarix. But now that we have vaccines, a raging debate has grown up around them. Parents especially express concerns about vaccine safety, parental autonomy, and the financial interest of vaccine manufacturers. One mother told me, “Why expose your child to a vaccine when virus can be prevented by abstinence?”
Most parents chose not to vaccinate their kids against this HPV, according to CDC statistics. Last week I suggested many parents feel their parental autonomy is threatened by the push to vaccinate their kids against HPV. They’re probably right.
As with any vaccine, parents need to weigh the risks and benefits. As you strive to make the best decision for your children, I wanted to share my personal experiences as a mom and pediatrician that have lead me to recommend the HPV vaccine.
1) You can catch HPV without having sex. HPV is an STD that is usually transmitted by vaginal or anal sex, but it can also be transmitted through genital-to-genital, or hand-to-genital contact. Hand-genital transmission is especially concerning to me because young people usually experience this type of sexual contact long before they have vaginal or anal intercourse. Hand-genital contact is often a form of undesired sexual contact. I know a woman who fell asleep on a train only to wake up with a strange man’s hand in her underwear. Even this type of contact puts you at risk for HPV.
An August, 2012 study found that 11.6 percent of females who had never had sexual intercourse were positive for at least one strain of HPV in either the vagina or cervix. The authors feel most of these women likely contracted HPV through hand-genital or genital-to-genital contact.
2) HPV is everywhere—it is an epidemic in the United States. A recent study published in the Journal of the American Medical Association found that 24.5% of females in the United States aged 14 to 19 years are HPV positive for genital HPV. Among women 20-24 years old, an astounding 44.8% were positive. An estimated 80% of sexually active people will contract HPV at some point in their lives.
You don’t have to be promiscuous to get HPV. Many people acquire the virus during their first sexual encounter, even with their spouse. “How did I avoid this?” an HPV-negative 40-year-old asked me. It’s because HPV prevalence has grown dramatically in the last 20 years. Many middle-aged people who had multiple sexual partners in their younger years are still HPV negative. These days that just doesn’t happen much.
3) Babies can get HPV from their mothers during delivery and from hand-genital contact during diaper changes. I’ve seen babies less than a year old with genitals covered in HPV warts. Other babies have HPV in their airway or vocal cords. The devastated mothers are too embarrassed to tell anyone about their baby’s illness. It breaks my heart.
4) HPV is a nasty virus that can grow on lots of different body parts. HPV warts, or papillomas, can grow almost anywhere on the skin, including the genitals, hands and feet. Papillomas can also grow in the throat, airway, and lungs.
5) HPV causes more than cervical cancer. This HPV is associated with many types of cancer including the cervix, penis, vagina, anus, throat, and lung. Although the HPV vaccine only prevents against certain strains of HPV, it does prevent those strains most likely to cause cancer. Out of the more than 40 sexually transmitted HPV strains, more than a dozen have been identified as cancer-causing, according to the National Cancer Institute.
6) No one seems to talk about the psychological ramifications of HPV—when people find out they are positive for HPV they often feel like an inferior partner and worry about their future personal life. When patients learn they are positive, their first response is usually not about their cancer risk. Crying, they tell me how angry they are at their partner and worry about their ability to find a good spouse.
7) Although HPV can and should be treated, it’s just no fun to go to the doctor every few months to have your cervix poked and prodded. I’m a general pediatrician and I don’t treat HPV, but I do hear the grumpy complaints of those who are undergoing treatment. Who wants to schedule all those appointments, sit in waiting rooms, and wait again with your feet in the stirrups…
8) In some states kids can get the HPV vaccine without parental consent. In some states tweens and teens can get the HPV vaccine without parental consent. State laws and age cut-offs vary. Parents are often asked to leave the exam room while the vaccine is discussed with their teen or tween, and a growing number of schools are offering the vaccine. These laws have been put into place in the interest of public health, and to provide comprehensive, confidential health care to teens and tweens. But how do we balance these needs with parental autonomy? Who should fund this care?
Finally, one piece of good news about HPV: the majority of HPV strains cause transient infection. In healthy people, the body’s immune system is usually able to clear the virus over time. The strains of HPV that are associated with cancer are also the strains that tend to be persistent—that the body’s immune system can’t clear. More good news: these persistent cancer-causing strains are also the strains protected against by the HPV vaccine.