HPV Vaccine questions

October 29, 2007 3:07 AM

Is it worthwhile for me to have the Gardasil (HPV) Vaccine?

There have been ads on Australian television recently (I think paid for by the pharmaceutical company but it's not explicit). These ads encourage women who aren't in the 14-26 age bracket that is covered by the Public Benefits Scheme to consider the vaccine. If it was worthwhile, I might be able to find the cash.

I asked my doctor about it today and he said, that if I already had HPV it would show up on the cells of my pap smear. Is he right? I thought what the cells showed was cancerous behaviour, not HPV. I thought that HPV could lie dormant in the body for a while (that being the whole point of the virgin-vaccination thing).

Suppose he's right and I don't have HPV. If I never have sex again - is there any other way to catch HPV?

Suppose I only have sex with my long-term partner, and let us assume that he is always faithful, if he hasn't already given me HPV, does that mean he doesn't have it and can't give it to me?

The last time I was vaccinated for something (flu), I developed psoriasis. I can't say that the vaccination did it of course, but it was the only major change in my environment at the time. Psoriasis sucks and I'm finally at a point now where it's very minor. How irrational is it of me to be wary of all vaccinations because of this?

I am aware that not all cervical cancer is caused by HPV, and therefore with or without the virus/vaccine, it is important to have regular pap smears.

In summary:
Will pap smears always show if you have HPV?
If you have never had genital warts, does this mean you don't have HPV?
IS HPV transmitted in any way other then sex?
Can HPV lie dormant in your, or your partner's body?
Is it likely that psoriasis will be stimulated or exacerbated by a vaccine?

posted by b33j to health & fitness (13 answers total)

Previously
posted by b33j at 3:09 AM on October 29, 2007

Will pap smears always show if you have HPV? No. There is a new test for HPV that tells you if you have certain types of HPV. A pap smear will only tell you if you have developed abnormal cells. An HPV infection can be asymptomatic.

If you have never had genital warts, does this mean you don't have HPV? No. Gardasil protects against at least 4 types of HPV, two of which cover 90% of genital warts cases. But if you don't have warts you could still have one of the HPV types that cause cervical cancer.

Almost all HPV is transmitted via sex.

You can have a silent HPV infection that causes problems further down the line. It can, for instance, cause havoc in many ways during a pregnancy.

The Gardasil vaccine has been shown to offer some protection against 10 other types of HPV in addition to the 4 they advertise.

(Information taken from here, here, and here)

Psoriasis can be triggered by things like stress or sickness, it is not out of the realm of possibility that it was related to your vaccination but it could also be a coincidence or triggered by something much smaller that you failed to notice. I personally would not let that stop me from getting vaccinated against cervical cancer.

Ideally you want to get vaccinated before you get HPV. Most people consider themselves to be unlikely to get an STD until it actually happens, which is exactly how they spread.
posted by hindmost at 3:53 AM on October 29, 2007

This website might be of interest : http://www.vran.org
Finding good resources on the cons for vaccines is not that easy.

I tend to consider vaccines as I would an insurance policy : is the cost (possible consequences of the vaccine) reasonable considering the probability of the event (sickness) and it's possible consequences (complications, death...) ? in the case of vaccines, I think the cost is very hard to determine and might be a lot bigger than advertised/known (if you dig a bit into it, you find out that there is a lot that is not known about the immune system), so unless the risk of getting sick is very high and the possible consequences huge (are they for HPV ?) I would not get the vacine.
posted by arnoooooo at 3:53 AM on October 29, 2007

If you are female you should get the vaccine, old, young, married, in a nursing home with dementia, it doesn't matter; get the vaccine, it could save your life.
posted by caddis at 4:47 AM on October 29, 2007

caddis that advice is hasty. Gardasil has been subject to a massive marketing campaign that would have you believe it is effective for all women. As far as I am aware there is no data at all about women aged >26, and there could be possible adverse effects.
If I was aged "nearly 40" and in a strictly monogamous relationship, I would wait for more data before having the vaccination. The risk of harm is probably minimal, but the risk of benefit is probably also tiny. I do not believe at present it is worth paying cash for. As and when there are data to support the use of Gardasil in 40 year old women, then it will rapidly become available free of charge in nationalised public health schemes, such as in the UK and Australia.
posted by roofus at 5:47 AM on October 29, 2007

My doctor's advice to me was this:

If you are in a monogamous relationship and neither you nor your partner has HPV, it may be safer in the long run to wait a year before getting the vaccine. While the CDC says that clinical trials have been done in over 11,000 women ages 9-26, why not wait a year (or more) to see the effects in a larger sample group?

She also said that there is another HPV vaccine set to release in the near future that is effective against more strains of HPV and is effective for longer. I haven't heard much more about that, but it's worth thinking about.
posted by summit at 6:02 AM on October 29, 2007

Get the vaccine.

The $50 (or whatever it costs now) is significantly less than the numerous doctor visit & prescription costs associated with fighting an STD.

A male friend of mine is a carrier of HPV (I guess? I would have thought he could get rid of it at some point--but I was told you don't). His ex-girlfriend had become infected, and then gave it to him. She told him, but as most men are asymptomatic-- he didn't bother to listen. So he moves on to several other women and starts to spread it around, because he was ignorant. I think he thought that it didn't matter if it didn't hurt him.
posted by rocket_johnny at 6:47 AM on October 29, 2007

Not worth it to pay out of pocket. Wait until more research has been done and other products brought to market. Your annual pap will ensure that abnormal cells are detected too early for you to develop cervical cancer.
posted by desuetude at 7:36 AM on October 29, 2007

Actually, the vaccine is expensive, and is not covered by insurance for, cough, older women such as myself (I am 42). It's $360.00 (three doses at $120 each).
posted by ClaudiaCenter at 9:17 AM on October 29, 2007

Thank you for all your information and advice.

Given that I am not going to become pregnant and am unlikely to enter a new sexual relationship any time soon, I'm happy to wait to see what research develops and if the price comes down or it goes on the free medicine list for women over 27. I'm putting this on my long term to do list.
posted by b33j at 12:33 PM on October 29, 2007

ClaudiaCenter is citing a low cost. When I was uninsured, I was told that three doses would cost me $900 ($300 each).

Additionally, I happen to have heard anecdotally (but from a reliable source) of a woman outside of the age group who was paralyzed after a routine Gardasil vaccine. I'm about as staunch a vaccine advocate as they come, but that story has encouraged me to wait for a bit more analysis.
posted by bijou at 7:58 PM on October 29, 2007

You might also look into Cervarix, an alternative to Gardasil, which is expected to be approved for older women (it's not on the market yet but should be soon).

Does the HPV Vaccine Benefit Women Who Are Already Infected With HPV?

Also, from here:

WILL I ALWAYS HAVE HPV?
The body’s immune system can fight off and get rid of the human papillomavirus, even the “high risk” types. Most students who acquire HPV in college have an effective immune response that clears the infection or reduces the viral load to undetectable levels in an average of 8–24 months. If one is infected with one of the “high risk” types and it stays around for more than one or two years, it may lead to cervical dysplasia and later even to cervical cancer. It is estimated that 50% of the women who receive cervical cancer diagnoses each year have never had cervical cytology screening (a Pap smear). Another 10% had not been screened within the five years before the diagnosis of cancer. If you know you are infected with HPV, it is important to get regular Pap smears to check for cervical changes.

WHAT DO I TELL MY PARTNER?
Couples in long-term, mutually monogamous relationships usually share the same HPV types. Repeated exposure through sexual intimacy does not appear to affect the body’s ability to eliminate the virus. Once your immune system has rid itself of one HPV type, it usually will remember that type and not be susceptible to re-infection with the same type. Because there are so many types of HPV however, exposure to one type does not appear to confer immunity to the other types. If you recently entered a relationship, or if you’re not sure both of you are mutually monogamous, condom use is important to decrease the risk of other sexually transmitted infections.

Lastly, studies have shown that many couples with HPV who practice long-term mutual monogomy are able to eventually overcome the infection and develop immunity to the specific strains with which they were infected. This varies depending on the risk level of the strain and the general health of the infected person's immune system.
posted by Brittanie at 10:18 PM on October 29, 2007

I forgot to add that since the development of Cervarix, which will be specifically marketed to adults and not teens, Merck has started to really push for Gardasil's approval for older women.
posted by Brittanie at 10:25 PM on October 29, 2007