Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States and most genital warts (condyloma accuminata) are caused by HPV.
In 2006 a vaccine (Gardasil) was approved for girls and women aged nine to 26 to prevent cervical, vulvar and vaginal cancers caused by HPV 16 and 18, as well as genital warts caused by HPV types 6 and 11. This vaccine has been shown to be quite efficacious in preventing these conditions, especially when given before adolescents and young adults become sexually active.
When looking at national statistics among teens regarding their sexual activity and first intercourse, over 60 percent of teenage girls had intercourse before graduating from high school and the percentage just continues to rise during college. Among those girls, in one study up to 50 percent may be exposed to HPV by their partner after their sexual debut.
Not all of those exposed to HPV will go on to develop warts or cancer, as many people can clear this viral infection on their own. The difficulty is, we don’t know who can clear the virus and who will go on to become infected. Obviously, girls and boys pass this virus to one another, and it is not through intercourse alone.
Genital to genital contact as well as oral and anal sex may cause transmission of this virus. In my practice, I have many adolescent girls who test positive for HPV on pap smears, as well as both girls and boys who have genital warts.
Prevention is the key. Ideally that is through education and abstinence, but as any parent knows, kids make mistakes, and some are more serious than others. Most of the patients in my practice begin taking their HPV (Gardasil) vaccine series between 11 and 13 years of age and upon completion of their three dose series are well protected. I personally have not seen any complications from the vaccine, besides complaints of pain with the injection and sore arms (most of my patients complain with ALL shots anyway).
When the vaccine was released there were many questions as to why it was not offered to boys too. It would seem like that would be appropriate? It was in fact given in other parts of the world to boys and young men. I even vaccinated my three sons (completely off label from FDA recommendations) as I felt it would protect them and their partners one day. Of course they complained, and said they “were guinea pigs”. Well, validation came this week when the FDA approved the use of Gardasil to prevent genital warts due to HPV types 6 and 11. The vaccine was approved for use in boys ages 9 – 26, in the same 3 dose series as girls.
Each year, about 2 out of every 1,000 men in the U.S. are newly diagnosed with genital warts. I recently saw a 24-year-old male with a wart on his penis, and he could not believe that it was a genital wart. Something about penis and wart just did not connect for him, how could that be a genital wart, I must be confused? Again, education and prevention is the key. The studies in men showed that Gardasil was nearly 90 percent effective in preventing genital warts caused by HPV types 6 and 11.
So talk to you doctor at your next checkup with your sons and ask about HPV prevention in boys. HPV is an equal opportunity virus and now we can equally protect both girls and boys.
That’s your daily dose, we’ll chat again tomorrow.