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GARDASIL.......................
Sep 6, 2008

Hi Dr. Bob, I recently finished the three-shot giardasil treatment. I'm 25 yrs old. I was told by my gynecologist that this only helps to prevent HPV for females who have never been sexually active. I've had one boyfriend who has performed oral sex on me. We've never had sexual intercourse. So, I was wondering if the Giardasil would still be effective for preventing HPV.

Response from Dr. Frascino

Hello,

Perhaps you misunderstood your gynecologist (or perhaps your gynecologist is misinformed!), but Gardasil is effective in girls and young women (and probably boys and men as well) who have not been infected with human papilloma virus (HPV). You could be sexually active without having contracted HPV and the vaccine would still be just as effective.

I'll reprint some information below from the archives about HPV and the HPV vaccine, Gardasil.

Dr. Bob

HPV Vaccine Jun 10, 2007

Why are folks at my church so concerned about the HPV vaccine?

Response from Dr. Frascino

Hello,

Good question!!! Actually, I really don't quite understand exactly what it is that some parents don't understand about Gardasil, the HPV vaccine licensed last year to help prevent most cases of genital warts and cervical cancer!

The facts are quite clear:

1. HPV (human papillomavirus) disease is the most common sexually transmitted disease.

2. There is no treatment for HPV infection.

3. HPV can cause cervical cancer. (Seventy percent of cervical cancers are caused by two variants of HPV. The HPV vaccine protects against these two variants.)

4. Most people infected with HPV do not know they are infected, yet can transmit the virus to unsuspecting sexual partners.

5. Twenty percent of American girls 14 to 19 years of age are already infected with HPV.

6. The vaccine only works if administered before the women become infected by the viral variants covered by the vaccine.

So what about the objections being raised by some parents:

The most egregious is the ridiculous notion that immunizing young girls against HPV will encourage promiscuity. This is another fallacy proposed by the misguided "abstinence-only" folks. It has been scientifically shown that the abstinence-only message is rarely, if ever, effective. Half of American girls become sexually active before graduating from high school. Even if this weren't the case, why would a vaccine make girls sexually indulgent? Even rudimentary sex education knowledge would advise that HPV is only one of many potential STDs, and certainly not protective against unwanted pregnancy!

The backlash against HPV vaccines is yet another harmful side effect of Dubya's "faith-based science" mythology.

Is it 2008 yet?

Dr. Bob

re:hpv (HPV) (Human papillomavirus ) Apr 4, 2008

I have been diagnoses with high risk hpv. I am very alarmed about this. I have read the causes could be from immune system like hiv. I am so afraid of that. Does it necessarily mean that. I have lost some weight recently, and am concerned. Feel well otherwise brigit

Response from Dr. Frascino

Hello Brigit,

HPV (human papilloma virus) and HIV (human immunodeficiency virus) are two very distinct and different viruses. Having one does not mean you automatically have the other. I'll reprint some information about HPV below. Regarding HIV, if you've placed yourself at risk by having unprotected sex, you'll need to get an HIV test at the three-month mark.

Good luck.

Dr. Bob

Human papillomavirus (HPV) February 22, 2006

What Is HPV?

How Is HPV Detected?

Can HPV Infection Be Prevented?

How Are HPV Infections Treated?

The Bottom Line

NOTE: In the U.S., counseling and referrals are available on a national human papillomavirus (HPV) hotline. Call toll-free at 877-HPV-5868 (877-478-5868). Hours are from 2 p.m. to 7 p.m. Eastern Standard Time Monday through Friday.

What Is HPV?

There are over 100 viruses known as human papilloma virus (HPV). They are common. One study found HPV in 77% of HIV-positive women. HPV is transmitted easily during sexual activity. In fact, it is estimated that 75% of all sexually active people between ages 15 and 49 get at least one type of HPV infection.

Some types of HPV cause common warts of the hands or feet. Infections of the hands and feet are usually not transmitted through sexual activity. Several types of HPV cause genital warts on the penis, vagina, and rectum. Those with HIV can get worse sores in the rectum and cervical area. HPV can also cause problems in the mouth or on the tongue or lips. Other types of HPV can cause abnormal cell growth known as dysplasia. Dysplasia can develop into cancers of the penis and anus, and cervical cancer in women.

Dysplasia around the anus is called anal intraepithelial neoplasia (AIN). The epithelium is the layer of cells that cover organs or openings in the body. Neoplasia means the new development of abnormal cells. Anal intraepithelial neoplasia is the new development of abnormal cells in the lining of the anus.

Dysplasia in the cervical region is called cervical intraepithelial neoplasia (CIN). One study found AIN or CIN in over 10% of HIV-positive men and women. Another study showed that women with HIV infection have a much higher rate of CIN than HIV-negative women.

How Is HPV Detected?

To detect HPV, health care providers look first for dysplasia or genital warts. Dysplasia can be detected by Pap smears. They are usually used to check a woman's cervix. They can also be used to check the anus in men and women. A swab is rubbed on the area being checked to pick up some cells. They are smeared on a glass slide and examined under a microscope.

A new HPV test called a reflex test is being used to follow up on Pap smear results that are not clear. It can indicate who needs more careful examination or treatment. The reflex test identifies which types of HPV are present and can indicate if aggressive treatment is needed.

Some researchers believe that anal and cervical smears should be checked each year for people with elevated risk:

People who have had receptive anal intercourse.

Women who have had cervical intraepithelial neoplasia (CIN).

Anyone with under 500 CD4 cells.

However, other researchers think that careful physical examination can detect as many cases of anal cancer as anal Pap testing.

Genital warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. The warts might look like small bumps. Sometimes they are fleshy and look like small cauliflowers. They can get bigger over time. Your health care provider can usually tell if you have genital warts by looking at them. Sometimes a tool called an anoscope is used to look at the anal area. If necessary, a sample of the suspected wart will be cut off and examined under a microscope. This is called a biopsy.

Genital warts are not caused by the same HPV that causes cancer. However, if you have warts, you may have also been exposed to other types of HPV that could cause cancer. Can HPV Infection Be Prevented?

There is no easy way to tell if someone is infected with an HPV. People who don't have any signs or symptoms of HPV infection can transmit the infection.

Condoms do not totally prevent transmission of HPV. HPV can be transmitted from person to person by direct contact with infected areas that aren't covered by a condom. To get the best protection from condoms, use them every time. Put them on before any contact with a possibly infected area.

Men and women with HIV who are sexually active may want to have a regular Pap smear, anal and/or vaginal, to check for abnormal cells or early signs of warts. A positive result can be followed up to see if treatment is needed. Promising preventive vaccines against some HPV types are being developed.

How Are HPV Infections Treated?

There is no direct treatment for HPV infection. Some people "clear" an HPV infection (are "cured"). They can later be infected with HPV again. Dysplasias and warts can be removed. There are several ways to do this:

Burning them with an electric needle (electrocautery) or a laser.

Freezing them with liquid nitrogen.

Cutting them out.

Treating them with chemicals like Trichloroacetic Acid (TCA), Podophyllin or Podofilox. NOTE: Podophyllin and Podofilox should not be used by pregnant women.

Other, less common treatments for warts include the drugs 5-FU (5-fluorouracil) and Interferon-alpha. 5-FU is a cream. Interferon must be injected into the warts. A new drug, imiquimod (Aldara®), has been approved for treatment of genital warts. Cidofovir (Vistide®), originally developed to fight cytomegalovirus (CMV), might also help fight HPV. A new drug called HspE7 has shown benefits in early research.

HPV infection can last for a long time, especially in people who are HIV-positive. Dysplasia and warts can return. They should be treated as soon as they are found to reduce the chances of the problem spreading or returning.

The Bottom Line

Human papilloma viruses (HPV) are fairly common. Different types of HPV cause warts or abnormal cell growth (dysplasia) in or near the anus or cervix. This abnormal cell growth can result in cervical or anal cancer. Genital HPV infections are transmitted through sexual activity.

HPV infection can last a long time, especially in people with HIV.

A Pap smear can detect abnormal cell growth in the cervix. It can also be used to check the anus of men and women. Although Pap smears may be the best way to detect early cervical cancer, careful physical examination may be the best way to detect anal cancers.

The signs of HPV infection -- warts or dysplasia -- should be treated as soon as they show up. Otherwise, the problem could spread and be more likely to return after treatment.



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