Q: I am 24 years old and I’ve had two boyfriends in the past. I’ve heard about this new vaccine that protects you against HPV. Should I get it? Who pays for it?
A Yes, you are a good candidate for vaccination. The Food and Drug Administration (FDA) just recommended that the vaccine be given to all girls between the ages of 11 and 12 and to all females ages 13 to 26. So you definitely fit into an age-appropriate category. Twenty-six was chosen as the high-end age (although from my perspective it’s still very young) because the vaccine was tested in women up to that age, and hence the vaccine’s current approval must match the ages that were tested.
The vaccine, called Gardasil, is produced by the pharmaceutical company Merck. It guards against SILs (squamous intraepithelial lesions) which are precancerous lesions of the cervix; hence it’s name: gard...a (against) sil. Specifically, the vaccine prevents diseases caused by HPV types 16 and 18, which are associated with about 70 percent of cervical cancers, and types 6 and 11, which are associated with genital warts.
Clearly if you’ve had several boyfriends (or even one), you, like all young women, may have been exposed to HPV. (As an aside, a national survey done in 2002 found that 26 percent of girls in the U.S. had had vaginal sex by the age of 15; that number rose to 77 percent by age 19). HPV is extremely infectious. Once sexual activity has been initiated, the incidence of HPV is 40 percent within two years and more than 50 percent within four years!
Even if you’ve been exposed to HPV, though, there’s a good chance that it wasn’t to all the types “covered” but the vaccine. A study by Merck showed that 76 percent of girls between the ages of 16 and 26 were still naïve (they hadn’t formed antibodies) to all four HPV types in the vaccine and less than 1 percent had evidence of past or present infections with all four types. So even if you’ve been infected by one, two, or three types of HPV, you can still expect to derive a benefit from the vaccine. You don’t need a new Pap smear (if you have been having it done regularly) in order to get the vaccine. Even if you’ve had an abnormal Pap test in the past, tested positive for HPV, or had genital warts the vaccine is recommended because, again, chances are that you’ve not had all four types of HPV that are targeted by Gardasil.
The vaccine is given as three injections over six months. It’s believed that immunity is acquired one month after the last shot and that it remains effective for at least five years. It’s not yet clear if booster shots are necessary, but Merck is following women who’ve been immunized to see how long their immunity lasts. Gardasil currently costs $360 for three doses (or $120 per dose). Insurance companies should pay for the vaccine, since it has been recommended for universal immunization of females in the age group I just mentioned. If there is a problem getting insurance coverage and/or you’re unable to afford the vaccine, Merck will be starting a program to help pay for the immunization.
Finally, many women are asking me if they need subsequent Pap smears after getting the vaccine. The answer is yes. There are over 30 types of HPV out there in the sexual world and although this vaccine protects against four very important ones, it doesn’t protect against all of them. Thirty percent of cervical cancers are still due to these other viruses.
Dr. Reichman’s Bottom Line: Talk to your gynecologist, internist, or, if you have a daughter in the appropriate age group, her pediatrician, about getting the vaccine. The fact that there is now an immunization against the most common cause of cervical cancer is truly phenomenal; take advantage of it!
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.