What you should know about the HPV vaccine
Q: How long will vaccine protection last?
A: Data is still coming in, but Koutsky believes the vaccine will be effective at least 10 years without a booster.
Q: How safe is the vaccine?
A: It's at least as safe as other routine vaccines, Koutsky says. More than 7 million doses have been distributed so far, and serious adverse events are lower for this vaccine than for other vaccines.
Q: How long will it take to see a decrease in cervical cancer?
A: Within five years, Koutsky expects to see a significant decrease in precancerous lesions in Washington state if at least 40 percent of 11- to 15-year-old girls get vaccinated. Q: Does Koutsky profit from the vaccine?
A: No, not personally. She does not take consulting or speaking fees from the vaccine maker, Merck, and does not own its stock. Merck has a contract with the University of Washington to support the vaccine trials.
Q: Should girls and young women get vaccinated if they're already sexually active?
A: Yes. The vaccine is recommended through age 26. Even if a young woman is already infected with one or two types of HPV, it's unlikely she's infected with all four types in the vaccine, so it would still prevent her from getting those types.
Reminder: The vaccine is free in Washington State for girls through age 18.
Q: Should women older than 26 get the vaccine?
A: The vaccine is not officially recommended for women older than 26, but some physicians provide it for off-label use. Koutsky says it might benefit women who are re-entering the dating scene after having had a single partner previously. Even if the new guy is older than 26 (and has likely developed immunities to genital HPV from previous exposure), he could also have a partner who is in her 20s, the age at which HPV is most often actively transmitted.
Q: Should teen boys and men get the vaccine?
A: Based on current data, the vaccine is safe and stimulates an immune response in boys and men. Sometime in 2008, scientists will know whether the vaccine prevents HPV infection and related lesions, including warts, in adolescent boys and men.
Q: Will condoms protect against HPV?
A : A study by Koutsky published in the New England Journal found consistent condom use resulted in a 72 percent reduction in HPV.
Q: Can you get HPV and still be a virgin?
A: Yes. HPV is carried on skin and sheds from the skin. Koutsky's team hasn't been able to determine whether virgins who have genital HPV got it from contact with men's genitals, hands or mouths.
Q: Is it true researchers have found genital HPV under the fingernails of men, and what does this mean?
A: Yes. Koutsky's team found genital HPV under guys' fingernails. Whether it's infectious and how it got there, they don't know.
Q: Can you get HPV from shaking hands or from the toilet seat?
A: Shaking hands — theoretically possible, but never been reported. Toilet seat? No.
Q: Is Merck's Gardasil the only HPV vaccine?
A: GlaxoSmithKline recently developed Cervarix, a vaccine to protect against HPV-16 and HPV-18. It was approved in Australia in May 2007. It's now under FDA review in the U.S. and they'll decide by Jan. 28, 2008 whether to license it.
Q: Cervical cancer rates are highest in the developing world. Will women there be able to afford this vaccine?
A: At $360 for three doses, it's the most expensive vaccine in the world and also requires refrigeration. A recent article in the New England Journal calculated the price would need to drop to less than $2 a dose to make the vaccine cost-effective and affordable for developing countries. Subsidies from private foundations, governments and health organizations may someday make this possible. In the meantime, some recommend a less-expensive HPV swab test for women between 30 and 45 years old. If the test comes back positive, women would be referred for diagnosis and treatment.
PATH, the global-health nonprofit based in Seattle, led projects in Peru and Kenya to develop cervical-cancer screenings for women in low-resource settings. That project included a single-visit "screen-and-treat" strategy where trained health workers looked for lesions by painting acetic acid (white table vinegar) on the cervix and shining a bright light. Suspicious lesions appeared as white blobs and were removed.
Q: Are volunteers still needed for Koutsky's HPV studies?
A: Yes. Koutsky's team is recruiting women aged 25 to 65 for an at-home HPV testing study. To be eligible, women must be in general good health, have had sex with men, and have used the internet to search for romantic partners in the past year. Participation includes collecting vaginal samples at home for HPV testing and completing questionnaires (no Pap tests or in-person visits). Volunteers receive their HPV results; this is a unique opportunity for type-specific HPV testing, which is not available commercially. For more information or to enroll, call 206-543-3327 or visit Web site: http://depts.washington.edu/hpvstudy
Paula Bock is a staff writer for Pacific Northwest magazine. E-mail: firstname.lastname@example.org.