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The HPV Vaccine: Part 3

Questions and Answers

In this segment, I address common arguments concerned parents make against getting their kids vaccinated.

1. The HPV vaccine will encourage sexual activity; therefore, we should not vaccinate

One of the cool things about being human is the ability to have a lot of complex, conflicting thoughts and feelings on one issue, but when our kids’ health is at stake, I think we need to be very honest with ourselves:  The anxiety that we are feeling probably isn’t about the HPV vaccine in and of itself; otherwise we would also feel this anxiety about the hepatitis B vaccine and the possibility of an AIDS vaccine.  I’ve yet to hear someone oppose hep B vaccinations on the grounds that it might encourage sexual activity, and everyone I’ve talked to hopes the AIDS vaccine gets here yesterday, so I’m not sensing that same anxiety with those vaccines.

I would like to humbly suggest that, since the feelings about the HPV vaccine are not consistent with feelings about hep B (which is given as a routine vaccination to very small children), this argument stems from fear that teens are going to have sex before they’re ready.  The HPV vaccine and its timing (when kids are eleven and are starting to develop into sexual beings) reminds us that sex is a not-too-distant possibility, so we feel fearful, and think the HPV vaccine is causing the fear when it actually isn’t.

These fears are totally valid, and I would not discount or minimize them for the world.  We live in a highly sexualized culture where teens and preteens are getting a lot of conflicting messages about sex and how it relates to them and their bodies and their self-worth.  Sex can be a risky activity; I completely understand that parents don’t want their kids engaging in sexual activity before they’re ready, and I certainly think teens and preteens need education so they know what consent is, what sex acts are, which sexual activities put them at which risks, and how to reduce those risks.

I also think these concerns need to be addressed with frequent, frank, factual communication between parents and kids.  Withholding a vaccine—trying to scare your kid out of sexual activity by threatening them with a horrible cancer—is not an honest, effective, or fair way to attempt to prevent sexual activity.  I think that if parents are refusing to vaccinate kids on these grounds, they are doing them a profound disservice, not just by putting the kids’ health at risk, but by not discussing their views and values with them.

I remember, very vividly, that as a teen not too long ago, what my parents said to me about sex was more important than what my peers, television, or the Internet said.  It sounds corny, but talk to your kids about sex.  They’ll listen.

Then maybe, after this discussion, you’ll feel less anxious.

But even if you don’t, they should still get vaccinated.

2. HPV vaccine will make teens think they are “immune” to STDs and reduce how often they engage in safe sex.  Therefore, we should not vaccinate.

I’m vaccinated against hepatitis A because I went on a medical mission trip to a third-world country.  No one discouraged me from getting the hepatitis A vaccine on the basis that it would encourage me to drink the local water, exposing me to other pathogens.  On the contrary, I was extremely encouraged to get it because it protected my liver from hep A, should I ingest the local water.

Furthermore, during my office visit to get the vaccine, the doctor, nurse, and even the secretary educated me on why I still should not drink the local water. The vaccine was a tool to help keep me safe, but not my only tool, and they made sure I had tools in addition to the hep A vaccine to stay safe.

In my ideal world, this is how the HPV vaccine would be viewed: Not an all-powerful panacea, but a useful tool among many in the toolbox of sexual health. Teens are smart, and if we educate them about sexual health, they will understand that being vaccinated against HPV means they are still vulnerable to gonorrhea, herpes, AIDS, and other diseases they’d really rather not get.  I see no reason to keep them from getting a valuable tool just because it is not an all-powerful tool.

3. The HPV vaccine only protects against certain strains of HPV, plus most infections with HPV are cleared anyway, so we should not vaccinate.

True, but, as my mother has said, “Being protected against only four strains is still one heck of a lot better than a sharp stick in the eye!” Strains 16 and 18 are the most common high-risk strains of HPV, and strains 6 and 11, while low-risk, are also very common and do carry a risk of cervical cancer.  There are other strains, but these are certainly among the most worrisome.

Yes, most HPV infections are cleared, but enough aren’t so that over 12,500 women were diagnosed with cervical cancer in 2013.  The vast majority of these cases were preventable with the HPV vaccine.

4. There are risks to any medical procedure!  My kid will not even lay eyes upon potential sexual partners until marriage and then they will be monogamous!  Why needlessly expose them to those risks?

There are two questions here: Are the risks worth it? And why should I vaccinate my kid if, because of their beliefs and lifestyle choices, they almost certainly will not need it?
Yes, there are risks to the HPV vaccine.  Among the reactions considered serious (and thus meticulously reported to and investigated by the CDC) are symptoms like headaches, nausea, allergic reactions to a vaccine component, local pain and swelling, dizziness, fatigue, and fainting.

These same risks apply to the tetanus vaccine, too, as well as just about every other vaccine your child has ever received, and I’d venture to guess many people do not cut themselves on rusty metal at any point in their lives.  I know I haven’t!

Still, I’m betting your kid is vaccinated against tetanus, and that’s probably because you’ve concluded that the risks of your kid contracting tetanus by freak accident are significantly worse than the risks of the vaccine.

Are the risks of cervical cancer really as trivial as the risks of the vaccine?  Is a headache as bad as even the most minor outpatient surgery?  Is having a sore arm as bad as needing your pelvis, legs, urinary system, and part of your colon removed?  Is feeling dizzy worse than worrying for days or weeks about the results of a biopsy?

As to why you should still vaccinate your kid, who you believe will not engage in sexual activity of any sort until marriage and will then remain monogamous, I have a couple of reasons:

Marriage is not a cure for STDs.  HPV infections acquired before marriage will remain after marriage, and there is a good chance an unvaccinated partner will pick up an HPV infection from an infected spouse.  Given that it is generally ideal for folks to have a fulfilling, loving sex life with their spouse, abstaining from sex isn’t a useful strategy to keep them from getting infected in this circumstance.  Vaccination is.

There’s also the unfortunate but very real fact that sometimes, even married folks will cheat.  True story: One of my dear friends is a wonderful, devout, churchgoing, Evangelical Christian woman who had no premarital sex and married a like-minded man from a similar family.  She just found out he has been cheating on her with multiple women for several years.  She didn’t get the HPV vaccine because she didn’t expect to need it—she was a virgin who married a virgin, and she doesn’t believe in divorce.

Now, on top of worrying about her marriage, she is worrying about her risk of getting cervical cancer.

It would be pretty awesome if she didn’t have to worry as much about the cervical cancer.

 5. Why vaccinate just girls?  Boys get HPV, too, and it leads to anal cancer and oropharyngeal cancer and all sorts of awful stuff!  If only girls get the vaccine, something is off, and I’m not vaccinating!

I have good news for you!  The CDC recommends the vaccine for all folks ages 9 to 26, including boys! The initial studies of vaccine effectiveness were only done on women and girls, so for a while the CDC only had data for women and girls, and thus they could only recommend its use in women and girls.  Western medicine, while not perfect by any means, does make a concerted effort to not recommend things for which there is no data.
Now, studies have been done on men and boys, providing data suggesting the vaccine was effective in men and boys, and the CDC was able to change their recommendation to include them.

So you’re the recipient of outdated information, and now you have current information!  Your son can be protected from oropharyngeal cancer and anal cancer, just like your daughter can be protected from cervical cancer! Aren’t you happy?  Aren’t you going to schedule that appointment right now?

No?

Much to my chagrin, folks who use this argument are rarely happy upon hearing that news, and none of them frolic joyously down to their family doctor to get their kids vaccinated.

I suspect this lack of frolicking is because they remembered that the HPV vaccine protects boys against anal cancer caused by the HPV virus.  And then they remember that boys get HPV in their anal canal by engaging in anal sex, usually by penetration from HPV-infected partners who have a penis.

Discomfort with homosexual sex and reluctance to discuss it can cause parents to hesitate in getting their sons vaccinated.

I’m not going to offer justifications about how boys are carriers of HPV so they need to be vaccinated for the sake of their female sex partners, because I think that argument is ridiculous.  There is no guarantee your son with have sex with women.  There is no guarantee your son will have sex with men.  There is no guarantee your son will have sex with anyone.  He shouldn’t be vaccinated for their sake, because we have no clue if “they” even exist.

Your son’s health, like your daughter’s, is worth protecting for its own sake.

 

Any other thoughts or questions?  Anything else you want me to argue? (Except against Anti-Vaxers.  Do I need to pull out my video again?  Because I will.)  Anything you’d like me to write about in future blog entries?  Leave it in the comments!
Until then, stay healthy, and get vaccinated!

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Fancci is a US osteopathic medical school student in her clinical years.  She hopes to one day open a rural family practice clinic, but first needs to survive the rest of med school and a residency.

Please join us over on the forums to discuss this post!

The HPV Vaccine: Part 2

Within the human papilloma viruses as a group, there is a lot of variation based on their DNA sequence. DNA is the Master Plan for the cell, and it is also the Master Plan for the virus. DNA contains the plans for cell-specific proteins, which are what make things and do things within the cell, and all cells and viruses have their own DNA.

Remember: Different strains of HPV=different DNA=different proteins.

Because of these differences in DNA sequence, some strains produce specific proteins which in true, terrible-at-naming-things Scientist fashion, have been called E6 and E7.

E6 and E7 run around the host cell and interact with some very important host cellular proteins, which, in the same scientific naming tradition, have been dubbed p53 and Rb.

p53 and Rb play vital roles in making sure that a cell does not divide when it shouldn’t.  For instance, a cell could have damaged DNA.  Under normal circumstances, the p53 and Rb proteins are guardians that survey the cell and assess its readiness to divide.  They have the power to say, “Stop!  We are not ready to divide!  Halt at once, and repair our Master Plan!” and the cell will listen, repair DNA, and not divide until p53 and Rb are cool with it.  E6 and E7 find p53 and Rb and physically prevent them from sounding the alarm, so suddenly, a cell that probably shouldn’t be dividing at all is instead dividing like crazy.

So we have cells dividing like crazy, creating masses that aren’t useful to us where they shouldn’t be…Sounds like cancer, right?

That’s because it is cancer!  See?  I knew we could Science this together!

Luckily, not all HPV viruses have E6, E7, or similar proteins.  And most humans with an intact immune system will either completely fight off most HPV infections, or the immune system will beat the HPV into dormancy.

At the same time, though, it is very rare for cervical cancer cells to not be infected with HPV, which rather strongly suggests that most cases of cervical cancer can be attributed to HPV.  Why wasn’t the HPV infection defeated by the immune system?  That may be because the human picked up a particularly nasty strain, but there’s also the fact that some humans don’t have an intact immune system—they could have an inherited immune disorder, or diabetes, or be on systemic steroids to treat a whole bunch of things, or have AIDS…I could literally make a blog entry on reasons why folks may be immunosuppressed.

The particularly nasty, common, high-risk strains of HPV with proteins E6 and E7 are called types 16 and 18.

Due to producing proteins E6 and E7, these strains are much more likely to cause cancer.

There are also two very common HPV strains, strains 6 and 11, and they usually cause anogenital warts.  However, these strains can also potentially cause cancer, and since so many people are infected by them, types 6 and 11 statistically give at least some people cancer.  It’s sort of like how, even though it is extremely unlikely, people manage to get struck by lightning.  There’s just a lot of lightning and a lot of people.  Statistically, someone will get struck.

So that’s the HPV virus in a nutshell. We’ve Scienced the heck out of it!  With that information in mind, let’s discuss the diseases caused by these cellular shenanigans!

Tell Me Why I Care:  The Effects of HPV Infections

Most commonly, HPV can cause cervical cancer.  These same strains can also cause anal cancer, oropharyngeal cancer, and something called respiratory papillomatosis which is a disease that occurs rarely when an HPV infection is transmitted to an infant’s respiratory tract from their mother during vaginal birth.  This means that masses will grow in the infant’s airway that will suffocate them if  not removed by surgery or lasers.

All of these are terrible.  All of these could potentially be a blog entry all by themselves.

However, given that this is the Sheroes blog and Sheroes has a lot of cervix-having members, I’m going to give you a relatively brief, generalized overview of cervical cancer.

Luckily for women of North America and most industrialized countries, we have access to something called a pap smear.

For readers who haven’t experienced this not-especially-fun-but-also-generally-not-too-painful procedure, a pap smear is when a doctor takes a sterile, specialized brush on a stick and swabs it lightly over your cervix. The brush picks up a layer of epithelial cells, the very cells HPV infects.  The doc then sends the sample to a lab.

A technician can put infected cells on a slide, stick the slide under a microscope, take a peek, and say, “Huh, this is not how a cervical cell should look!”

And then they will send the report to your doctor, who will tell you there is something called a dysplastic change.

Dysplastic change is a fancy phrase for “your cells look weird”.  However, in a woman who has had proper screening at regular intervals throughout her adult life, this is probably not a cause to panic right away since the change has probably been caught early. Depending on the individual patient, doctors tend to opt for either “watchful waiting” or something called a colposcopy and biopsy, in which case they’ll coat your cervix with a very dilute acid that makes the HPV infected cells turn white.  They will then take a small sample of your cervical tissue called a biopsy, and send that to the lab for analysis.

If the biopsy does show evidence of cancer, then the doctors can treat it with the usual suspects: surgery, radiation, chemo.

While a treatment plans are highly individual, in general, cancers which are caught early and confined to the surface of the cervix can be treated with a simple outpatient surgical procedure with nearly 100% success, as long as all of the cancer is cut out.

However, cervical cancer has a tendency to spread locally. It can move to the uterus, fallopian tubes, or ovaries.  This development may also necessitate a hysterectomy.  That can be really hard for women to go through emotionally, but again, survival rates at this stage are around 85%.

Even worse, the cancer can also invade nearby structures, like the anal canal, or ureters. One cause of death in cases like these is kidney failure, because the cancer literally blocks urine from getting out, which damages the kidneys irreparably.

In cases this advanced, patients may be offered a procedure that goes by several names, one of them being “hemicorporectomy.”

Dust off your Latin and Greek; we’re going to break this word down:

Hemi=half

Corp=body

Ectomy=surgical removal

…Yeah.

It’s intense.

Let’s take a moment to think about that word and what it might mean for a patient.

The patient’s legs, colon, reproductive system, and lower urinary tract are removed, because the cancer has spread that far.  Doctors recreate what structures they can, but they’re surgeons, not magicians.  It is a radical surgery with radical consequences. It is not done lightly—it is done because the patient will die without it.  Once cervical cancer reaches a certain stage, there is no radiation or chemotherapy that has been shown to increase survival rates.

And some patients still die, either because the cancer has spread too far, or because it recurs.  It is a horrible disease, and while it can be screened for, screening does not help women who without access to regular screening.  Since cervical cancer generally does not become symptomatic until relatively late, cases in unscreened women can be quite advanced, and the consequences can be devastating.  It is estimated that over 4,000 women will die of cervical cancer in 2014.

That’s terrible. The vast majority of these cancers are due to HPV infections and, thus, can be prevented. Luckily, there are two HPV vaccines on the market: Gardasil and Cervarix. Gardasil protects against HPV strains 6, 11, 16, and 18.  Cervarix only protects against strains 16 and 18.

These two vaccines are made from viral proteins produced in bacterial, yeast, or insect cells.  They cannot cause HPV infections because there is no viral DNA in the vaccine. Instead, they stimulate the immune system to respond to the viral proteins, so if the recipient is ever exposed to that strain of HPV, the immune system will be ready to kill the virus and prevent an infection.

How awesome is that?  Get vaccinated!  Get your kids vaccinated!  Vaccines for everyone, less cancer and anogenital warts and respiratory papillomatosis for all!  Heck yes!

Still not convinced? In the next installment, I’ll answer common questions about the HPV vaccine.

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Fancci is a US osteopathic medical school student in her clinical years.  She hopes to one day open a rural family practice clinic, but first needs to survive the rest of med school and a residency.

Please join us over on the forums to discuss this post!

The HPV Vaccine: Part 1

I’m here today to talk about the HPV vaccine.

I know that’s the blandest introductory sentence ever.  I’m sorry, Freshman Comp professor, but I do have a purpose behind it: most blog entries I’ve read about the HPV vaccine frame it as a controversial vaccine starting from the introductory sentence, and it really shouldn’t be controversial.  I’ve chosen to start out with an innocuous topic sentence to convey how boring and routine and non-controversial this vaccine should be.

Getting yourself or your kids the HPV vaccine should be a no-brainer, and I’m here to convince you of that fact.

First, a caveat:  There are folks who will want to turn any discussion about vaccinations into a “controversy”, because they believe Vaccines are Evil.  There are plenty of other articles debunking them and their thinking, so I’m just going to address Anti-Vaxers with this video:

https://www.youtube.com/watch?v=WrjwaqZfjIY

Now shoo, Anti-Vaxers!  We have nothing to discuss, here!

Understanding the Human Papilloma Virus (HPV)

The discussion of the virus is going to involve Science.  Trust me, even if you are Science-adverse, you are smart, and you can handle this!  Just hang with me and we’ll get through the Science together!

Okay, onward!  To the Science!

The human papilloma virus is, as the name implies, a virus.  It’s a pretty hardy little guy that can survive heat, drying, and some kinds of disinfectants, so if it gets on a surface,  it will probably stick around for a while and remain infective.  Most viruses are transmitted by skin-to-skin contact, but the fact that HPV is so resilient does make it difficult to prevent transmission.  For instance, scratching a wart and then touching a cut on a different part of your skin can transmit HPV from the wart to your fingernail to the cells at the cut.  Similarly, if someone gets HPV on their hands and it gets on the outside of a condom while the human is applying a condom during safe sex, the HPV can be transmitted to their sexual partner from the condom.  Fortunately transmission of the virus via an inanimate object (whether a condom, fingernail, or table)does not appear to be super common, but it is possible. So condoms (and other safe-sex barrier methods) have some use in reducing the spread of HPV, but they don’t completely eliminate the risk.

I mean, condoms are totally awesome in preventing all sorts of other STDs, like AIDS, or chlamydia, or gonorrhea, or pregnancy.  Absolutely practice safe sex and use condoms.  Just know that there are limits to safe sex, and unfortunately, this is one of them.

So moving on, how does the virus actually get into your body and infect you? Normal human skin is really resistant to viral entry, so HPV has to get in by a break in the skin—a scratch, a nick, or a microtear, which is a scratch so tiny you probably don’t even know you have it.  Also, mucous membranes – which cover the penis, vulva, vagina, cervix, GI tract, and anus, among other places –are particularly susceptible to microtears and don’t have as strong defenses as regular skin.  Unsurprisingly, this makes mucous membranes an easy target for HPV viruses.

Once the HPV gets past the top layer of cells in your skin or mucous membrane, the virus enters the basal cells.  Basal cells are constantly dividing and producing new cells that will become your skin cells or the cells of your mucous membrane,  so that you don’t run out of skin and walk around skinless (assuming you managed to not die of a massive infection long enough to walk around).

However, if you have HPV, then during the growth and maturation of these new cells the virus will hijack the cell’s growth process to reproduce itself – even as the cell continues to mature.  Once that virus-laden cell reaches the surface of the skin, the virus is shed off into the environment with its host cell, ready to infect more cells and repeat the cycle.

In fact, a lot of viruses reproduce and spread this way, and sometimes this can be pretty benign– including some HPV viruses.  For instance, warts are maybe kind of unsightly, but they are not going to kill you. Unfortunately, HPV can also cause cancer sometimes, which can kill you.

So, what’s the deal with HPV and cancer? Since when does a virus cause cancer, anyway? I’ll answer those questions in the next installment.

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Fancci is a US osteopathic medical school student in her clinical years.  She hopes to one day open a rural family practice clinic, but first needs to survive the rest of med school and a residency.

Please join us over on the forums to discuss this post!