In the dawn of the vaccines Gardasil and Cervarix, pediatricians, family physicians, and ob.gyns. are faced with the daunting task of educating parents about the sexually transmitted infection human papillomavirus.
We can all relate to the moment the words leave our mouths, and the parents are already refusing it because they are sure their children will never engage in such activities. Or they have been inundated with negative media reports that there are many side effects, and that the body will clear the human papillomavirus (HPV) infection on its own. It is understandable that there would be some hesitation to consent to a three-dose vaccine for a virus that is passed sexually for a child who most recently was more interested in dolls than the opposite sex. As well, many pediatricians are on the fence as to how important it is to give this vaccine to the 10- to 16-year-olds, so they shy away from detailed explanations, and the vaccine is declined.
Well, half of all oropharyngeal cancers are caused by HPV (Oral Oncol. 2011;47:1048-54), and the incidence of oropharyngeal cancers caused by HPV has increased from 16% in 1984-1989 to 72% in .2000-2004 (J. Clin. Oncol. 2011;29:4294-301).
Dr. Francine Pearce
Another CDC report on results of the 2006-2010 National Survey of Family Growth indicated that although the rates of vaginal intercourse were declining among teens, the rates of oral sex were escalating. In the survey of more than 6,000 teens aged 15-19 years, 41% of females admitted to performing oral sex, as did 35% of males. That number increased to more than 80% in both men and women when 20- to 26-year-olds were surveyed. (Natl. Health Stat. Report 2012;56:1-16).
The reason put forth for the increase in oral sex was that teens deemed it a "safer" way to have sex, and some even felt that it is not a form of sex and that they maintain their virginity as long as they don’t engage in vaginal intercourse. Many studies even point out that teens deem oral sex as a casual interaction and term it the new "goodnight kiss."
With this reality, as pediatricians and family physicians, we need to get very comfortable with this vaccine and be aggressive about educating families about the risk not only of cervical cancer, but vaginal, vulvar, and penile cancers, and most importantly the oral cancers. The time from infection to presentation of a tumor is usually about 10 years.
Although there are more than 100 strains of HPV and our bodies can clear most of them in 1-2 years, HPV 16/18 has been shown to be oncogenic and much harder to treat in the oropharyngeal area when compared with the cervical area. It also has been noted that the survival rate is better and there is less metastasis with HPV-associated cancers than non–HPV-associated cancers.
Current studies support that the HPV vaccines are decreasing the incidence of HPV infections (J. Inf. Dis. 2013;208:385-93). Awareness and education are key to eradication of this virus, and prevention starts in our offices.
Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at pdnews@frontlinemedcom.com.