HPV Update: Vaccine Is Now Indicated up to Age 45

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A new age group can now benefit from the HPV vaccine, Gardasil 9. The original Gardasil vaccine was approved in 2006 for preteens and young adults up to age 26.  In 2018, the FDA approved a new and updated Gardasil vaccine for men and women aged 27 to 45. The new guidelines are a huge step forward in protecting people who were not previously eligible for vaccination.

About the HPV Vaccine

Gardasil 9 protects against certain HPV infections that can cause cervical cancer, head and neck cancer, and other malignancies. HPV is the most common sexually transmitted infection in the U.S. If HPV infection is left untreated, it can cause genital warts, precancerous lesions of the vulva, vagina and cervix, cervical cancer, and cancers of the mouth and throat. HPV vaccination helps to prevent precancerous and cancerous lesions caused by the 9 HPV strains contained in the vaccine.

About HPV

Human papillomavirus, or HPV, refers to a family of over 150 related viruses. HPV infection can occur in both men and women and is extremely common. According to statistics from the Centers for Disease Control and Prevention, 45% of men and 40% of women ages 18 – 59 had a genital HPV infection in 2013-2014. Additionally, HPV causes 33,700 cancers in men and women in the U.S. every year.

HPV is transmitted through sexual activity and is most commonly spread through vaginal or anal sex. Most people will be exposed to HPV at some point in their lives; most exposed individuals will not have symptoms, and may not know that they have acquired HPV. HPV is usually detected through a Pap smear or HPV test in women. Even though men can carry HPV, there is currently no FDA-approved test for the detection of HPV in men.

Symptoms of HPV

Women with HPV-related warts may notice a growth on the inside or outside of the vagina; this can be so small that it can be barely felt, or it may be a large visible growth. Occasionally, women may have itching associated with genital warts. Abnormal bleeding can occur with significant HPV-related lesions. However, most people who carry HPV will experience no symptoms at all. This is why it’s so important to see your Long Island gynecologist or OBGYN regularly. Regular screening is the best way to protect your reproductive health and to detect abnormal cell changes caused by HPV.

Diagnosing and Treating HPV

Since HPV is acquired sexually, the best protection is to be careful about your sexual activity. Condoms are not 100% effective at preventing HPV infection, but they definitely offer some degree of protection. For optimal protection, condoms should be used for every sexual encounter, for the entire duration of the encounter.

Women who are sexually active should be screened for HPV regularly at their gynecologist’s office. I often tell my patients that in developed countries like the U.S., female cancers associated with HPV usually occur as a result of neglect: Most women with cervical cancer have either never been screened, or have not been screened at recommended intervals. Regular screening at recommended intervals is the best way to detect HPV, and to ensure that HPV infection does not develop into a more serious condition.

Women who test positive for HPV on Long Island may require additional testing. Commonly, an in-office evaluation called colposcopy is performed. Colposcopy is a minor office procedure not very different from a Pap test. During colposcopy, I insert a speculum, swab the cervix and vagina with vinegar, and look closely with a special pair of binoculars that helps to identify any precancerous or cancerous lesions. Generally, I do biopsies even if everything looks normal; this reduces the chance of missing an important lesion.

There is no cure for HPV, but there is effective treatment for precancerous lesions associated with HPV (known as “dysplasia”). In many cases of mild dysplasia—especially in younger women—the disease clears on its own. Many women with HPV infection and mild dysplasia are simply monitored periodically until the infection either requires treatment or resolves on its own.

If a biopsy of the cervix shows severe dysplasia, surgical excision may be recommended. In our practice excision is usually performed using a loop electrical excision procedure, or LEEP. An alternate procedure called cone biopsy is sometimes used. These minor procedures usually take just minutes to perform, and women can generally return to their daily activities the following day. For the safety and comfort of our patients, we routinely offer anesthesia and perform such procedures in a hospital or surgicenter.

Is HPV Vaccination Covered by Insurance?

This is a tricky question: Many insurance policies nowadays claim to cover vaccination, but in fact reimburse doctors’ offices less than the cost of the vaccine itself. To avoid such problems, we offer patients a prescription for the vaccine which they can fill at the pharmacy of their choice. Once a patient fills the prescription and has Gardasil in their possession, it’s easy to make arrangements for administration of the vaccine in our office.

If you haven’t received the HPV vaccine, contact us today to schedule an appointment. You can also call us to learn more about HPV and your options for prevention and treatment.

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