HPV: Why Should My Daughter Get Vaccinated?

Gynecologists have been concerned about the effects of the human papilloma virus (HPV) on a woman’s cervix for years, but it has been only recently that the general public has become more aware due in a large part, to the media and the advent of an effective vaccine.

HPV and Warts

Unlike what we told each other as children, warts on our skin (hands, feet, etc.) are not to be blamed on frogs or toads, but on the Human Papilloma Virus (HPV). Our mothers, fathers, siblings and playmates were our likely sources of infection when we were young. Most of these “skin” viruses are benign (essentially harmless) and simply a nuisance. Certain types of HPV, however, can cause serious disease, particularly in women.

Viruses 101

Viruses have inhabited humans for as long as humans have inhabited the earth. These tiny collections of genetic material are adept at adaptation (ability to change and become suited to new environments). It is difficult to treat an organism that is able to easily change its appearance. The human papilloma virus is no exception in its ability to mutate (change appearance). In fact, there are over 100 sub-types of HPV; all related, but all having distinct disease-causing characteristics.

Viruses cause everything from simple warts, common colds, and influenza to cervical cancer and liver cancer (hepatitis B and C viruses). The link between liver cancer and hepatitis B and C viruses has been recognized for many years, so it should come as no surprise that certain types of HPV are linked to cervical cancer.

The Cervix

The cervix is a dynamic place. It would have to be when you consider that it can be closed so tightly that the insertion of even a q-tip is impossible, but manages to open wide enough during childbirth to accommodate a baby’s head. Cells are constantly being shed from the surface of the cervix as new cells, originating from deep within its layers, are generated. This sort of environment is very “virus-friendly” and certain strains of HPV thrive there.

Immune Systems 101

To understand how HPV affects a woman’s cervix it is necessary to understand something about the role of the immune system.

Let’s consider the chicken pox virus (varicella zoster) for a moment. Though now vaccine-preventable, many of us had this itchy disease as children and seemed to recover without difficulty. But did we really “recover” completely? In fact, our immune systems stashed the virus away in a place where it could no longer cause illness. As our immune systems age or otherwise become impaired due to increased stress, coinciding illnesses, use of immunosuppressive medications, etc., some of us will again suffer the effects of the chicken pox virus and develop painful shingles (herpes zoster). Our immune systems will let the “cat out of the bag” or more accurately the virus out of the nerve root where it had been “loitering” for years.

HPV and the Cervix

So what does any of this have to do with HPV on a woman’s cervix? Not all human papilloma viruses that find a home on a woman’s cervix (via sexual contact) cause cervical cancer, in fact, the vast majority do not. If they did, cervical cancer rates would be astronomical as it is estimated that 80% of all sexually active women will be infected with HPV by the age of fifty. Fortunately a woman’s immune system usually “figures out” how to “handle” HPV. Though she may experience concerning changes to her cervix and even undergo surgical treatment for pre-cancerous pap smears and biopsies, her immune system will work hard to keep the virus at bay. Things that impair her immune system, smoking, immunosuppressive medications, aging, etc., may increase her risk for recurrence of disease over the years.

Some types of genital HPV are more concerning than others. These “bad actors” (high risk HPV) are much more likely to cause cervical cancers. Sub-type numbers sixteen and eighteen are the two most notorious and are implicated in about 70% of all cervical cancers. The newly licensed HPV vaccine includes protection against these two types in addition to types six and eleven that cause external warts (venereal warts, condylomata). The other 30% of cervical cancers are caused by a variety of sub-types for which there is currently no vaccine.

Vaccine Indecision

An intuitive gynecologist for whom I once worked, told me many years ago before it was commonly agreed, that a virus was implicated in cervical cancer and that someday there would be a vaccine. The hitch would be getting parents to vaccinate their young daughters. He was right on both counts.

We would like to believe that our children will make good choices concerning their sexuality if we raise them “correctly”. Unfortunately, humans often learn by trial and error and our children are no exceptions. Youthful choices tend to follow us into adulthood and resonate throughout our lives. Thankfully, with experience, comes better decision-making. Protecting our children as they become better decision-makers is key.

During nearly fourteen years of assisting with thousands of cervical biopsies in women of all ages and from all walks of life (high school students, college students, school teachers, accountants, secretaries, doctors, lawyers, nurses, wives, mothers, grandmothers, widows, conservatives, liberals; starting to get the idea?) I learned that HPV is not simply a disease of the promiscuous. Now that a vaccine is available how will we explain our failure to vaccinate when a daughter is struggling with abnormal pap smears or having difficulty carrying pregnancies after surgery to her cervix? In the worst-case scenario, how will we respond to a daughter fighting to survive cervical cancer?

With near complete prevention of cervical cancer in sight, I urge you to have your daughters vaccinated as soon as they are eligible. Protect them before they start navigating adolescence and young adulthood as imperfect people. Additionally, keep in mind that many thousands of monogamous women have been infected with HPV by husbands who contracted the virus from a previous wife or partner.

The currently available HPV vaccine (Gardisil) can be given to girls and women between the ages of nine and twenty-six years. Please discuss vaccination with your health care professional. Ontario County Public Health has a limited supply of HPV vaccine under the Vaccines For Children (VFC) program for girls under the age of nineteen years who have a financial barrier to vaccination. Call 585-396-4343 for more details.

Kate Ott, RN, BSN
Public Health Nurse
Communicable Disease
Ontario County Public Health