• heather-corinna

    Sharon: if you have a minute, I had a question here from a Scarleteen fan who read this when we linked to it.

     

    When you say, “Most doctors will do automatic HPV testing on certain women getting pap smears,” are you talking about a digene test done with a pap?  That’s what I assumed you meant, but it seems that doesn’t feel clear.

  • jodi-jacobson

    Sharon is out of the country and without a secure internet connection so asked that I post this reply:

    Yes, the HPV testing that is done with the pap smear is a DNA test (the brand name is digene).  The pap smear involves a small plastic brush that removes cells from the surface of the cervix and the endocervix (the central part of the cervix that leads to the uterus).  The brush is then put in liquid and the container is sent to the pathology lab.  The cervical cells are examined under a microscope, and the liquid is sent for testing for HPV if appropriate (for women under 30, if there is a certain kind of abnormal cell, and for all women over 30 in most cases).  The test is for HPV 16 and 18, as well as for 11 other types of HPV known to cause cervical cancer.  This helps your provider determine what needs to happen if there are abnormal results; sometimes a biopsy is needed, which is done by way of a colposcopy, sometimes a repeat pap needs to be done in a few months, sometimes a repeat needs to be done in a year, and in some cases your provider may inform you that you do not need another pap for 3 years.

    Some people think that in the future we will no longer be looking at cells under a microscope and will only be checking HPV on everyone, and in some countries with few resources doctors are trying to use just the HPV test to screen people more cost-effectively.  For now, though, in this country it’s a pap smear with HPV testing.

  • heather-corinna

    Thanks so much!  That’s what I figured, but some readers of ours felt confused. :)

  • saltyc

    Two questions:

    1. how long do either of the vaccines last,

    and

    2.

    Note that the vaccine that covers just HPV-16 and HPV-18 is not recommended for men at this time (because types 16 and 18 cause cervical cancer in women but don’t appear to cause any problems for men).

    Shouldn’t you still recommend it to men to reduce the chance of spreading the disease to a woman who can be affected by it? Isn’t that also a problem for a man, that he can be carrying a potentially deadly disease?

    • sharonmd

      We don’t know for sure how long the vaccines last for. They remain very effective for at least a year after then 3rd dose, and seem to become slightly less effective after that but to remain effective for at least 5 more years. The vaccine is relatively new and we therefore do not have long-term results at this time. In the coming years we should know much more.

      As to your question about men and the bivalent (HPV 16 & 18 only) vaccine, recommendations for vaccinations are based on multiple criteria. This list is far from exhaustive, but includes how effective it is, how long immunity lasts, how well it works to prevent bad outcomes, and how much money you save by using it and preventing those bad outcomes.

      We don’t have any good data on how well vaccinating young men will prevent transmission to women. Presumably it will, but many times what seems like an obvious effect of a treatment ends up not being the effect after all.

      We also don’t know how long the immunity lasts, so it’s hard to know how cost-effective it will be in the long run. The only good data we have is that the quadrivalent vaccine (the one that includes protection from the viruses causing genital warts) does protect young men from genital warts and thereby saves money and discomfort.

      You are right that HPV 16 and 18 are potentially deadly, but given the excellent access to medical care people in developed countries enjoy it is extremely unlikely that a woman will develop invasive cervical cancer even if she does get HPV.

      When you add all those factors up, and take into account the cost of the vaccine ($500-$1000 for the 3 shots, if you include the cost of the vaccine and the office visits), it’s hard to recommend it to men at this time. The case to vaccinate women is much stronger, as they get a direct benefit that we have been able to show. There is no clear direct benefit to women of vaccinating men. This may change in the future.

      The basic idea of when do we decide that doing something is worth the money is a complicated discussion. Unfortunately, every $1000 we spend on vaccinating men against HPV-16 and 18 is $1000 we don’t spend on things that we know save money and improve lives. Since we don’t have infinite resources, we can’t blindly recommend every single intervention. I know it’s a somewhat dissatisfying answer, but with health care costs skyrocketing we’re better off spending our money on cost-effective interventions for young men, like screening and treatment for STIs, comprehensive sex ed, and mental health programs.

      Because of the benefits against genital warts, the quadrivalent vaccine (Gardasil) *is* an option for young men. There is also compelling evidence that for men who have sex with men the vaccination is a good investment because of the high incidence of anal cancer, especially for HIV positive men (HIV positive women also have a much higher rate of cervical cancer than HIV negative women)

  • saltyc

    Not convinced.

    Given the extremely short duration of the shot, and

    given the excellent access to medical care people in developed countries enjoy it is extremely unlikely that a woman will develop invasive cervical cancer even if she does get HPV.

    I will try my darnedest to keep my daughter from getting the shots. I’m sure not sold on this and I intend of keeping the lines of communication open so that I hope to know when she starts having sex, and hopefully it would be long after she’s 13, which is after vaccination when she’s 12 starts to wear off. I’m sorry, but this really doesn’t smell right to me. If it’s not worth $1000 to keep a man from possibly infecting a woman, it’s not worth $1000 to keep a 12 to 13 year-old girl from the very small chance of being infected, when that money could be better spent.

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