"Getting" Gardasil

I'm a single mom and until recently I thought I had done a pretty good job of educating my two teenage sons, ages 18 and 21, about sex and sexual health. We never sat down for "big talks" about these subjects. Rather, I tried to weave them into our everyday conversations.

We talked about hormones, wet dreams (a tough one), condom use and, of course, sex itself-something I hoped wouldn't happen for my boys for a long time.

But of course boys grow up and sex does happen. So I dove into more discussions about condoms and responsibility, and took to leaving a box of condoms on an agreed upon bookshelf for use in "emergencies."

After that, I started to think (and hope) my job as a sex educator was done.

But then I learned about Gardasil. A friend of mine was trying to figure out if this was a vaccine her daughters should get-or not. She mentioned that boys got the vaccine, too, and that it was a protection against HPV (human papillomavirus), the most common sexually transmitted infection there is.

Clearly, I needed to get educated. I learned that HPV can be transmitted through oral, anal, or genital sex-or even through touch-- and an estimated 20 million Americans are currently affected. Approximately 50% of all males and females will be infected with HPV in their lifetime. 74% of the 6 million new cases of genital HPV per year occur in 15 to 24-year-olds.

While HPV is generally not associated with infertility, the condition can lead to problems that are known to restrict a woman's ability to conceive or maintain a pregnancy. When the virus doesn't clear on its own (which it often does), it can have consequences: pre-cancers and cancers, cervical, vaginal and vulvar cancer, and genital warts. In boys and men HPV can cause genital warts. HPV has also been associated with ano-rectal, neck and head cancers and, therefore, vaccination may decrease the incidence of these cancers down the road, too.

I learned that there is no general test for either boys or girls to check their overall "HPV status," but that girls are advised to get frequent Pap tests to see if there are any abnormal cells on the cervix.

Gardasil is an FDA-approved vaccine that must be administered in 3 doses over a period of six months. It has been on the market since 2006.

The Center for Disease Control (CDC) recommends routine vaccinations with Gardasil for girls ages 11 to 12 and for young women ages 13 to 26 who have not already been vaccinated. The CDC says that Gardasil can be given to boys and men ages 9 to 26, if the parent and pediatrician decide it's right for a particular boy.

Was it right for my boys?

I called their pediatrician, NYU's Michael Traister, MD, to find out whether he thought they should be vaccinated. He gave me the following reasons for boys to get the vaccine: 1) to protect the girls since boys are the "reservoir" for giving HPV to their partners, 2) to help protect against genital warts, and 3) the suggestion that both ano-rectal cancers and some head-to-neck cancers can have markers for HPV.

Dr.Traister said Gardasil clearly gives antibodies to the HPV serotypes included in the vaccine. He added that in 2007, 4,021 women in the US died from cervical cancer. 70% of the 4,000 were potentially preventable with Gardasil. So, from a public health point of view, it does save lives.

But some OB-GYNs feel differently about Gardasil. They say that it doesn't eliminate all strains of HPV. Girls diagnosed with serious conditions caused by HPV are relatively few in number. Some believe that recommending the vaccine for girls is "overkill" and that it is even more so for boys.

It is true the vaccine doesn't save all that many lives when compared to a disease such as breast cancer. (In 2007, 40,598 women died of breast cancer compared to the 4,021 who died of cervical cancer in 2007.)

Still, I hadn't heard of a down side to getting vaccinated, until a Google search brought up cases where people had reactions to the vaccine and died as a result.

I put in a call to Mt. Sinai School of Medicine based gynecologist Joan Berman,MD, to get her opinion. Dr. Berman, it turns out, says she and many OB-GYNs are recommending the Gardasil vaccine strongly: "HPV is everywhere, " she says, "And the HPV story is far from complete, as it is implicated in other health issues." Single, newly divorced women are now getting the vaccine at her practice, too.

I asked Dr. Berman about the people who had reacted very negatively to the vaccine, and she replied, "The vaccine carries no more risk than other vaccines. Unfortunately, a very small number of patients may react negatively, but in general, there is little downside to getting it."

Enter OB-GYN Dahna Brecker, MD, who practices at one of the most well-known cancer treatment centers in the US. She acknowledges that she saw a skewed population, but saw many young women with significant cervical dysplasia secondary to HPV. She said, "There is no reason in 2011 that any young woman should have to experience this." Dr. Brecker believes that boys should be vaccinated too, as they are often the "vector for this unseen pathogen." And, according to Dr. Brecker, enough men suffered from anal warts and significant dysplasia secondary to HPV that Memorial Sloan Kettering had a clinic devoted to this entirely.

After speaking with Drs. Traister, Berman and Brecker, I knew that my job as a mom teaching her kids about sex and sexual health was far from over. There is clearly a health risk for them that I haven't addressed.

But, I've got to get their attention long enough to listen! My older son just graduated from college and is off to a job on Wall Street next month. My younger son turned 18 yesterday.

Somehow I need to give them a balanced review of what I now know-showing them the seriousness of what I learned without getting too dramatic and causing them to tune me out entirely.

I'm going to give it my best. If there is a downside, I don't see it. And, as a single divorced woman, I have to consider whether I should get the vaccine myself. Perhaps I'll be the trailblazer in my family.

Carolyn Berger, LCSW, is Founding Board Chair of Path2Parenthood and has a practice devoted to fertility, all family building options, and adoption.


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