HPV Vaccine - Potential for Fertility Preservation

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This article is part of the June 2006 INCIID Insights Newsletter

HPV Vaccine (Gardasil) - Potential Benefits for Fertility Preservation

Dr. Sogol Jahedi, OB/GYN resident, Lutheran General Hospital

Angeline Beltsos,M.D., Fertility Center of Illinois

 

 

Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of women and men including the skin of the vulva, vagina, cervix, penis, anis or rectum.  Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.

 

Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women.

 

Some types of HPV can infect a woman’s cervix and cause the cells to change. Most of the time, HPV goes away on its own. When HPV is gone, the cervical cells go back to normal.  However, there are cases where HPV lingers and continues to change the cells on a woman’s cervix. These cell changes can lead to cancer over time, if they are not treated.

 

The American Cancer Society estimates that in 2006, over 9,700 women will be diagnosed with cervical cancer and 3,700 women will die from this cancer in the U.S.  At least 50% of sexually active people will get HPV at some time in their lives. Every year in the U.S., about 6.2 million people get HPV. HPV is most common in young women and men who are in their late teens and early 20s.

 

On June 8, 2006, an HPV vaccine (manufactured by Merck) was licensed by the Food and Drug Administration (FDA) for use in females, ages 9-26 years. The vaccine is called Gardasil and it protects against four types of HPV, including two that cause most (70%) cervical cancers (types 16, 18), and two that cause most (90%) genital warts (types 6, 11). The vaccine is given through a series of three injections over a six-month period. The second and third doses should be given two and six months (respectively) after the first dose.

 

The licensed vaccine has been found to be 100% effective in preventing cervical precancers caused by the targeted HPV types. It has also been found to be almost 100% effective in preventing precancers of the vulva and vagina, and genital warts that are caused by the targeted HPV types.  Ideally, the vaccine would be administered before females become sexually active—since this vaccine is most effective in females who have not yet acquired HPV infection.  The proposed recommendations are to provide routine vaccination for 11-12 year-old girls and catch-up vaccination for 13-26 year-old females.

 

However, females who are sexually active may also benefit from the vaccine. Those who have not been infected with any vaccine HPV type would get the full benefits of the vaccine. Those who have already been infected with one or more HPV type would still get protection from the vaccine types they have not yet acquired. Few young women are infected with all four vaccine HPV types (6,11,16,18).

 

In the realm of fertility, the HPV vaccine may indirectly assist a woman in maintaining her fertility.  HPV infection itself does not cause infertility.  However, the treatment can infrequently lead to cervical problems that then cause infertility.  The treatments for HPV-related severe precancerous or cancerous conditions such as cone biopsy or LEEP excision can lead to scarring and narrowing of the initial highway of the female reproductive pathway leading to the egg.  It can also compromise the cervical mucus, which normally assists in sperm transport.

 

Furthermore, women who have had cervical surgery and then become pregnant can suffer from cervical incompetence, which can lead to preterm birth.  Therefore, the HPV vaccine indirectly may lead to less chance of infertility by maintaining cervical health.  Because HPV is a sexually transmitted disease, clinical trials are currently in place to examine the efficacy of giving this vaccine to young men as well.  The less that the male partner is infected also benefits the woman because there is less chance that she would be infected. 

The HPV vaccine is an exciting new prospect in preventing the spread of HPV among young women and men, leading to better overall health and improvements in maintaining a healthy pregnancy.

 

 

Bibliography:

1.  CDC  www.cdc.gov 
2.  UpToDate  www.utdol.com Barbara McGovern,MD Human papillomavirus vaccines  2006
3.  UpToDate Reichman, R and Negron G. Clinical presentation and diagnosis of human papillomavirus infections  2006

 

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