The U.S. Centers for Disease Control and Prevention (CDC) estimate that there are six million new cases of human papillomavirus (HPV), a sexually transmitted disease (STD), each year -- many of them in teens and young adults. The U.S. Food and Drug Administration (FDA) recently licensed a new vaccine (Gardasil) for the prevention of diseases caused by HPV in females. Nancy Brown, Ph.D., a senior research associate with the Palo Alto Medical Foundation's (PAMF) Research Institute's Department of Health Services Research, provides answers to questions parents may have about the new vaccine.

• What is HPV?
• How is HPV transmitted?
• What are genital warts?
• How can HPV be treated?
• Can HPV cause cancer?
• What about the vaccine?
• Is it controversial?
• What can parents tell their daughters about the new vaccine?

What is HPV?

HPV is the most common STD in the United States. HPV is a virus that can cause warts on any area of skin or mucous membrane, including the mouth or genital area.

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How is HPV transmitted?

Although HPV is classified as an STD, it can actually be transmitted through any skin-to-skin contact between an infected and non-infected person, not just through sexual contact. Studies are looking at whether HPV can be also transmitted through indirect contact, such as sharing underwear or towels. HPV can be transmitted even if the person with HPV does not have any symptoms (such as warts). Besides abstinence, condom use can assist in prevention. In women, regular Pap smears can detect the virus early. Early detection is important to prevent cancer.

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What are genital warts?

Genital warts are small raised areas of skin on the anus or genitals, which can cause itching and irritation. Warts can appear in small groups or in random patterns. Some people say they look like cauliflower. Genital warts may also be flat and nearly invisible, and women can even experience them internally. Genital warts pass very easily from person to person.

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How can HPV be treated?

There is no cure for HPV, so treatments focus on getting rid of the symptom: warts. People who think they may have HPV should see a doctor as soon as possible. Many types of HPV can have serious consequences if left untreated (see "Can HPV cause cancer?" below). Treatment options include creams, surgical procedures and medications that help the immune system fight the HPV infection.

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Can HPV cause cancer?

If left untreated, some types of HPV can cause cancer. Other types of HPV, such as those that cause genital warts, can also cause cervical cancer if the warts are not treated. Cervical cancer kills more women every year than any other cancer. About .01 percent (1 in 10,000) of HPV infections in women lead to cervical cancer. The good news is that having regular Pap smears can help detect genital warts, pre-cancerous changes or cervical cancer in the early stages when these can be treated effectively.
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What about the vaccine?

In 2006, the FDA licensed a vaccine (Gardasil) for the prevention of cervical cancer and other diseases in females caused by HPV. Since HPV is the leading cause of cervical cancer in women, the CDC recommends that girls 11 to 12 years of age be vaccinated (with three doses). However, it can be given to girls between 9 and 26 years of age.

The idea is to vaccinate girls before they become sexually active, but all sexually active women should receive the vaccination, too. HPV is the most common sexually transmitted infection in the United States and is the most common in people in their teens and 20s.

The vaccine, which has been tested with thousands of women and is considered effective without serious side effects, is given in three injections over a six-month period. Most insurance companies cover the vaccinations.
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Is it controversial?

Like many STD-related products, there is controversy surrounding the vaccine. Opponents say that the vaccine might encourage unprotected sex. However, surveys show that many parents support vaccinating their children.

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What can parents tell their daughters about the new vaccine?

If you are a parent who has already starting talking with your preteen or teen about his or her changing body and sexual health, this will not be difficult. You can explain that this vaccine protects women from a sexually transmitted disease that is linked to cervical cancer, and that professionals recommend every young girl get vaccinated (with three doses) before she becomes sexually active.

If you have not started this conversation, this is your opportunity. You could say "it prevents cancer," and leave it at that. However, this explanation is not really accurate. If you are going to protect your child, start the talk. Begin with stating your values clearly, such as "I expect that you will not have sex until (insert age or context)." Then talk about the importance of knowing how to prevent unwanted pregnancy and STDS with birth control and condoms.

If you think that your 11-year-old daughter is too young to hear about sexual intercourse, sexually transmitted infections and condoms, think again. National surveys have found that about 7 percent of children have had sexual intercourse before 13 years of age, and about 25 percent of children have done so by 15 years of age. The CDC estimates that there are six million new cases of HPV each year -- many of them in teens and young adults.
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