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How You Can Prevent This Cancer-Causing Sexually Transmitted Infection

Image of Doctor talking to a boy. Boys and girls 11 and older should be vaccinated against human papillomavirus, which can lead to cancers years after infection. Those in the armed services and beneficiaries should also get the vaccine if they haven’t already (Courtesy of the Centers for Disease Control and Prevention).

If you're in the military, should you get the vaccine for Human Papillomavirus (HPV) if you haven't already?

The evidence says YES - and the sooner, the better.

Why? Because HPV can cause cancers years after exposure or resolve itself with no symptoms, but who wants to take that chance? The virus is responsible for approximately 40,000 cases of cancer each year, almost all of which are preventable, says the Centers for Disease Control and Prevention.

HPV is the most common sexually transmitted infection (STI) in the United States. According to the CDC, there were 43 million Americans with the HPV STI in 2018.

While the number of infections is high, most cases of HPV clear themselves. If they don't, HPV can result in genital warts, or, worse, cervical, vaginal, vulvar, and anal cancer in women, penile and anal cancer in men, and cancer of the back of the throat.

The HPV vaccine is Food and Drug Administration-approved for persons 9-45 years of age. The CDC Advisory Committee on Immunization Practices (ACIP) routinely recommends the vaccine for persons 11-26 years of age, making it a vaccine that both parents and service members should consider.

Discuss Your HPV Status at PHAs

The HPV vaccine is not currently mandatory in the military. The FDA approved the vaccine in 2006, so many recruits may already be vaccinated, which is one reason it is not offered in basic training.

"However, we recommend that providers discuss HPV vaccination with service members at their annual Periodic Health Assessments and at any other clinical visit as appropriate," said Dr. Bruce McClenathan, medical director for the Immunization Healthcare Division, South Atlantic Region Vaccine Safety Hub, at Fort Bragg, North Carolina.

"Many service members may have already been vaccinated to HPV, so they may want to check their childhood/adolescent immunization records or ask their parents," McClenathan suggested.

"If there is no evidence of previous HPV vaccine receipt, I would recommend that all service members 26 years of age or younger discuss the HPV vaccine with their provider and request to begin the series. Why pass on a vaccine that can prevent cancer?" he said.

The number of shots needed for a full vaccination varies depending on your age. Up to three doses may be needed for the vaccine to be fully effective, but many people who start the vaccination series don't finish it.

"Catch-up HPV vaccination is recommended for all persons through age 26 who are not adequately vaccinated," McClenathan added.

Acknowledging the stigma attached to STIs, Jennifer Ritschl, a nurse with the IHD at Fort Bragg, said: "Don't be afraid to ask questions."

For military personnel and beneficiaries, "we need people to understand there's no judgment: We're here to help."

A physician discussing prevention with a sailor Navy Cmdr. John Lydon, a physician at the Naval Hospital Jacksonville’s OB/GYN clinic, discusses prevention with a sailor (Photo by: Jacob Sippel, Naval Hospital Jacksonville).

Other Criteria for Vaccination

ACIP says those who are between the ages of 26 and 45 may want to get the vaccine after talking with their health care providers even though they are likely to have been exposed to HPV already.

Women who are breastfeeding may get the vaccine. There is no evidence that the vaccine affects fertility.

However, women who are pregnant should not get the vaccine. If they receive a first dose and then find out they are pregnant, additional doses can be delayed until after the pregnancy.

Men who have sex with men should also consider getting vaccinated: HPV can be spread during anal and oral sex, as well as through skin-to-skin touching.

The CDC emphasizes that HPV can be spread even when an infected person has no visible signs or symptoms.

How do you know you're infected? You may not, so, again, vaccination is the way to go.

The most common side effects of vaccination are usually mild, like a sore arm from the shot, and go away quickly, FDA says.

Routine Pap smears for women ages 21 to 65 years old can help prevent cervical cancer in those unvaccinated for HPV.

CDC also recommends using latex condoms the right way every time you have sex. This can lower the chances of getting HPV. But HPV can infect areas not covered by a condom, meaning you may not be fully protected with condoms alone, CDC says.

Children and Adolescents' HPV Vaccinations

For children and adolescents getting back-to-school physicals, school sports exams, and immunizations, "I strongly recommend leveraging those appointments to get the HPV vaccine if the patient has not completed the vaccine series," McClenathan said.

There may be some parental hesitancy about getting the HPV vaccine, said Ritschl.

"The current reason I hear most often is parents deciding to postpone HPV vaccination until their child is caught up on required immunizations," she said. This is "because COVID-19 has adversely affected immunizations across the board. Many patients haven't been seen physically in the clinic for several months or even a year," she said.

"Many parents also focus on the STI prevention aspect and think their child doesn't need the vaccine because they aren't having sex. That is a dangerous assumption," Ritschl said. "We know HPV is spread in more ways than just during 'sex,' and while we want to prevent genital warts, this vaccine is primarily about preventing cancer."

McClenathan said: "We know the vaccine is much more effective if given before any potential exposure to HPV. In addition, choosing to give the vaccine before age 15 also allows one to complete the series with only two shots instead of three."

But there are still parents who are concerned about adverse effects of the vaccine, Ritschl noted.

"These concerns are often unfounded, because they are based on information from unreliable sources, such as social media or word-of-mouth," Ritschl said. "We discuss the proven benefits of the HPV vaccine with these parents and provide them with credible sources for information such as the DHA Human Papillomavirus website and the CDC website."

McClenathan said: "As both a vaccinologist and a parent of an adolescent, I would recommend the HPV vaccine without reservation. My own child has received this vaccine - that is how strongly I believe in the vaccine and its ability to safely and effectively prevent cancers associated with HPV infection."

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