HPV vaccine can prevent cervical cancer, genital warts

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. The human papillomavirus, or HPV, can cause genital warts and cervical cancer, but there is a vaccine available. Here with me to talk about HPV is Dr. Manika Suryadevara. She's an associate professor of pediatrics at Upstate, where she specializes in infectious disease. Welcome to "The Informed Patient," Dr. Suryadevara.

Manika Suryadevara, MD: Thank you for having me on to speak about this very important cancer prevention vaccine.

Host Amber Smith: Please tell us about HPV. What is this virus?

Manika Suryadevara, MD: HPV is the human papillomavirus, and it is a sexually transmitted infection that can go on to cause genital warts, or, even more severely, new, different types of cancers.

And it is the most frequent sexually transmitted infection in the United States. It's actually so common that almost every individual who is unimmunized will acquire this infection at some point during their life.

Host Amber Smith: I didn't realize that. So it's more common than herpes or gonorrhea?

Manika Suryadevara, MD: It is. So at any point in time, there are about 40 million people with an HPV infection. The next most common sexually transmitted infection would be herpes at 19 million infections, so you can see how frequent this virus infection really is.

Host Amber Smith: So how many different types of HPV are there, and is there only one that causes cervical cancer?

Manika Suryadevara, MD: So that's a great question. There are over a hundred different types of HPV and then over 40 of which can infect the genital area. And by infecting the genital area, that could mean multiple things. These viruses have been stratified based on their risk for developing into cancers. So you can have low-risk HPV, which more commonly causes the genital warts, or you can have the high-risk HPV.

And those are more likely to go on to cause cancers, not just cervical cancer, even though that's the association we make, but any sort of genitourinary cancers. So that includes penile cancer, anal cancer, and it also can cause a head and neck or a throat cancer.

Host Amber Smith: Do you see HPV infections in children, or is it mostly young adults, or is it older adults?

Manika Suryadevara, MD: There are about 13 million new HPV infections that occur each year in the United States. And more than half of these infections are occurring in our young adult population. So that's typically people between the ages of 15 to 24 years old. Now, most of HPV infections are asymptomatic.

So that means that most people in the United States who are infected with HPV don't even know that they have infection. This infection may or may not clear itself from the body without any intervention or even knowledge that there was an infection. The HPV infection that persists, however, can stay in the body for years and ultimately go on to develop cancer.

So while the infection can be acquired in the young adult period, it is most often manifested with these cancers later on in life.

Host Amber Smith: So there's no reliable symptom that people get,so most people wouldn't even necessarily know they're infected? Is that right?

Manika Suryadevara, MD: That is correct. So if someone were to develop genital warts, that would be an indication that they probably have an HPV infection.

For cervical disease, there is a screening method. So women who are getting their Pap smears, can be identified to have abnormal cells that may be due to HPV infection, but outside of that, HPV is often diagnosed at the time of cancer diagnosis, particularly for throat cancer and noncervical disease.

Host Amber Smith: Would a doctor diagnose HPV if there were genital warts, or is there a way to do that when you see genital warts?

Manika Suryadevara, MD: Genital warts is most often caused by HPV infection.

Host Amber Smith: So it's assumed that if you have the warts, that's probably why.

Manika Suryadevara, MD: Exactly.

Host Amber Smith: Now I think you described this: Once a person's infected, does their body just fight it off and it goes away, or does it stay in the body?

Manika Suryadevara, MD: Most often when a person is infected with HPV, the body fights it off, and the infection gets cleared, and there's nobody even knows about it. However, there is a substantial proportion of infection that stays in the body, and it is the virus that stays in the body that leads to cancer development.

And when we're trying to just see how much disease burden that really means, you can look to see the data regarding HPV cancers, and each year HPV has been found to be responsible for 35,000 cancer cases in the United States. It is the major cause of cervical cancer, penile cancer, vaginal cancer, anal cancer and throat cancer.

And in fact, HPV causes 70% of mouth and throat cancers in the United States now, so where we used to associate mouth and throat cancers with smoking and alcohol, now HPV causes most of them.

Host Amber Smith: And is that through sexual contact usually?

Manika Suryadevara, MD: Correct. That is through sexual contact.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith talking with Dr. Manika Suryadevara.

She's an associate professor of pediatrics at Upstate specializing in pediatric infectious disease. And our subject today is HPV, the human papillomavirus.

So let's talk about treatment and prevention. Can HPV be cured if someone develops it?

Manika Suryadevara, MD: There's no antiviral treatment to get rid of the virus, so treatment of HPV really is based on the symptoms that are presenting. So individuals with HPV genital warts can see their doctor to see if there's any ways to reduce the warts, and those with HPV cancers should be followed by their providers and may need chemotherapy or surgery or radiation for treatment.

But there is no medicine to remove the HPV from the body. What we can do is we can prevent infection, and the best way to prevent infection is the HPV vaccine.

Host Amber Smith: So tell me more about the vaccine. How does it work?

Manika Suryadevara, MD: So the HPV vaccine, the one that we currently are using in the United States, is 9-valent, which covers for the majority of HPV types that are causing cancers today.

And essentially the vaccine is recommended to be given at the 11- to 12-year-old well-child check. And, you know, you hear 11- and 12-year-olds, and you think, oh, why are we giving them the vaccine this early? And there are multiple reasons for doing so. There is definitely rationale for doing that. The first reason is because at the 11- to 12-year-old well visit is when these teens are getting other adolescent vaccines, their tetanus shot for school, their meningitis shot, so it really fits into the adolescent vaccine platform. A second, very important reason to vaccinate at the 11- to 12-year-old visit is because we know that younger adolescents produce a much stronger antibody response to the vaccine, compared to older adolescents. And this is why when you get the vaccine, when you're a younger teen, so 11 or 12 years old, you only need two doses of the HPV vaccine series.

Whereas if you get the vaccine after your 15th birthday, you need three doses of the vaccine series to get the same response. So it's really recommended to start at the 11- to 12-year-old visit and can even be given down as young as 9 years of age to get these kids immunized and protected.

Host Amber Smith: Now you mentioned kids, boys and girls. Cervical cancer only affects women, though, so why are the boys being vaccinated?

Manika Suryadevara, MD: So again, while we consider HPV vaccine to really protect against cervical cancers, essentially it's protecting against all HPV-associated cancer. And if you look at mouth and throat cancer, men are at higher risk of acquiring HPV throat cancer than women.

And men can also develop penile cancer due to HPV. So by vaccinating boys and girls, you are protecting both genders from developing HPV-associated cancers later in life.

Host Amber Smith: I don't think a lot of people realize that a vaccine exists that can prevent cancer. Does this surprise people when you explain this to them?

Manika Suryadevara, MD: It does surprise people because when we think of HPV, we think of it being a sexually transmitted infection. But the whole goal of vaccine really is to prevent these cancers. You know, 4,000 women are dying each year from cervical ,cancer, and that's with screening and with treatments. And here we have a vaccine that can prevent infection and the subsequent development of cancers in our sons and our daughters.

So I think it's a very important message to send that we're really trying to prevent cancers in our teens by giving the HPV vaccine. Now the HPV vaccine, while it can be started around 11 to 12 years of age, is recommended all the way through 26 years of age for everybody. And then for adults who are between the ages of 27 and 45, if they are considered themselves to be at higher risk for acquiring HPV infection, they can talk to their provider and discuss whether they should also be vaccinated.

Host Amber Smith: I wondered because there's a lot of people who, you know, this vaccine wasn't available when they were adolescents. So in general, can people who are older than 21 get vaccinated?

Manika Suryadevara, MD: Recommendations for a routine vaccine or HPV series go all the way through 26 years old. So if you're an individual who's 24 years old and has not been immunized against HPV, definitely speak with the provider to get vaccinated. And then adults who are 27 through 45 can talk to their provider about risk factors and the benefits and risks of getting vaccinated.

Host Amber Smith: What about people in their 50s, 60s and older? Do they need HPV vaccines?

Manika Suryadevara, MD: Currently guidance goes up through 45 years of age, where there's universal routine recommendations for administration of vaccines as early as 9 years old, all the way through 26 years old. And then for adults 27 through 45, it's based on an individual case, discussing benefits of the vaccine.

Host Amber Smith: Is that because of the time it takes for the cervical cancer to develop?

Manika Suryadevara, MD: Correct. Any kind of HPV-associated cancer, the older you are in life, the less likely it is you are to be exposed to the virus, and the vaccine works best prior to exposure to the virus as opposed to once infected. So the recommendations really are to capture everybody who's younger and at risk of newly acquiring HPV infection. And that's where the focus is.

Host Amber Smith: If people got the vaccine as children, are they going to need boosters later on in life?

Manika Suryadevara, MD: As of right now, no boosters are recommended or needed. We have over 10, 15 years' worth of data showing significant antibody response and significant reduction in HPV disease. We're talking about genital warts and cervical precancers as well as cancers associated with HPV in the vaccinated population. So no booster doses are needed, and we have a lot of safety and efficacy data showing that even 10, 15 years later, the vaccine is working very well.

Host Amber Smith: If someone has already been infected with HPV before they're vaccinated, is the vaccine going to have any protection for them?

Manika Suryadevara, MD: Yes, so it is very important if someone has been already infected with HPV to get the HPV vaccine, because it is likely that they were infected with only one type of HPV, and the HPV vaccine prevents against nine types of the virus. So to ensure that they stay protected from future infections, it is very important that even if an individual has been infected in the past, that they do go and get the HPV vaccine.

Host Amber Smith: What if you have a couple -- partners -- that are never with anyone else; are they at risk for HPV in other ways?

Manika Suryadevara, MD: The risk factors for developing HPV-associated disease, as you mentioned, earlier onset of sexual activity, multiple partners, I would say, to be fully protected even though you are solely with one other partner, my recommendation for everybody, because we know it is a safe and effective vaccine that does prevent cancer, my recommendation to everybody is to get vaccinated.

Host Amber Smith: Has the vaccine been in use long enough to have an impact on reducing the number of cervical cancers or genital wart cases?

Manika Suryadevara, MD: Yeah. So we have over 15 years' worth of data on vaccine safety and efficacy, and there are multiple studies coming out, showing significant reduction in HPV infection, genital warts, precancers and cancers in the U.S. and in other countries around the world with robust HPV vaccination programs.

Host Amber Smith: Are there other vaccines that are designed to protect against other cancers?

Manika Suryadevara, MD: Yes. So the main one that comes to mind is the hepatitis B vaccine. Hepatitis B virus can be acquired, again, through sexual transmission or through contaminated blood exposure. And we know that chronic hepatitis B virus also leads to liver cancer. Now we have a hepatitis B vaccine that's been in use for quite a while, currently given to infants in the first 6 months of life, but then can be administered to, any unimmunized individual at any age to prevent the acquisition of hepatitis B virus, and the subsequent development of liver cancers.

It's a very similar purpose of, here we have a vaccine that prevents liver cancers, and we routinely vaccinate all our newborns with it, and anyone who's older who has not been unimmunized again for the sole purpose of cancer prevention.

Host Amber Smith: Well, thank you. I really appreciate you making time for this interview.

Manika Suryadevara, MD: Well, thank you for having me.

Host Amber Smith: My guest has been Dr. Manika Suryadevara, an associate professor of pediatrics at Upstate, specializing in pediatric infectious disease. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.