<p>Good post Scidoc, I buzzed over that earlier post. I do not think anyone (ACOG,ACS,CAP or ASC) is at all advocating HPV testing to substitute for Pap smears, at least not yet. Getting the vaccine will not completely eliminate the need for Pap smears. The vaccine may put us all out of business in the future (I’m a cytopathologist), but probably not until we have more data.
What I have read about more recently is the possiblity of screening women with HPV testing, then doing Pap smears next, as more of a diagnostic test. That comes down to a cost and availability ratio, both approaches have false negatives, but as our cytotechnologist workforce ages, it becomes more of a likelihood.</p>
<p>My D. also had abnormal pap. Tested positive for HPV. Her GYN still rec. the vaccine as it covers 5? strains of the HPV that may be carcinogenic and it is felt that if one is only exposed to one, the vaccine will still offer protection for the other strains. She is getting her second dose this month. Has had one boy friend the last 3 years–so lack of promiscuity is no protection.</p>
<p>Also, I didn’t realize (or really hadn’t thought about it), condoms offer little protection as HPV is transferred by any skin to skin contact from infected area.</p>
<p>I had an abnormal PAP once, but when they retested & ever since, it has been normal. Don’t believe I was ever tested for HPV back then. I believe the vaccine currently protects against 4 strains of HPV & have also read that it should protect vs. the remaining strains even if the patient has one or more strains of HPV. Never thought of how HPV is/was transmitted either. Wonder whether it makes sense to re-test to be sure your D isn’t getting a false positive?</p>
<p>She will be having every 6 mo. checks. I assume they will repeat the HPV test at some point. This next appt. I am going with her to ask more questions than she was able to think of.</p>
<p>I work at a Pediatrician’s office and we are already getting requests for it.</p>
<p>Check to make sure your insurance covers it–a few don’t right now but we’re guessing they all will within the next few months, and certainly by the summer.</p>
<p>What I’m waiting to see is if it becomes almost mandatory like the meningitis one. I think most colleges require the meningitis vaccine these days (we give it to just about every 18 year old and folks younger than that if they want it, usually starting at age 12).</p>
<p>I’m surprised they recommend Gardasil for 9 year olds. I’d wonder the long term effect of this–how long would it last? If the girl got it at age 9 and didn’t have sex until she got married at, say, 25, would it still be good?</p>
<p>This is definitely a vaccine we are watching closely–for side effects, effectiveness, long term, etc.</p>
<p>However, I wouldn’t give it to my daughter (if I had one) until she got married. Why? Because I would forbid her to have sex until marriage.</p>
<p>I’m with Sax. There’s been no long-range testing of this vaccine and hence we don’t know if there are any long-range risks. I can’t do a risk analysis without this information.</p>
<p>Perhaps we should withhold tetanus vaccine from children, too – it will only encourage them to be careless around rusty nails. If we forbid them to play with sharp objects, that should be all the protection they need.</p>
<p>Our OB-GYN recommended it for my Ds, as have the several physicians we have in the family. All have begun the series of shots, including the older ones. Although it is optimal to have the series at a younger age, they still recommended it for all of them. </p>
<p>p.s. Hanna, I just wanted to say that I always enjoy your posts.</p>
<p>I don’t have daughters, but if I did, I’d make sure they received the vaccination. No one intends to pick up an STD, but HPV can be transmitted even without intercourse. And what about the risks from assault? I just believe in getting any vaccination possible, and have always made sure that my sons are up to date.</p>
<p>“what about the risks from assault?”</p>
<p>Not to mention the risk of a husband’s infidelity years down the road…</p>
<p>At my last gyno appointment, I was told that I wasn’t a good candidate for the vaccine (my fiance’s mother, a nurse practitioner, agreed). I’m getting close to the upper-end of the recommended age-range for the vaccine and since I’m getting married soon, they said it wasn’t necessary.</p>
<p>Personally, I don’t see much of a point in it. Cervical cancer is very easy to screen for and every woman over 18 (regardless of sexual activity) should be going to annual gyno visits. Medically, it’s cool that they are getting closer to vaccinate people against cancers, but I’m not quite sold on its need as of yet.</p>
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<p>Now, that’s just naive! You can’t forbid your children to do anything, especially be sexually active. The nature of it being forbidden drives the kid to test their boundaries and experiment further. </p>
<p>Also, the vaccine can give a false sense of security (it does NOT protect against all strands of HPV, but some are confused), so it may have the reverse effect and deter some women from getting their annual check-ups.</p>
<p>I have a stupid question— at what age do/did you switch your d over from ped to a gynecologist? Is a family doctor/internist as good as a gyno for teens? I don’t have a gyn, just my internist who I like very much and who can do all the routine gyn stuff.</p>
<p>It’s a matter of personal preference as to when women start seeing a GYN (I asked at my last visit because D is 17). If the doc you have is comfortable doing the basic GYN stuff & there are no particular complications, it isn’t urgent to switch. When you’re thinking about starting a family, you definitely should have an OB/GYN to help you thru pregnancy & delivery issues (IMHO). The docs in our family suggest getting an OB/GYN who is a good surgeon, just in case it’s needed, so that’s how we chose ours.</p>
<p>I don’t understand why you wouldn’t get the vaccine, just because you’re in the upper range for it. I would get it if I were in the range, as it adds a layer of protection & who knows what the future will bring? I tend to get whatever vaccines are recommended for myself & family & have generally been glad we have. My OB/GYN strongly recommends the vaccine for everyone in the age range & so does the CDC (Centers for Disease Control). The benefits I’ve read about seem to outweigh the risks.</p>
<p>OK, she’s currently seeing a pediatrician. I just don’t know a good gyn to switch her to, as I don’t have one for myself. But I don’t think the peds do any gyn stuff.
wow, in the midst of all the college app frenzy I haven’t even thought about this stuff…glad this was brought up</p>
<p>We still have 19-20 year olds (girls and boys) who come to the ped’s office. Not sure if the girls have an OB/GYN or not, I’m not sure if our docs recommend a certain one to them at a certain age.</p>
<p>It seems that people either wait until they’re 21 to leave the ped or they opt out pretty early–I haven’t seen a ped since I was 16 and actually haven’t been to a doctor in a year and a half now.</p>
<p>And as far as my argument about daughters and sex–put it this way. I’m 20, sophomore in college, and have never had a desire to have sex. If I raise children I’ll try my best to make sure they think the same.</p>
<p>Finally–someone mentioned about multiple strains of HPV that it doesn’t prevent? Is this sort of like the annual flu shot that only takes care of a few types of flu?</p>
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<p>Obviously, this is a personal choice, and complicated by your age. HPV is a highly contagious virus, and “true” intercourse is not required for infection. When you have close contact with a sexual partner, not intercourse, just close contact, you have been exposed to every partner that person has ever had, not quite like classic sexually transmitted diseases. I once read some data that said by about age 25, 50-75% of adults have been exposed to HPV. In one study at an elite college health center, 40% of women were actively infected at presentation.</p>
<p>If you are not infected, and your partner is not infected, the vaccine is not necessary. But if your partner has ever had intimate contact with another person, it is about 50-50 that he is infected - note I said intimate contact, not intercourse.</p>
<p>As an MD who makes my living looking at Pap smears, I understand that they are a screening test - that means to me that there are a number of smears that will be negative when the woman has a malignant or pre-malignant condition. That false negative rate remains despite a whole host of measures that have been taken to reduce the number of false negative smears - including the pressure of many multi-million dollar lawsuits - Pap smears are a screening test that have to be done multiple times, and sometimes are negative despite all that. Being vaccinated, even for a low risk person, is just another little bit of insurance against a poorly sampled Pap smear.</p>
<p>Finally, I’ve been in the middle of a few nasty situations where one married partner begins to accuse the other of infidelity based on a positive Pap smear (mostly in pre-HPV testing days, but still). HPV is not like other STDs, and it is better to treat it medically, and not dwell on the social aspects. The changes we see from HPV can come from a recent infection, or an infection from years ago, it is almost impossible to prove which one. A vaccine would prevent some of that heartache.</p>
<p>Re: Multiple strains of HPV. The vaccine is raised against the strains of HPV that are most closely associated with cervical cancer (HPV is a wart virus, similar but slightly different than the virus that causes warts on your fingers; there are probably 1000 strains of HPV). Longitudinal studies have been done on the rates of infection and the numbers of pre-malignant conditions seen in vaccinated women, and we know that the vaccine greatly reduces the incidence of these pre-malignant conditions, BUT, it will be 20 years before we truly know how many cases of cervical cancer are prevented, and how many remain.
Why would cervical cancer still occur in vaccinated women? Mainly because the low risk strains of HPV do occasionally cause pre-malignant changes, and rarely a person with low risk HPV will progress to cancer - that’s why we aren’t ready to do away with the Pap smear altogether.
ALso, the most common HPV test that is done during the work-up of an equivocal Pap smear, only tests for the high risk HPV types. The rationale is that if a woman has equivocal cytology and is negative for high risk HPV types, then she is at very low risk for cervical cancer over the next year, and can be safely followed, regardless of whether or not she is actually infected with low risk HPV.</p>
<p>And to finish answering AFPrep’s question - the vaccine will give you immunity against the most high risk types of HPV. We have years of data to tell us that the virus does not mutate so fast that you need a shot every year, we think HPV may have been like it is for thousands of years. It is not clear if the immunity will be permanent like polio or temporary like tetanus. This is where Coureur could help.</p>
<p>We had a falling out with our pedi, so my kids stopped seeing him & have been relying on the allergist (who provided for most of our medical needs anyway) & now that son is >18, he started seeing my internist for his pre-college check-up. We will do the same for D when she is >18, as he doesn’t like to see patients <18.
I think it’s easiest for girls to go to the same OB/GYN as their moms (at least that’s what we did in my family). We found one by asking around a lot. I ask lots of questions, so I needed to find a doc that was OK with lots of Qs & would provide answers. Over the years of seeing him, he became unresponsive to Qs, so eventually I switched to a new OB/GYN who has a great rep as a surgeon & is great about answering my many Qs.</p>
<p>I had wanted a female OB/GYN, but had trouble finding one who wasn’t on a part-time schedule & wasn’t terribly overbooked. I ended up with males & they’ve been OK. One of my sisters has a female & she has a lot of trouble scheduling her appointments, as the doc only works part-time & seems to take frequent & extended breaks.</p>
<p>My D. absolutely did not want to go to same OB-GYN as I do. I told her everything would be confidential, but somehow she thought it would be weird. She chose a female (mine is male) and seems comfortable with her. </p>
<p>Wecandothis, at one point I switched to family doc for gyn as it was easier to get appts. and I was through with child bearing. That was the one time I had an abnormal pap. I followed up with my GYN doc who said that, in his opinion, the GYN are more adept at getting good tissue samples and are “pickier” about who reads their slides. After that I stayed with OB-GYN for anything related to those areas. Maybe cangel can speak to that opinion.</p>