1. The New HPV Vaccine Laura Zakowski, MD No conflicts of interest

2. Case n A 25 year old female is seen for a complete physical exam. -She has read about the HPV vaccine, and wonders if she is a candidate -She is single and has had three lifetime sexual partners (male and female) -No known history of sexually transmitted infections or abnormal pap smears

3. Question 1 n What is the most common STI? -A. HIV -B. HSV -C. HPV -D. Hep B

4. HPV infection n HPV most common STI -75% will develop HPV n Half those infected are ages 15-24 n Most infections asymptomatic and transient -10% are not

5. Question 2 n What 2 types of HPV are associated with cervical cancer? -A. 6 -B. 11 -C. 16 -D. 18

6. HPV types n HPV types 16, 18 -70% of cervical cancers n HPV types 6, 11 -90% of genital warts

7. Other risks for cervical cancer n Never screened: -Half of women with cervical cancer n No screening in last 5 years: -10% of women with cervical cancer

9. HPV type 16 Number CIN 2-3 PersistHPV Placebo75012111 Tx75507

10. *HPV types 6, 11, 16, 18 NumberCIN/AISWarts Placebo78618391 Tx785841 * Drug company data

11. Antibody mean titers

12. HPV vaccine n Recommended age groups: -9-26 years -Females only n Begin series at age 11-12

13. Question 3 n Do you recommend HPV vaccination for this patient? -Yes -No n Answer: Ideally before onset of sexual activity, but it is preventive against non- exposed strains

14. HPV vaccine n Series: -3 injections -Now, 2 months, 6 months n Injection site pain most common s/e n Headache most common systemic s/e n Can be given with other vaccinations

15. Question 4 n After a patient is immunized, what do you recommend for cervical cancer screening? -A. Unchanged frequency -B. Reduced frequency n Answer: Continue with same cervical cancer screening frequencies n Continue with safe sex practices

16. Costs n Cost: $360 for the entire series n HPV 16/18 12-year-old girls: -QALY: $14,583 -Reduce cervical cancer rates by 61.8%

18. References n www.cdc.gov/std/hpv www.cdc.gov/std/hpv n Vaccinate adults! 2006;10(2):1 n Schiffman M. NEJM 2005;353:2101 n Taira AV. Emerg Infect Dis 2004;10:1915 n Mao C, et al. Obstet Gynecol 2006;107:18-27. n Gardasil. Merck & Co, Inc.