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Editors' Message  |   April 2008
Physician, Educate Thyself and Thy Patients About HPV and Vaccination
Author Notes
  • Address correspondence to Bethany A. Weaver, DO, MPH, PO Box 89069, Tampa, FL 33689. Dr Weaver discloses that she is a consultant and a member of the speakers bureau for Merck & Co, Inc. E-mail: bweaver@hcso.tampa.fl.us 
Article Information
Preventive Medicine
Editors' Message   |   April 2008
Physician, Educate Thyself and Thy Patients About HPV and Vaccination
The Journal of the American Osteopathic Association, April 2008, Vol. 108, ii. doi:
The Journal of the American Osteopathic Association, April 2008, Vol. 108, ii. doi:
Genital human papillomavirus (HPV) is considered the most common sexually transmitted disease in the United States. Diagnosing and managing clinical HPV-related conditions, such as cervical dysplasia and genital warts, contribute to a large portion of healthcare costs in the United States, as described by Edward John Mayeaux, Jr, MD, in the lead article in this supplement to the JAOA. In the second article, Susan L. Hendrix, DO, reviews the important benefits of prophylactic vaccination against HPV. 
The quadrivalent HPV L1 virus-like particle (VLP) vaccine is currently the only commercially available prophylactic HPV vaccine in the United States that is approved by the US Food and Drug Administration (FDA). This vaccine, as reviewed in detail by Dr Hendrix, is highly effective and safe, offering direct protection against HPV types 6, 11, 16, and 18, which are responsible for 90% of genital warts, 70% of cervical cancers, and a large portion of anogenital dysplasias.1-5 
The Advisory Committee on Immunization Practices (ACIP) recommends this HPV vaccine as a routine immunoprophylaxis for girls aged 11 and 12 years, with routine catch-up vaccination for females aged 13 through 26 years. Healthcare providers who assume medical care for females aged 11 through 26 years should be routinely offering this important and safe vaccine to prevent genital warts and cervical cancer. Physicians who cannot offer the vaccine in their offices should provide their young female patients with alternate sites where they can go to receive this vaccine. Studies show that patients are much more likely to comply with a vaccination program if their healthcare provider strongly recommends it.6 
Counseling females about continued risk—albeit a clinically significant decreased risk—for anogenital dysplasias and cancers after they have received the HPV vaccine is important. Healthcare providers should emphasize these risks. Females remain at risk despite vaccination because there are more than 40 different anogenital HPV types.2,4,7 Therefore, vaccination against HPV types 16 and 18 will not offer cross-protection against most of the other HPV types. The FDA will consider new and exciting data with regard to continued high efficacy of HPV vaccination in mid-adult women (aged 27-45 years). 
The articles in this issue are aimed at educating primary care physicians so that they then may appropriately counsel and educate their patients about the risks of HPV and the benefits of vaccination. 
Jansen KU, Shaw AR. Human papillomavirus vaccines and prevention of cervical cancer. Annu Rev Med. 2004 :55:319-331.
Wiley DJ, Douglas J, Beutner K, Cox T, Fife K, Moscicki AB,et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. 2002;35(suppl 2):S210-S224.
Clifford GM, Smith JS, Aguado T, Franceschi S. Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta analysis. Br J Cancer. 2003;89:101-105.
Schiffman M, Solomon D. Findings to date from the ASCUS-LSIL Triage Study (ALTS) [review]. Arch Pathol Lab Med. 2003;127:946-949.
Fleischer AB, Parrish CA, Glenn R, Feldman SR. Condyloma acuminata (genital warts): patient demographics and treating physicians. Sex Transm Dis. 2001;28:643-647.
Fleischer AB, Parrish CA, Glenn R, Feldman SR. Condylomata acuminata (genital warts): patient demographics and treating physicians. Sex Transm Dis. . (2001). :28: 643-647.
Muñoz N, Bosch FX, De Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518-527.