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A Teen Shot Vaccine for girls raises issue of sex By Dr. Richelle K. MarracinoPublished: February, 2007

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A Teen Shot Vaccine for girls raises issue of sex  If you are a parent of a preteen daughter, you probably have enough on your plate. As you deal with the issues of friends, cell phones, clothing and more, protecting her from someday getting a sexually transmitted disease may be the last thing on your mind.  There's a new vaccine called gardasil, given to girls typically around 11-12, to protect against genital infections caused by the human papillomavirus (HPV). Here's what you need to know.  Genital HPV infection is common. According to the Centers for Disease Control, an estimated 20 million Americans have the virus.  HPV doesn't always manifest symptoms. It is possible to have the virus and infect another person without knowing it. There is no cure for the virus. It stays in the body for life. In some people, it remains dormant, but in others it causes problems.  There are more than 100 types of HPV. The vaccine protects against four types, the two that cause cervical cancer and the two that cause genital warts.  Cervical cancer is a serious disease of the cervix, or opening of the uterus (womb). When HPV infects the lining of the cervix, it can cause abnormalities of the cells and can lead to cancer. The Pap test is performed to detect these changes and test for the virus. Although Pap tests help catch the disease early, cervical cancer affects roughly 10,000 women annually in the U.S., causing about 3,700 deaths each year.  When the virus infects the genital skin, it can cause genital warts. These appear as soft fleshy skin-colored growths. Genital warts are not associated with serious disease but they can cause irritation and discomfort. Approximately one million new cases are diagnosed each year in the U.S. In 2000, approximately 9.2 million Americans between the ages of 15 and 24 were found to have genital warts.  Although gardasil doesn't protect against all types of cervical cancer and genital warts, it is highly effective in preventing those due to the four HPV types the vaccine targets. It also protects against virus-related abnormalities of the vagina and vulva. It does not prevent against other types of sexually transmitted diseases. It will not help against HPV types a person has already been exposed to.  In order to prevent disease, the vaccine should be given before a person comes in contact with the HPV virus. It is therefore recommended for girls ages 11-12, although it can be given between the ages of 9-26.  It is a series of three shots given over a period of six months. The vaccine is safe for most girls. Side effects often include dizziness, fever, nausea, and pain at the site of the injection.  If your daughter receives the vaccine, it will still be important for her get regular Pap tests after age 21 or earlier if she becomes sexually active. If someone already has one type of HPV, the vaccine may still be helpful to protect against the other types  Some people regard gardasil as controversial, since they feel it might give teenage girls a false sense of protection against all sexually transmitted diseases, and possibly encourage promiscuity. Parents may find it awkward to think about their young daughter as someday being at risk for a sexually transmitted disease. Others may not have even broached the whole "birds-and-bees" discussion with their child, and may be caught off guard by the pediatrician offering this immunization.  But consider this: If you are a mother who has gone through the treatments for an HPV-related disease or cancer, you know how troubling and unpleasant it can be. Gardasil could do more than spare your daughter unneeded suffering. It could save her life. And it may relieve you of one thing to worry about as you go about raising your daughter. Dr. Richelle K. Marracino is a family practice physician at UC Riverside Campus Health Center. Information: 951.827.3031.

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