NEW YORK NURSE: March 2010
by Cynthia Fortino, RN, BS, SUNYIT, Nancy C. Kovach, RN, SUNYIT, and Gina Myers, PhD, RN, CNR-PC
The Centers for Disease Control (CDC) consider HPV to be the most common sexually transmitted disease in the United States. Hutchinson and Klein (2008) write that human papillomavirus (HPV) infections often have few symptoms and clear up on their own, making it hard to determine their prevalence. They also report that sexually active young men and women ages 15-25 are at greatest risk of acquiring HPV and account for approximately 74% of annual infections. While most HPV infections are relatively harmless, this virus has been detected in 99.7% of cervical cancers worldwide. Currently in the United States, there are 20 million individuals infected with HPV.
New vaccines are now available to protect against HPV, but they have been met with much controversy. What should nurses tell their clients about the vaccines and safe sexual practices?
More than 100 different types of HPV have been identified and are classified by location and the type of disease caused. There are 40 known types of HPV that can infect the genital tract; 15 of which are considered high-risk for developing cancer. HPV types 16 and 18 are most common and are associated with approximately 70% of cervical cancers. HPV types 45 and 31 are the next most common and account for 10% of cases of cervical cancer.
A comprehensive review of the literature was conducted by Miksis (2008) comparing condom use and the vaccine in preventing HPV infections. This means that a number of studies on each topic were reviewed and the results summarized. Overall, the studies indicated that the effectiveness of condoms in preventing HPV was inconsistent when compared to vaccinations, yet identified good reasons to continue recommending their use. Condoms provide protection against other sexually transmitted diseases such as HIV and other strains of HPV that the vaccine does not protect against. Also, since women are currently the only ones receiving the HPV vaccine, condoms may protect men who are at risk for acquiring HPV.
HPV vaccines are a significant advancement in women’s health. When people ask your opinion as a nurse, you can tell them research shows that a combination of the HPV vaccine and condom use provides the greatest degree of protection from HPV. For patients who choose to receive the HPV vaccine, nurses must stress the importance of completing the vaccine series to ensure immunity.
For nurses, educating young clients and their parents about vaccinations requires going beyond describing the effectiveness of the vaccines. Although the HPV vaccine can offer protection against some strains of HPV, it cannot protect against them all. Emphasis should be placed on the fact that while the vaccines are one of the tools available to fight HPV infection, they do not replace the need for condoms.
It is a myth that abstinence prevents HPV infection. HPV can be transmitted via skin-to-skin contact even without penetration. Therefore condom use is still recommended as an additional protective measure against HPV exposure.
Receiving the HPV vaccine is not a replacement for regular Pap tests. It is known that certain strains of HPV can lead to cervical cancer. Although the vaccine is effective in preventing certain types of cervical cancer, it is still important to continue with routine Pap testing.
The HPV vaccine and condom use are controversial as they involve adolescents, sexual behaviors, and STDs. Due to the sensitive nature of the vaccine, it is important to convey a non-judgmental attitude when educating the adolescent and parent about the implications of the vaccine. Presenting factual information will help the parent and adolescent to make an informed decision in regards to receiving or declining the vaccine. The article by Miksis can be found in the Journal of Obstetric, Gynecologic and Neonatal Nursing.
Hutchinson, D. J., & Klein, K. C. (2008). Human papillomavirus disease and vaccines. American Journal of Health-System Pharmacists, 65, 2105-2112.
Miksis, S. (2008). A review of the evidence comparing the human papillomavirus vaccine versus condoms in the prevention of human papillomavirus infection. Journal of Obstetric, Gynecologic and Neonatal Nursing, 37, 329-337.