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Thursday, Dec. 26, 2013

Why Can't Women Over 26 Get an HPV Vaccine?

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I’m a 39-year-old female. I’ve been divorced for a few years and was in a monogamous relationship for nearly 14 years before that. Recently, I started dating a great guy who disclosed to me that he has HPV in the form of genital warts. I thought, OK, no problem, there’s a vaccine for that. Then I found out that because I’m over 26 years old, I cannot get the vaccine. I was told that because of my age, administering it to me would be “off label” and my doctor was not willing to do it. So basically, if I continue with this relationship, I can either choose to keep it sexless or knowingly risk being infected with a highly contagious virus that’s transmitted skin to skin (where condoms might not be an adequate measure to eliminate exposure). Is that correct? Is there somewhere I can go to get the vaccine off label? Other advice?

It does seem unfair, doesn’t it? If you are an older person who hasn’t had many sex partners and thus has a lower chance of having been exposed to HPV already, why can’t you get one of the two vaccines (Gardasil and Cervarix) that protect you against future infection?

Part of this has to do with how the vaccines were tested prior to being approved for use by the FDA. The pharmaceutical companies who manufacture the vaccines initially only tested their effectiveness in women up to age 26. There’s no data that proves that the vaccines are safe or effective in people over that age. Therefore, they are only approved for use by the FDA in people age 26 or younger, and any other administration of the vaccine is considered “off label.” You might be able to find another clinician who is willing to give you the vaccine, but you will probably have to pay for it out of pocket, as health insurance will not usually cover an off-label use of any pharmaceutical. Without insurance coverage, the HPV vaccine costs about $500—not cheap!

When Gardasil was first introduced, it was only approved for use in women, not men, and administering the vaccine to men was considered an “off-label” use. In 2009, Gardasil was approved for use in boys and men up to age 26. Will a similar expansion of vaccine approval ever happen for older people? I talked to Meghan Benson, director of community education at Planned Parenthood of Wisconsin, to get her take on vaccine access.

Meghan confirmed that PPWI does not offer an HPV vaccine to people over the age of 26 because no research shows that the vaccine is effective in people over that age. She doesn’t believe that approval will ever be expanded to include older people, partly because they are naturally at lower risk for HPV infection—at least for the types of HPV that can lead to cervical cancer. Why? The cells of the cervix change with age. Cervical cells in young people are much more susceptible to infection than in older people; by the time you’re 39, your cervical cells have some natural protection. In addition, most people have already been exposed to HPV and developed some immunity to the virus by the time they’re older. In your situation, where you have a low number of sexual partners in your lifetime, this might not apply, but statistically, older people have more immunity and lower levels of HPV infection, so they’re not a group that would be a priority for further vaccine research.

Meghan was not aware of any research that specifically looked at the types of HPV that cause genital warts (which are different from the types of HPV that cause cervical and other cancers). Because the types of HPV that are linked to cancer have much more serious consequences than the types that cause genital warts, most research and vaccine development has focused on those. Only one of the two HPV vaccines—Gardasil—protects against genital warts as well as cervical cancer, partly because genital warts are seen as less of a public health risk.

So, if you can’t get the vaccine but you are aware that your partner has or had genital warts, what can you do? First, I’d like to say that the fact that your partner was upfront about his HPV is awesome. There’s so much stigma and shame about disclosing the fact that one has or had an STI that I give full marks to people who have honest conversations about their status with partners. Bravo! Second, it’s important to find out how long ago he had genital warts. Most people naturally clear HPV from their bodies within a few years after being infected, so it’s possible that he is no longer contagious (although impossible to know for sure—the longer the time since he had genital warts, the less risk there is, but not NO risk). Third, if his genital warts are recent or recurring, the risk of transmission is reduced if you avoid sex during an outbreak of warts or treatment of an outbreak. And finally, although condoms don’t provide complete protection from HPV, male/external condoms do significantly reduce the risk of transmission, and female/internal condoms may provide even more protection, since the outer ring of the female/internal condom covers more of the vulva.

Almost all sexual contact carries some risk of STI transmission. You can and should take steps to reduce your risk, but it can’t be completely eliminated. Like warts that appear on other parts of the body, genital warts can be kind of annoying, but they can be treated and do not have any serious negative consequences. I think that a lot of the fear that people tend to have about HPV is because of the shame that we associate with infections that are transmitted sexually rather than because of the actual amount of physical harm that HPV usually causes. Ironically, since HPV vaccines have become available, I’ve seen a big increase in anxiety and worry around HPV, since the advertisements for the vaccines over-emphasize the negative consequences in order to encourage people to get the vaccine and thus maximize profits for the companies that manufacture them. My response to you probably raises as many questions as it answers, but ultimately, I don’t think a previous diagnosis of genital warts should keep someone away from a sexual partner who is otherwise awesome.

 

Disclaimer: Laura Ann Stuart is not a medical doctor. For questions regarding medical conditions, such as HPV, please double check with a doctor.

 

Laura Anne Stuart owns the Tool Shed, an erotic boutique on Milwaukee’s East Side. She has a master’s degree in public health and has worked as a sexuality educator for more than fifteen years. Want Laura to answer your questions in SEXPress? Send them to laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

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