No single treatment has been shown to be uniformly effective in removing warts or in preventing them from recurring. Current CDC guidelines suggest several fairly con­servative approaches to HPV management that focus on the removal of visible warts. The most widely used treatments include cryotherapy (freezing) with liquid nitrogen or cryoprobe and topical applications of podofilox, imiquimod cream, or trichloroace­tic acid. For large or persistent warts, cauterization by electric needle, vaporization by carbon dioxide laser, or surgical removal may be necessary. However, these more radi­cal treatments can cause severe side effects. Even though there is no "cure" for HPV infections, genital warts often disappear on their own without treatment (Centers for Disease Control, 2009g). Consequently, some people elect to adopt a "wait and see" approach in lieu of immediate treatment.

In June 2006 Merck & Co., developer of a vaccine against four HPV types respon­sible for the majority of genital warts and cancers associated with HPV, obtained Food and Drug Administration (FDA) approval for their product Gardasil. In the same month, the Advisory Committee of Immunization Practices, appointed by the U. S. Department of Health and Human Services, voted unanimously that females ages 11-26 should be vaccinated with Gardasil (women older than 26 were not included in clinical trials) and that the vaccine should be available to girls as young as 9. Gardasil protects vaccine recipients against HPV types 16 and 18, two "high-risk" strains associ­ated with the development of about 70% of cervical cancer cases (Centers for Disease Control, 2010d). The vaccine also blocks infection by two other strains of HPV (types 6 and 11), which are responsible for 90% of genital warts (Giuliano et al., 2011; Moon, 2011). Recent evidence also suggests that Gardasil could help reduce the incidence of oral cancer (cancer of the mouth or throat) caused by HPV, especially type 16 (Zelkow – itz, 2009). The rate of oral cancer has risen steadily since 1973, and many health experts believe that this increase is related to the transmission of HPV via oral-genital contact (Zelkowitz, 2009).

In October 2009 the FDA licensed another HPV vaccine for use in females ages 9-26—Cervarix, produced by GlaxoSmithKline. This vaccine has also proven to be an effective prevention tool (Centers for Disease Control, 2010c). The Advisory Commit­tee on Immunization Practices now recommends routine vaccination for females in the appropriate age range with either Gardasil or Cervarix.

Recently, the FDA also approved the use of Gardasil to prevent anal cancer in both males and females, ages 9-26 (Kuehn, 2011). In October 2009 the FDA licensed Gar­dasil as a tool for preventing HPV infections in males ages 9-26. A number of studies

Critical Thinking Question

have demonstrated the effectiveness of Gardasil in males without accompanying serious adverse side effects (Giuliano et al., 2011; Kim, 2011).

Mandatory HPV vaccination for youth, especially for girls, has been the target of resistance from vocal political and religious organizations that oppose providing an STI prevention vaccine to teenagers and preteens. This is yet another example of how activist groups politicize public health issues related to sexual behavior, regardless of the harmful consequences of their actions, in seeking to exert control over our sexual­ity. The opposition to an HPV vaccine is mounted by the same groups that oppose over-the-counter sale of emergency contraception and comprehensive sex education in public schools because of the erroneous assumption that denying young people access to sexuality information, health protection, and birth control will prevent them from experiencing sexual intercourse before marriage.

The arguments for and against mandatory vaccination of American youth pose issues widely debated in both professional and nonprofessional circles. These view­points are outlined in the Sex and Politics box, "Arguments Against and For Mandatory ► HPV Vaccination."

Should government agencies have the option of denying teenage women access to an HPV vaccine? Why or why not? What are the implications for society of politicizing and possibly blocking a chance to prevent cervical cancer?

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