19 STIs and Related Vaccination

Introduction

Sexual activity is an uncomfortable topic for many parents and caregivers, but it is crucial to talk with a child about ways to protect themselves. The Nemours Foundation (Anzilotti, 2018) recommends having puberty and sexually transmitted infections (STIs) conversations between the ages of 10-13. The discussion can occur at an older age, but should be done before a child becomes interested in sexual exploration. Common STIs spread easily, and approximately half of all new cases occur between the ages of 15 and 24 each year in the United States (Shannon et al., 2018). Adolescents are more at risk of developing an STI than adults. Reasons for this include fewer health examinations, more risky sexual behaviors, being embarrassed to talk to their health care provider and caregivers, and biological factors (Shannon et al., 2018).  In addition to teaching their children about STIs, caregivers can protect them by getting the human papillomavirus (HPV) vaccine.

What is HPV?

Human papillomavirus (HPV) is a virus that causes most cervical cancer, as well as vaginal, vulvar, anal, penile, and oropharyngeal cancers (CDC, 2021c). Oropharyngeal cancer is the most common HPV-associated cancer (Kaiser Family Foundation Women’s Health Policy, 2021). According to the Centers for Disease Control and Prevention (CDC) (2021c), “Each year in the US, about 46,143 new cases of cancer occur in parts of the body where human papillomavirus (HPV) is often found, and HPV causes about 36,500 of these cancers”. Disease transmission occurs through vaginal, oral, and anal sex with someone who is infected (CDC, 2021a). According to the American Sexual Health Association, 80% of Americans that are sexually active will become infected with HPV at some point during their lives (Johns Hopkins Medicine Newsroom, 2018). HPV infections are very common; most people will become infected between months or a few years after becoming sexually active (CDC, 2021a).  This virus is highly contagious but also preventable.

Preventing HPV

Youth are known to engage in risky behavior due to rapid physical development changes, social and family influences, and a developing brain (Balocchini et al., 2013). Both boys and girls have a higher likelihood of risky sexual behaviors, such as not using a condom or having multiple sexual partners, compared to adults (Shannon et al., 2018). However, behavior is not the only risk factor. According to Shannon et al. (2018), adolescent females have a greater chance of getting infected with an STI because they do not have as much cervical mucus to protect them. They have more cells outside their cervix than older women (known as cervical ectopy). Infection rates are estimated at 29% of females ages fourteen to nineteen and 58.7% of males aged twenty to twenty-four (Shannon et al., 2018). HPV can cause long-term consequences, and receiving the vaccine prior to becoming sexually active prevents future health problems.

The HPV vaccine helps the body make antibodies that prevent the outbreak of the disease if the person is exposed to the virus. (Mayo Clinic, 2021). There are 150 different strains of HPV, and more than 40 of these strains can cause cancer (Kaiser Family Foundation Women’s Health Policy, 2021). The current vaccines protect against the strains that cause the most common cancers. ​​HPV infections and related cancers have dropped 40% since the United States started using the vaccine in 2006 (CDC, 2021b). All HPV infections, including those that cause genital warts, have dropped 88% among teen girls, and 81% in adult women (CDC, 2021b).

Vaccine Schedule

The HPV vaccine consists of two or three shots. It is recommended that children receive their first dose between age eleven and twelve and their second dose six to 12 months after the first dose. If a child’s first dose is on or after their fifteenth birthday, they will receive three doses over six months (CDC, 2021a). It is best to get the vaccine early to build immunity and protection from the virus before exposure.

Protection from HPV

The HPV vaccine provides long-lasting protection. Research shows that protection does not decrease with time (CDC, 2021b). Some possible vaccine side effects include headaches, nausea, dizziness, fainting, pain, redness, and swelling where the shot was given (CDC, 2021b). The most common brands of the HPV vaccine are Gardasil 9, Gardasil, and Cervarix. These three vaccine brands were tested and researched by the U.S. Food and Drug Administration (FDA) for over 15 years and have proven to be safe (CDC, 2021b). Gardasil 9 covers the nine most common cancer-causing strains and was studied for safety and effectiveness in a clinical trial with more than 15,000 males and females. Gardasil’s clinical trial included more than 29,000 males and females, while Cervarix was tested on more than 30,000 females (CDC, 2021b).

According to the Centers for Disease Control and Prevention (2021b), the misbelief that the HPV vaccine causes infertility is not true. However, if an unvaccinated person has an HPV infection that requires treatment (such as radiation, a hysterectomy, or chemotherapy), infertility risk will increase due to the treatment (CDC, 2021b). Other common HPV vaccine misconceptions include vaccine safety, vaccine necessity, HPV disease knowledge, and lack of physician recommendation (John Hopkins Newsroom, 2018). Several national resources are included at the end of this chapter to increase caregiver knowledge.

Vaccine Considerations

Some parents and caregivers may feel uneasy about childhood vaccinations. If unsure, they should speak with their child’s pediatrician. However, receiving vaccinations is one of the best ways to give children protection against viruses such as HPV (Office of Infectious Disease and HIV/AIDS Policy (OIDP), 2022). MD Anderson Cancer Institute (2017) recommends treating this vaccination the same as any other vaccination. If a parent is uncomfortable talking about the vaccine because they are concerned it will promote sexual activity, Dr. Lois Ramondetta recommends to “leave sex out of the conversation if you’re not comfortable talking about it” and focusing on cancer prevention (MD Anderson Cancer Institute, 2017).

The vaccine has been proven safe and effective by The U.S. Food and Drug Administration FDA and the Advisory Committee on Immunization Practices. The FDA concluded that the benefits highly outweigh the possible minor side effects of getting vaccinated (Johns Hopkins Medicine Newsroom, 2018). The HPV vaccine is necessary for preventing HPV-related cancers, and it can prevent ninety percent of six deadly cancers (Brody, 2021).

Resources

Social media shares information that may not be evidence-based and readers should consider it with caution. Unfortunately, people are getting HPV information from social media instead of medical professionals (Osazuwa, 2021). The following organizations provide reliable information to learn more:

• VFC
  • The Vaccines for Children (VFC) program is a federal program that helps families of children under 18 receive free vaccines if the child is uninsured, eligible for Medicaid, American/Indian, or Alaskan/Indian (CDC, 2021a). Any questions or concerns about vaccines should be discussed with a healthcare provider.
• Gardasil 9
  • Gardasil 9 is a brand of the HPV vaccine. This resource provides information on the safety and effectiveness of the HPV Vaccine.
• CDC
  • CDC provides a comprehensive overview of HPV, the vaccine overview and safety, and protective sexual behaviors
• American Cancer Society
  • The American Cancer Society provides information on what cancers HPV causes.
• Kid’s Health
  • Although it can be uncomfortable and difficult for caregivers to talk to their children about STIs is a key step in preventing STIs.

References

Anziilotti, A. (2018). Talking to your kids about stds. Kidshealth. https://kidshealth.org/en/parents/stds-talk.html

Balocchini, E., Chiamenti, G., & Lamborghini, A. (2013). Adolescents: which risks for their life and health?. Journal of Preventive Medicine and Hygiene, 54(4), 191–194.

Brody, J. E., (2021). The HPV vaccine prevents cancer, but most kids don’t receive it. The New York Times. https://www.nytimes.com/2021/12/13/well/live/hpv-vaccine-children.html

Centers for Disease Control and Prevention. (2021a). HPV vaccine.  https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html

Centers for Disease Control and Prevention. (2021b). HPV Vaccine Safety. https://www.cdc.gov/hpv/parents/vaccinesafety.html

Centers for Disease Control and Prevention. (2021c). How many cancers are linked with HPV each year? https://www.cdc.gov/cancer/hpv/statistics/cases.htm#:~:text=Each%20year%20in%20the%20United,about%2036%2C500%20of%20these%20cancers.

Johns Hopkins Medicine Newsroom. (2018). The HPV vaccine: why parents really choose to refuse. https://www.hopkinsmedicine.org/news/newsroom/news-releases/the-hpv-vaccine-why-parents-really-choose-to-refuse

Kaiser Family Foundation Women’s Health Policy (2021). The HPV vaccine: Access and use in the U.S. https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/#

Mayo Clinic. (2021). HPV vaccine: who needs it, how it works. https://www.mayoclinic.org/diseases-conditions/hpv-infection/in-depth/hpv-vaccine/art-20047292

MD Anderson Cancer Institute. (2017). HPV vaccine: How to talk to your kids. https://www.mdanderson.org/publications/focused-on-health/HPV-vaccine-talk-to-your-kids.h10-1591413.html

National Cancer Institute. (2021). HPV and cancer. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer

Office of Infectious Disease and HIV/AIDS Policy (OIDP). (2022). Vaccines work. HHS.gov. https://www.hhs.gov/immunization/basics/work/index.html

Osazuwa, P.N., Rohde, R.L., Boakye, E.A. (2021). HPV vaccination is safe—you don’t have to whisper it. JAMA Network. 4(9). e2125124. doi:10.1001/jamanetworkopen.2021.25124

Shannon, C. L., & Klausner, J. D. (2018). The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Current Opinion in Pediatrics, 30(1), 137–143. https://doi.org/10.1097/MOP.0000000000000578