How should I counsel a young woman with a history of cervical dysplasia about the Gardasil vaccine?—STEPHANIE PADILLA, MN, RNC, ARNP, Seattle
If the patient in question is age 26 years or younger, she is still a good candidate for Gardasil or another FDA-approved human papillomavirus (HPV) vaccine. Though the optimal time for starting HPV vaccination is prior to the initiation of sexual activity—and Gardasil is labeled for administration as early as age nine years in both girls and boys—all young people can still benefit from vaccination. A patient with a history of cervical dysplasia has undoubtedly already been exposed to HPV, but expert opinion would still recommend initiating the vaccination series as soon as possible to help reduce the chance of contracting another strain of the virus.
Gardasil protects against four types of HPV—two implicated in approximately 75% of cervical cancer cases and two responsible for about 90% of genital warts. Exposure to HPV may not provide lifetime immunity even against the strain encountered, which also strengthens the argument for vaccination. Unfortunately, HPV vaccination will not affect this patient’s current case of dysplasia, and Pap tests (and other diagnostic tests as indicated) should continue in accordance with institutional protocols and guidelines from the American Congress of Obstetricians and Gynecologists. For more information, see Hum Vaccin. 2009;5:696-704.—Lisa Stern, APRN (139-9)