An ounce of prevention

At least half of sexually active people will be infected with HPV at least once in their lifetimes. Should we vaccinate our children - both boys and girls?

By JUDY SIEGEL-ITZKOVICH
HPV prevention521 (photo credit: MCT)
HPV prevention521
(photo credit: MCT)
We are a secular couple and have three teenagers, two girls and a boy. We have seen advertisements for human papilloma virus (HPV) vaccine on TV and wondered whether it is important to vaccinate all of them – the girls to prevent them (when they eventually have sex lives) from contacting cervical cancer and the boy to protect him from infecting a girlfriend. Please tell us more about HPV, its prevention, risks and treatment. We understand that the vaccine, which is quite expensive, is not provided free by the Health Ministry or health funds but has to be purchased privately or with health fund participation. What should we do?
 – V.R., Tel Aviv
Dr. Limor Helpman of the gyneco-oncology unit of Lis Maternity Hospital at the Tel Aviv Sourasky Medical Center replies:
HPV is known as a pathogen connected to precancerous and malignant lesions of the cervix. HPV infection causes a wide variety of changes ranging from papillomas (benign epithelial tumors) on the sexual organs to actual cancer of the cervix, vulva and vagina as well as malignancies in the rectum, mouth and throat. There are 100 different strains of the virus, and 30 of them target the sexual organs.
Infection is more common than is generally thought, and at least half of sexually active people will be infected with HPV at least once in their lifetimes. Most are asymptomatic and will go away without treatment. Younger women have a better chance of overcoming the infection than older women. But some HPV infections become persistent and may cause precancerous lesions. This risk depends on mixed strains of the virus, the person’s age and immune system and environmental factors.
Pap smear biopsies are aimed at detecting changes early before they become cancerous. Each test has 60 percent accuracy, while a repeat test has 85% accuracy. Cervical cancer can result from carrying high-risk strains of HPV. The virological lab at Tel Aviv Sourasky Medical Center recently introduced a new system to examine and characterize Pap smears and conduct HPV genotyping. It can do this for up to 21 strains simultaneously. We have found that a quarter of HPV infections with high-risk infections were from sub-strains #39 and #52, which are much less known abroad. So it seems that there are different HPV strains here than those reported common in the medical literature. Our screening is aimed at early detection of precancerous lesions before they become malignant.
It usually takes several years from the time of infection until a lesion becomes cancerous. Among the treatments are cryotherapy (freezing the lesion), laser treatments or removing the lesion with the loop electrosurgical excision procedure (LEEP). The chosen treatment depends on the level of change in the cells and other data.
Recently, two protective HPV vaccines have been put onto the market by commercial companies; they have both received approval from the US Food and Drug Administration. They have both shown high effectiveness in preventing precancerous and cancerous lesions caused by a variety of strains and substrains. Such vaccinations are pioneers in the primary prevention of cervical cancer and are recommended.
As for your second question, I strongly recommend that parents of all teenage girls and boys get the vaccine, even though it is not in the basket of health services. It is highly protective and worth the money. Not only secular youth should get vaccinated but everyone in this age group.
My usual breakfast includes a few slices of whole-wheat toast. I read somewhere that toasting the bread reduces the nutritional value of the whole wheat. Is this true? Should I eat regular bread instead? – P.E., Rehovot Dorit
Adler, chief clinical dietitian of the Hadassah University Medical Center in Jerusalem’s Ein Kerem, replies: Toasting can have some influence, but to my knowledge, the effect is not dramatic. I would suggest eating bread both ways, toasted and not toasted. You might want to introduce other whole grains as well as pulses into your diet rather than just bread.
Reader R.E. comments on a dermatologist’s answer to a previous question about generalized itchiness and a rash for which prednisone was diagnosed:
My husband had a similar complaint of a recently developing generalized itchiness and rash. He went to a dermatologist who also prescribed a prednisone cream. But this merely treats the symptoms and does not address the cause. So we tried to think what might be the cause – a new allergy to our dogs, perhaps? A food or medication causing such an allergy? Then we realized that I had recently bought a bargain detergent, so we ran his clothing through the rinse cycle of the washing machine without any detergent. This brought about a real improvement; it took a second such water-only wash for complete relief. The itchiness and the rash were gone. A few days later our suspicion that the detergent was the cause of my husband’s agony was confirmed when he slept on a sheet that we had not rewashed – the itchiness returned within minutes. Now we use a mild detergent without the problem of the contact reactions.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.