This is a vaccine to prevent infection with the human papilloma virus, HPV. Gardasil®, by Merck, is a vaccine that protects against 4 different strains of HPV: 16 and 18 (which cause 70% of cervical cancer) and 6 and 11 (which cause 90% of genital warts cases). Similar vaccines are currently undergoing testing and may soon be available. This vaccine is given as a series of 3 shots, with the first shot preferably between 11 and 12 years of age. The 2nd dose should be given 2 months after the first dose and the 3rd dose 6 months after the 1st dose. For adult and catch-up pediatric dosing, see the CDC recommendations.

In the United States, about 11,000 women will get invasive cervical cancer in 2007. About 3,600 women will die of this disease in 2007. This vaccine will prevent most cases of cervical cancer and genital warts. It is also protective against many vaginal and vulvar cancers.

In the future this vaccine may be recommended for older unvaccinated women, pending further research. In addition, the vaccine may ultimately be recommended for boys and men, pending further research. Vaccination of men could limit overall spread of HPV and may also reduce the risks of certain oral, anal, and penile cancers.

The vaccine is given in the deltoid muscle of the arm or the upper outer thigh muscle.

Safety in pregnancy and breastfeeding has not been proven. The vaccine can cause some reactions including pain, swelling, or itching at the site of injection; also fever, nausea, or dizziness can occur. Rare serious reactions including Guillain-Barré syndrome have been reported, but it is not yet clear if the vaccine was the cause.

Individuals with prior severe reactions to this vaccine may not be able to receive another dose. There is some controversy about giving this to people with yeast allergy. Check with your doctor regarding this issue and for any other contraindications for this vaccine. Also check with your doctor to find out what other ingredients may be in the vaccine, its container, or any diluent in case of allergies or other concerns. Immunization is usually postponed for individuals with a moderate or severe acute illness.

In theory, it is best to be immunized prior to sexual activity to get optimal protection from the vaccine, but the CDC recommends that females already sexually active still get the vaccine. Individuals who have already been infected with one or more strains covered by the vaccine may get less benefit from the vaccine, but should still receive it. Immune response may not be as effective in people with immune compromise.

• Multiple sex partners
• Early age at first sexual activity
• Smoking
• Alcohol use
• Stress and other infections like herpes or HIV concurrently