A 23-year-old woman with a 5-pack-year history of cigarette use wonders if she is a candidate for the quadrivalent HPV vaccine. She has been sexually active for 5 years with three partners. Her recent first pap smear was normal, but her examination revealed two nontender vaginal lesions which resemble flesh-colored cauliflower. You first educate her that quitting smoking will help her immune system fight the strain of HPV that she already has acquired.
What advice should you give her?a. She is already infected with one strain, but the vaccine will still be effective against acquiring the other three strains
Human papillomavirus (especially subtypes 16, 18, 33, and 45) has an established relationship to genital warts and cervical cancer. The current multivalent vaccines are highly effective in establishing immunity to the subtypes included in the vaccine, even if one or more of the subtypes is already acquired. It is yet to be proven how much cross-reactive protection exists to subtypes not included in the vaccine. The vaccine is not effective in treatment of any disease (ie, vaginal warts) caused from prior infection. Because over 40 sexually transmitted HPV subtypes exist and the vaccine includes the types responsible for about 70% of cervical cancer, there is still a risk of cervical dysplasia caused from other subtypes not covered in the vaccine. Therefore, continued pap screening is needed. This patient’s likelihood of clearing her current HPV infection increases with tobacco cessation.