No doubt – the HPV vaccine (Gardasil) is the vaccine I hear the most hesitancy about. And yet I convince parents each and every day to get it – with patience, understanding, and some awesome, strong evidence that it works and is safe.

Little background: HPV (Human Papilloma Virus) is a nasty little virus that you get from other people – through intercourse, oral sex, or just heavy “making out” (yes: kissing can spread HPV).

The CDC states that at least 75% of the reproductive-age population has been exposed to HPV!

HPV lays dormant in most people, but sometimes it causes growth. Sometimes, uncontrolled growth.

Uncontrolled growth = cancer. Cancers of the cervix, vagina, anus, mouth, throat, head and neck in women and men. It also causes anogenital warts. Fun times.

HPV is one of the main reasons women get Pap smears – to see if this virus is causing trouble.

“The HPV vaccine? Isn’t that the new one? It seems like it hasn’t been out very long.”

• The first HPV vaccines were released in 2006.  That’s almost 17 years ago! 17 YEARS!
• The updated version (from the 4-strain to the 9-strain) came out in 2014. 9 years ago!
• It ain’t new! It’s been used for almost two decades and has been given safely to over 270 million people across the world!

“Isn’t this a little early to get a vaccine for something that’s transmitted through sex? My kids aren’t having sex.”

• The vaccine works BETTER when you are YOUNGER. Your immune system is SMARTER when you’re younger, and holds onto the “information” for longer periods of time!
• As evidence of this, you only need two shots if you get the series before age 15. After age 15, you need three shots.
• It is devastating to think about – but why not protect our kids from things that are out of our (and their) control as well? What if something happened to them, like sexual abuse?

“Are there any bad side effects or reactions to this vaccine?”

• In my 12 years of practice as a general pediatrician, I have never seen a severe reaction to an HPV vaccine.
• A sore arm, dizziness, and fainting can be common 15 minutes following the vaccine, so we often will watch them in the office for a while after they get the shot.

“Does it work?”

• Heck yes, it does. Like, really well. Better than most vaccines, actually.
• The longest studies done on these vaccines are at 10+ years, and they seem to be between 90-97% effective at preventing these cancers and warts.
• There is evidence nearly 99.9% of people who get the shot create some form of antibody to the virus.

“Why should boys get this vaccine?”

• Boys give HPV to girls. And vice versa.
• Boys can get anal cancer, anogenital warts, oral cancer, and throat cancer from this virus.

“Why should I believe you about all this? The internet says I shouldn’t get this vaccine.”

You don’t have to believe me. Though I am a pediatrician who has given thousands of HPV vaccines in my practice.  It’s OK. I know some vaccines just seem plain ole scary.

Maybe believe my cousin, though? She’s a cancer doctor. A gynecologic oncologist, to be exact. And what virus does she spend all day battling in order to save the lives of women? HPV.

My cousin is Mae Zakhour, and she practices gynecologic oncology at Spectrum Health Medical Center in Grand Rapids, MI. She treats HPV cancers in women, daily - some as young as 25!

Her exact words to me – to share with you – are:

“Timely HPV vaccination is the safest and most effective way to prevent cervical cancer and other HPV-related diseases. As a gynecologic oncologist, I see and treat young women with cervical cancer on a weekly basis, and even for those in whom cure is a possibility, it comes with a cost.

The treatment for cervical cancer, > 95% of which are caused by HPV, can have devastating effects on a woman’s fertility and quality of life. I want to do everything possible to prevent that for my children. They are getting the HPV vaccine.”

So there you have it. Two moms, who also happen to be doctors, sharing information with you to help you make a very important decision for your child.

And both letting you know we’re getting our kids vaccinated for HPV at age 9 without hesitation!

It’s normal to be nervous about vaccines. What I hope you take from this is more confidence in the HPV vaccine - by knowing it’s super safe, it’s been out a long time, it’s super effective, and it’s super important.

RELATED: New Study Says Boys Less Likely to be offered HPV vaccination (checkupnewsroom.com)

Vaccine and Immunization (cookchildrens.org)

‘We Have a Vaccine That Can Prevent Cancer' (checkupnewsroom.com)

Texas Ranks Near Last in HPV Vaccination Rate (checkupnewsroom.com)

They can be very ugly. They can cause pain if they’re in a tough spot. They can last forever.

Because of this, I’ve seen families try just about anything and everything to treat them.

But what actually works?

Many warts will go away on their own over time. Studies have shown about 80% of warts are gone after four years … but sometimes we can’t wait that long, especially when it’s your child in pain.

Here’s a look at some of the alternative and conventional treatment options for treating warts, along with my thoughts on if they are worth your time:

1. Apple cider vinegar – There are limited studies that show mixed results for using apple cider vinegar. It can be very irritating to the skin for some children. It’s OK to try but I wouldn’t get my hopes up.
2. Salicylic acid – Yes, this is a cream typically used for acne, but salicylic acid has been shown in some studies to effectively treat warts. The skin irritation associated is common and expected, but it has a better chance of working than apple cider vinegar…so it might be worth it.
3. Tea tree oil – While tea tree oil has been studied (and actually works for a few pediatric skin issues), warts are not one of them.
4. Crushing aspirin or Vitamin C and applying – No on these as well. No evidence that they are effective and it sounds like a lot of work.
5. Aloe vera – While unlikely to cause any problems, aloe vera is not effective treatment.
6. Duct tape – One small study showed that covering a wart with duct tape led to resolution of the wart. Later studies were done which showed it didn’t work, but the researchers used clear tape instead of silver duct tape. So, right now we’re in a sticky situation (sorry) where we don’t know if it works or not. I would use the silver if I wanted to try it. It has been suggested to combine it with the salicylic acid treatment.
7. Freezing – The most standard treatment is freezing. Freezing works well, but might require retreatment after a few weeks if it doesn’t completely go away. Freezing can be difficult for warts on the feet or hands because the underlying nerves can be damaged.
8. Surgical removal – If all else fails, a physician can provide local anesthesia and remove the warts.

So there are lots of alternatives to try, but a conversation with your pediatrician is a great place to start. From there, you may be referred to our Dermatology team or to Pediatric Surgery. 

But for the most part, the best weapon against warts is patience.

Related To This Topic:

• Plantar Warts
• Molluscum Contagiosum: The Most Common Rash You Never Knew About
• 7 Skin Conditions Young Athletes Need To Know About
• 5 Common Medical Conditions That No One Shares On Instagram

No topic triggers as much controversy on our social media sites or Checkup Newsroom as vaccines. When it comes to the HPV vaccine, people are especially passionate.

You may have seen the comments on Cook Children’s Facebook page after we announced an upcoming Facebook Live event. “Take The Shot. Prevent Cancer. A Conversation About HPV” will feature experts from Cook Children’s and Baylor Scott & White at 1:30 p.m. CST on Thursday, April 12.

We know there is a small but aggressively vocal group of people who have made their mind up on this issue. No amount of science will sway their firm stance against vaccines.

However, we feel it’s important as a health care organization to provide facts for our readers. That’s why we are taking this opportunity to discuss some of the arguments against the HPV vaccine and debunk many of the myths being spread on the Internet.

Myth 1: The HPV Vaccine is New

The United States currently has the safest, most effective vaccine supply in history. Years of testing are required by law to ensure the safety of vaccines before they are made available for use in the United States. This process can take 10 years or longer. Once a vaccine is in use, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) monitor any possible side effects (adverse events) through the Vaccine Adverse Event Reporting System and other vaccine safety systems.

The HPV vaccine – Gardasil^® 9 – went through years of extensive safety testing before they were licensed by FDA. Tens of thousands of people participated in studies for the HPV vaccines. No serious safety concerns were identified in these clinical trials. FDA only licenses a vaccine if it is safe, effective and the benefits outweigh the risks. CDC and FDA continue to monitor HPV vaccines to make sure they are safe and beneficial for the public.

Click here to learn more.

Myth 2: The HPV Vaccine Causes Side Effects

While no vaccine or medicine is completely without risk, the Centers for Disease Control and Prevention (CDC) & the Food and Drug Administration (FDA) review all safety info on HPV vaccines. Most reported adverse events following HPV vaccination are considered minor. Pain at injection site, headache, nausea, fever & fainting are the most common adverse events after HPV vaccination. Fainting occurs in some people because the vaccine stings a little more when it is given. Keeping vaccine recipients in a seated position for 15 minutes after the injection prevents fainting episodes. Click to learn more.

Approximately 79 million doses of HPV vaccine have been distributed since the vaccine was introduced, and no serious side effects have been linked to HPV vaccination. The most common side effects after HPV vaccine are mild and include pain in the arm where the shot was given, fever, dizziness, and nausea. For more information, click here.

Myth 3: The HPV Vaccine Could Cause Fertility Problems For My Child

Currently, there no legitimate data or any evidence that suggest getting the HPV vaccine will have an effect on future fertility for women. In fact, getting vaccinated and protecting against HPV-related cancers can help women and families have healthy pregnancies and healthy babies.

Not getting HPV vaccine leaves people vulnerable to HPV infection and related cancers. Treatments for cancers and precancers might include surgery, chemotherapy, and/or radiation, which might cause pregnancy complications or leave someone unable to have children. Click here to learn more.

Myth 4: A Child 11 Or 12 Years Old Is Too Young To Receive The Vaccine

For HPV vaccine to be most effective, the series should be given prior to exposure to HPV. Most of our kids (80 percent) will become infected with the types of HPV that can cause cancer unless they get vaccinated. Waiting increases the chance that they will become infected before the vaccine can protect them. Click to learn more.

Like all vaccines, we want to give HPV vaccine earlier rather than later. If you wait, your child may need three shots instead of two. More information on this topic can be found here.

Myth 5: HPV Vaccination Gives My Child Permission to Be Promiscuous

Research actually shows the opposite. According to a study published by the American Academy of Pediatrics (AAP), HPV vaccination among 11 to 12 year olds did not increase sexual activity-related outcomes such as pregnancy, STD infection or testing or contraceptive counseling. Click here to read the study.

Studies tell us that getting the HPV vaccine doesn’t make kids more likely to start having sex. However, HPV is a very common infection in women and men that can cause cancer. Starting the vaccine series today will help protect your child from the cancers and diseases caused by HPV as an adult. Intimate contact that is short of intercourse (making out) is sufficient to transmit HPV. Click to learn more.

Myth 7: I Heard The Shot Causes HPV

The HPV vaccine does not cause HPV infection or cancer. The HPV vaccine is made from one protein from the virus, and is not infectious, meaning that it cannot cause HPV infection or cancer. Not receiving HPV vaccine at the recommended ages can leave one vulnerable to cancers caused by HPV. Click here to read about the science behind this statement.

Myth 8: The HPV Vaccine Is Too Expensive

Are you interested in getting HPV vaccine for your child but concerned about the cost? The Vaccines for Children (VFC) Program may be able to help. VFC provides vaccines for children ages 18 years and younger, who are uninsured, Medicaid-eligible, American Indian or Alaska Native. Learn more by clicking here.

Myth 9: The HPV Vaccine Damages Women’s Ovaries

The CDC is aware of public concern about the safety of HPV vaccine. Since the vaccine’s introduction in 2006, vaccine safety monitoring and studies conducted by the CDC, FDA and other organizations have documented a reassuring, excellent safety record. There is no current evidence that HPV vaccines cause reproductive problems in women.

Myth 10: The HPV Vaccine Contains Dangerous Amounts of Aluminum

Small amounts of aluminum have been used safely in vaccines for more than 70 years. It’s added to help the body build stronger immunity against the germ in the vaccine. Aluminum is one of the most common metals found in nature and is present in air, food and water. The amount of aluminum present in vaccines is low and is regulated by the U.S. Food and Drug Administration (FDA).

Aluminum is present in U.S. childhood vaccines that prevent hepatitis A, hepatitis B, diphtheria-tetanus-pertussis (DTaP, Tdap), Haemophilus influenzae type b (Hib), human papillomavirus (HPV) and pneumococcus infection. Click here to learn more.

Myth 11: The HPV Vaccine Doesn’t Really Prevent Cancer

Every year, more than 30,000 people in the US are diagnosed with a cancer caused by HPV. That’s one case every 20 minutes.

More Articles On HPV:

• New Study Says Boys Less Likely to be offered HPV vaccination
• ‘We Have a Vaccine That Can Prevent Cancer'
• Texas Ranks Near Last in HPV Vaccination Rate
• Study Finds 1 in 9 Males Infected with Oral HPV
• Pediatrician Leads New Initiative To Improve HPV Vaccination Rates
• Protection From HPV Now Easier For Kids
• Early Evidence Shows HPV Is Working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• What's New With the HPV vaccine?

A new study shows that health providers are less likely to offer the Human papillomavirus (HPV)

The research was presented at the Annual Meeting of the Society of Gynecologic Oncology in New Orleans on March 24 and was taken from NIS-Teen, a national survey which collects data from parents to adolescents aged 13 to 17 years old to track vaccination rates in the United States.

ABC News reports the most recent statistics from 2016 show about 65 percent of girls had started the HPV course, only 56 percent of boys had.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women. Boys are especially vulnerable to throat cancer.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Jason Terk, M.D., a pediatrician at Cook Children’s, says vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it. And, physicians may not provide a definitive endorsement of the HPV vaccine because they incorrectly believe they will meet resistance from the parents of their teen patients.

Dr. Terk has taken steps to improve the HPV rates among Cook Children’s 27 primary care practices by providing educational sessions showing how pediatricians can improve their vaccination rates

Dr. Terk has received national attention for calling HPV vaccination rates an “epic fail.”

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

Girls had a head start on HPV vaccinations. The vaccine was approved by the FDA for use in girls in 2006 and for boys three years later. 

The study shows that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine. Dr. Terk said that's one of the reasons why boys are lagging behind girls in HPV vaccine rates. He also said there's a public consciousness about HPV causing cervical cancer, but many people aren't generally aware or understand that HPV vaccination is just as important for males. He said that many haven't connected the increase in head and neck cancer is caused largely due to HPV infection.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends."

So why aren’t more people getting this vaccine?

According to NPR, a new analysis from the Blue Cross Blue Shield Association found only 29 percent of the teens its members insure receive a first dose of the human papillomavirus (HPV) vaccine by their 13^th birthday. The CDC found that nationally only 43 percent of teens are up-to-date on all the recommended doses of the vaccine.

Another recent study found that Texas ranks 47^th in the cancer-preventing vaccine. Out of the 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage.

“A simple vaccination can mean the difference between getting a deadly cancer or not. Unfortunately, not enough people are getting the importance of this message,” said Jason V. Terk, a Cook Children’s pediatrician.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

Teens and younger adults who start the series later, at ages 15 through 26 years, will need three doses of HPV vaccine to protect against cancer-causing HPV infection.

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives. HPV is the most common sexually transmitted virus in the United States. Most sexually active people will have genital HPV at some time in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

Dr. Terk wonders if there’s a disconnect when parents think about their child receiving the HPV vaccination.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

More Resources:

• Vaccines and Immunizations
• HPV Vaccines: Vaccinating Your Preteen or Teen
• What is HPV?
• HPV Questions and Answers
• CDC approves 2-dose HPV vaccine schedule

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

The study, published in the journal of Annals of Internal Medicine, states 11 million (one in nine) U.S. males were found to have oral HPV. The research was done between the years 2011 and 2014.

While most people with HPV don’t develop symptoms or health problems, the Centers for Disease Control and Prevention (CDC) says HPV causes 30,700 cancers in men and women, inlcuding 6,479 cancers of the back of throat, including the base of the tongue and tonsils in both men and women.

Jason Terk, M.D., a Cook Children's pediatrician in Keller, says vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The recent studies show that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"Only 34 percent of adolescents in the U.S. have received the HPV vaccine series. Here in Texas, that number drops to 33 percent," said Jason Terk, M.D., a pediatrician at Cook Children’s. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Jason Terk, M.D., a pediatrician at Cook Children’s, has received national attention for calling HPV vaccination rates an “epic fail.” Now, he’s steering a plan to improve HPV vaccination rates for pediatricians in each of Cook Children’s 27 primary care practices.

Using the reporting capability of the electronic medical record at Cook, Dr. Terk will calculate the HPV vaccination rate of each primary care pediatrician’s and practice’s 12-14 year old patients. Then, half of those pediatricians and practices will be given an educational session showing how they can improve their vaccination rates while the other half will serve as a control group.

The goal is to get more patients between the ages of 12 and 14 vaccinated against HPV.

“We will help lay out an action plan for the practices and set a goal of increasing vaccination rates by 10 percent over six months,” Dr. Terk said.

The physicians will then be given a progress report after 3 months.

“We will compare the vaccination rates between the group who received the educational sessions and those that did not both at 3 months and 6 months to measure the effectiveness of the educational sessions and action plan,” Dr. Terk said. “If the process improves vaccination rates, we will spread the education throughout the system with the goal of providing the best care for all of our patients.”

Vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it. And, physicians may not provide an unequivocally affirmative endorsement of the HPV vaccine because they erroneously believe they will meet resistance from the parents of their teen patients.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The study shows that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

New recommendations from the Centers for Disease Control and Prevention (CDC) requires only two doses of the vaccine spread over six months for younger teens 11-14 years of age. The Advisory Committee on Immunization Practices (ACIP), the body that formulates recommendations on how the vaccines which are licensed by the FDA should be used in this country, voted for the change.

The ACIP says older teens and young adults, ages 15 to 26, will still need three doses because they don’t have as robust a response as younger teens.

“This is good news because it will mean that more younger teens can be considered fully vaccinated if they complete their series of two doses over six months prior to their 15th birthday,” said Jason V. Terk, a Cook Children’s pediatrician in Keller and someone who has been at the forefront of HPV vaccination efforts. “Fewer doses means better compliance with this important cancer-preventing vaccine.”

Under the new schedule, the first of two doses of the HPV vaccine should be administered at 11 or 12, although it could be given as early as 9, as under the previous guidance. The second dose would be administered six to 12 months after the first dose.

According to the CDC, about 80 million Americans are infected with HPV; in most cases, the immune system clears the infection. Still, more than 38,000 cases of HPV-associated cancers occur in the United States every year.

Related Articles

• Early evidence HPV vaccine is working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• 'Epic fail
• Cook Children's Keller Clinic
• What is unique about pediatric leadership?

About the Source

Jason Terk, M.D., is a Cook Children's pediatrician in Keller. He earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

Trust me, you don’t want to get advice about sex or STDs from teenagers.

Here are some frequently asked questions:

1. Do kids even get STDs?

Yes. About 10 million new cases of STDs are diagnosed each year between the ages of 15 and 24.

2. How will I know if my boyfriend/girlfriend has an STD?

Many STDs don't have obvious symptoms and many teenagers are ashamed to or do not want to talk about it. Because of this, you will never know for sure if your partner has an STD.

3. How serious are STDs?

Identifying and treating STDs is very important. Some like gonorrhea and chlamydia can start with small symptoms but get worse and cause severe, life-threatening infections. Others, like HIV, may not show symptoms at all but can lead to serious health complications later.

4. Are all STDs treatable?

Some STDs go away after treatment but not all. HIV can lead to AIDS which is a life-long condition with severe consequences. Herpes can cause recurrent outbreaks of sores on the genitals which can come back again and again. Human papilloma virus (HPV) causes genital warts which can lead to cervical cancer (in girls) and penile cancer (in boys).

5. Do you just get STDs from sex, or from other stuff too?

You can get an STD from vaginal sex but that’s not the only way.

Oral sex can also transmit most of the infections. A person can get gonorrhea or chlamydia of the throat. HPV and herpes can also be transmitted via oral sex.

HPV and herpes are also contagious via skin to skin contact so even touching another’s genitals can transmit these infections.

If you are a teen reading things, there's a lot more you can learn about STDs. If you have other questions, ask your doctor or talk to a parent. Mom and dad, if you are reading this, please be available to talk to your child.

In a study that was released early online from the journal Pediatrics, researchers looked at the percentage of girls aged 14-19 years were infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2003-2006 and compared that to the percentage of 14-19 year old girls infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2009-2012.

They found that the rate of infection in the years prior to routine vaccination in this group of girls was 11.5 percent. That percentage dropped to 4.3 percent in the years following routine recommendation of a vaccine. This is a rather remarkable finding given the relatively small numbers of girls who had received the full 3-dose series of the HPV vaccine.

It further illustrates how well this vaccine protects against such an important infection that can cause cancer in later years. This evidence of early success will likely lead to even more important measures of success with decreased numbers of women having abnormal pap smears that indicate cervical dysplasia and ultimately decreased numbers of cancers.

Imagine how much better it will be when we improve the numbers of teens getting this important vaccine!

Jason V. Terk, M.D.

According to researchers at Albert Einstein College of Medicine in New York, HPV raises the chances someone will get head and neck cancer by at least sevenfold.

For their study, 96,000 people took a mouthwash test for oral HPV infection. Four years later, 132 of them developed some form of head and neck cancer. People infected with a strain called HPV-16 were between two and 22 times as likely to be in the cancer group.

"This study backs up knowledge we already have about how common HPV is and how significant its association with cancer is," said Jason Terk, M.D., a pediatrician at Cook Children's primary care location on Keller Parkway. "HPV is an infectious disease and we all need to be concerned."

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

But there is good news. HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9. And a new version of HPV vaccine, approved earlier this year, has even more cancer protection.

"Only 39 percent of adolescents in the U.S. have received the HPV vaccine. Here in Texas, that number drops to 33 percent," said Dr. Terk. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Some parents may feel uncomfortable talking to their children about the HPV vaccine. For those parents, here's Dr. Terk's advice:

• Explain that the vaccine protects against a very common infection that causes cancer

• · Most people (80%) will get infected with the types of HPV that can cause cancer

• · HPV vaccination equals cancer protection

• · It is best to get the vaccine at 11-12 years of age with the other adolescent vaccine; it works best at this age.

Also good to remember, research shows that youth who receive the HPV vaccine are not more likely to have sex. 

About the Source 

Jason Terk, M.D., earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!

Human papilloma virus is a cause of warts that affect the genital areas of males and females. They can also cause infection of the mouth and throat.

HPV is the most common sexually transmitted disease in the United States.

HPV does not show symptoms for many people who are infected but it can lead to cancer of the cervix or penis. Every year approximately 17,500 women and 9,300 men will be affected by cancers that are caused by HPV.

HPV Vaccination

Fortunately, we now have a vaccine that prevents HPV. It was licensed for use in 2006 and targets four strains of the virus: 6, 11, 16 and 18. Types 6 and 11 account for 90 percent of genital warts and types 16 and 18 lead to cervical cancer.

Any time something is “new,” rumors abound. I was privy to an online discussion about HPV on Facebook this week ... because it’s not the best venue for having these discussions I had to hold my fingers (tongue).

But, here are some of the myths I saw that I felt needed to be addressed, beginning with the HPV vaccine has been proven ineffective.This myth takes on a few different forms. I’ll address each one.

HPV Vaccine Myths

1. Myth: The HPV vaccine does not decrease the amount of HPV disease.

Truth: In the United States, the percentage of cases of HPV caused by those strains in the vaccine dropped by 56 percent after the introduction of the vaccine. Other studies in the UK and Australia showed decreases in the number of HPV cases after introduction of the vaccine. The vaccine prevents HPV disease.

2. Myth: The effectiveness of the vaccine wears off over time.

Truth: This study in Pediatrics showed that, at the end of eight years of surveillance, those who received the vaccine continued to have antibodies to the virus. There is no indication that will decrease over time but studies continue. Even if we found a fall-off, a booster could be used to prolong coverage and if we could get protection for any period of time it would decrease the rates of HPV and cervical cancer.

3. Myth: Even if it prevents HPV, the vaccination has never been shown to prevent cancer so why get it?

Truth: Despite the logical conclusion that decreasing HPV infection rates should decrease the rate of cervical cancer, some challenge the HPV vaccine by saying that it has never been shown to decrease the rate of cervical cancer. This study in Denmark showed a 40 percent decrease in atypical cells found on Pap smears (a precursor to cervical cancer). I believe that more studies like this will show even more proof that it is preventing cancer.

4. Myth: The HPV vaccine is not safe.

Truth: This is perhaps the most pervasive of all the different myths about HPV vaccine. News reports and anecdotal stories of teenagers who have received the vaccine and then experience weird, otherwise unexplainable symptoms can be quite compelling. The problem with relying on those stories is that, even before the HPV vaccine, teenagers had events or health outcomes that were unexplainable. Even those who choose not to be vaccinated today have some of the same symptoms. Wouldn’t it be nice if we had some way to determine if these events were caused by the vaccine or were merely coincidental?

Fortunately, we do. If we look at a large population of teenagers who received the vaccine and compare them to another population who did not, we can see if the vaccine increased the risk for bad outcomes or if there were events that would have occurred anyway.

Multiple studies have done this. One of my favorites is one that included almost 200,000 girls who received one or more doses of HPV vaccine. It showed a slight increase in passing out after the shot (we ask girls to sit for a while after receiving it) and skin infection, but no other increase health risks. Another included almost 1 million and showed no increase in autoimmune, neurologic or blood clotting disorders.

I am not concerned about the safety of these vaccines. I understand that, with anything new, parents are going to have concerns but as more and more data come in, the safety of HPV vaccine is confirmed. My kids will get it when they are the right age.

5. Myth: The HPV vaccine allows or causes teenagers to be promiscuous. (Related: We shouldn’t vaccinate because it protects promiscuous kids.)

Truth: This is the most infuriating myth for me regarding the HPV vaccination debate. It angers me because it preys upon the fear of some parents that their child might take sexual risk as a result of something the parents have done. If that is a concern, it might be justifiable if it were true ... BUT it’s not.

Studies have shown that girls who receive the vaccine are no more likely to engage in risky sexual behavior or to have more sexually transmitted diseases. Using that myth to scare other parents is inappropriate, just stop.

6. Myth: Because I’ve raised my child “right,” they won’t be at risk for HPV.

Truth: What? This line of thinking has so many holes.

First of all, you won’t always know about your child’s activities. Trust me, you won’t always know. You may think you know, but I’ve diagnosed a pregnancy in more than one girl who “never had sex.” Stuff happens.

Protect your child even if you’re sure they’d never have sex or won’t until they meet “the one.” Why? You can’t predict you child’s future partner’s sexual behavior. Maybe your children will grow up, meet the partner of their dreams and only have sex with that person for their whole life. But, maybe their partner’s history isn’t the same. Their partner could carry HPV, could give it to your child and leave them at risk for cervical or penile cancer. Why risk it? By withholding the shot, you are only putting your child at risk.

These are some of the common myths I’ve heard about HPV. I’m sure there are many more out there. But I urge you to go in with an open mind and talk with your doctor about your questions or concerns. We’d be happy to help!