Behind the Headlines: Should we protect girls from warts and cervical cancer?

Doctors have called for schoolgirls to be vaccinated against genital warts, according to news reports.

Quadrivalent HPV vaccination is supported by many doctors (Photograph: SPL)
Quadrivalent HPV vaccination is supported by many doctors (Photograph: SPL)

A British Association for Sexual Health and HIV (BASHH) survey showed support for vaccination to protect against genital warts as well as cervical cancer. The association believes this would cut NHS costs for treating genital warts and reduce the psychological burden on girls and women.

What did the survey find?
Schoolgirls are currently offered the bivalent HPV vaccine Cervarix, which protects against HPV types 16 and 18, responsible for 70 per cent of cervical cancer cases.

The quadrivalent HPV vaccine Gardasil protects against an additional two types, 6 and 11, which cause 90 per cent of genital warts and 30 per cent of cervical smear abnormalities.

In 2008, the DoH chose Cervarix for the school HPV vaccination programme, saying it represented the best value for money for the NHS. But the BASHH survey of 520 sexual health professionals showed 93 per cent would opt for Gardasil for their daughter. In addition, 61 per cent said they had paid for their daughters to receive this vaccine on top of the routine school vaccination.

BASHH plans to present the findings of its survey to parliament. Dr Keith Radcliffe, president of BASHH, said: 'If the government had purchased Gardasil back in 2008, like almost all other developed countries did at the time, today we could be well on the way to eradicating genital warts.

'Instead, over the past three years, cases of genital warts continue to consume valuable resources in our clinics.'

Why is the issue being revived?
The contract for HPV vaccine is up for review in the spring. The DoH said it will re-examine cost effectiveness, considering new data on protection against genital warts and other HPV-related cancers, as well as cervical cancer.

Peter Greenhouse, a consultant at the Bristol Sexual Health Centre and BASHH spokesman, said he hoped the DoH would revise its 'weighting of what is valuable'.

When the decision was taken to vaccinate against HPV, the joint committee on vaccination and immunisation recommended the quadrivalent vaccine be used if the two vaccines were similar in cost.

Mr Greenhouse said he believes the DoH did not give enough weighting to the prevention of genital warts when the vaccines were judged in 2008. 'Genital warts can have a huge psychological impact as they're profoundly damaging to your sexual self-esteem, but that's not the whole story.'

He said abnormal smears caused by types 6 and 11 saturate sexual health services and tie up resources for detecting HPV-related cancer.

'If we don't vaccinate against genital warts, we will get to the situation where the majority of smears will be abnormal but not cancerous. We will dilute the positive smears,' he said.

Some critics suggested vaccinating against warts would lull teenagers into a false sense of security. RCGP immunisation lead Dr George Kassianos disputed this claim calling it 'simply nonsense'.

Informing Patients
  • HPV vaccination programme protects girls aged 12 to 14 against HPV types that cause cervical cancer.
  • Doctors want the NHS to use Gardasil, which also protects against genital warts but which was deemed too costly by DoH.
  • The DoH is set to review its decision in the spring.

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