Introduction
Human Papilloma Virus (HPV) has been termed as the highest sexually transmitted infection in America. The HPV virus has an asymptomatic nature which makes it easy to go undetected. The virus has a high potential of causing cancer specifically cervical and genital warts. The teenage population is of concern because it is a sexually active group, has multiple sexual partners and engages in unsafe sexual practices which increase the risks of infection. The high prevalence rates and the mortality rates associated with HPV have increased concerns for early detection, treatment and prevention with vaccination. This and the fact that some of the vaccines have raised concern about their effects on health among the teenagers warrant more research and evaluation. The focus thus is more geared on the actual process of HPV, that is, the diagnosis, detection, treatment, vaccination and treatment of the virus. It is worth noting that since the diagnosis, detection, treatment, vaccination and treatment of the HPV virus affects the government, it is necessary to evaluate its efforts and ethical concerns together with the proposed strategies and solutions as well as the objectives of Healthy People 2010.
Diagnosis, Detection and Prevention
The asymptomatic nature of HPV has made it difficult to diagnose and detect it. This is worsened by the unlikelihood of teenagers coming out to express the problems they could be experiencing since it is usually sexually related (Krishnan, 2008). The common method of diagnosing HPV is the Pap test which is done on young teenage girls after three years of being sexually active. The HPV testing normally follows the Pap test and is usually done on the DNA to ascertain the type of HPV (Garland & Tabrizi, 2006).
The diagnosis and detection of HPV have been made easier by advancements in technology. Initially, the methods used for detecting HPV were direct probe hybridization with examples of southern blot and dot blot which were less sensitive, time consuming and labor intensive and required great amounts of DNA for detection (Garland & Tabrizi, 2006). The main methods for detection of HPV are Hybrid capture 2 and Polymerase chain reaction (PCR). The PCR has the amplification assay capability of increasing the HPV sequences that are present in biological specimens. Although the reagents for the HPV are not standardized, the micro array systems and linear array assay are used due to their ability to allow the detection of multiple types of HPV. The types of HPV range from the low risks of HPV 6 to 11 to high risk of HPV 16 at which cancer risks are usually very high.
The diagnosis and detection of HPV among teenagers elicits different opinions. Some argue that there is no need of testing for HPV among teenagers. The American College of Obstetricians and Gynecologists (2010) asserts that “most adolescent girls should wait until they turn 21 to have their first Pap test, but those who have HIV and others with weakened immune systems should begin routine cervical cancer screening right away” (p. 3). On the other hand, some experts assert that teenagers are sexually active and should be tested since their risks of HPV infection are very high. It is worth noting that HPV testing is common for young girls unlike boys since no standardized test has been agreed upon for men. However, the manifestation of HPV among men is most commonly recognized through warts.
Vaccination and Prevention of HPV and Cervical Cancer
The main vaccines are Gardasil and Cervarix which are suited for females aged between 9 and 26 and males aged between 9 and 18 years. The Gardasil vaccine has the ability of protecting against HPV types 6, 11, 16 and 18, while Cervarix protects against HPV types 16 and 18. The wide scope of Gardasil makes it more common than Cervarix. The Food and Drug Administration has had developments for approving preventive vaccines against HPV among teenagers and young adults (Rodriguez, 2010). Deresinski (2007) asserts that this vaccine should be given more to young girls aged between 11 and 12 years who have not received the first vaccination. He however argues that the vaccine benefits the sexually active teenagers who are not already infected as compared to those infected while the administration of the vaccine does not require HPV testing.
Vaccination against HPV is faced with different challenges that limit its effectiveness. These challenges include the lack of knowledge, nature of the disease, societal myths, socio-economic status, religious factors and beliefs as well as parental attitudes and beliefs and the awareness of the health care provider (Rodriguez, 2010). These challenges do influence the different opinions surrounding the virus. Some controversies surround the vaccination and nature of HPV infection. For instance, the American College of Obstetricians and Gynecologists (2010) argues that “there is no point in testing for HPV because it is so common among teens and 90% of HPV infections are naturally resolved by the immune system within two years,” (p. 4). The ACOG has this opinion since to them; the immune system of teenagers develops to be able to overcome the virus. They assert the vaccine has some negative impacts especially on young girls while making the vaccination mandatory would breed more rebellion. However, Rodriguez (2010) differs in this and asserts that “the establishment of mandatory school-based vaccination programs is one solution to the problem of compliance, however, time for implementation will be required and the success of the program will depend on public acceptance” (p. 6). Overall, the lack of mandatory vaccination would be effective as compared to mandatory vaccination due to the nature of the virus, societal perceptions, and negative effects on the teenagers as well as the psychological impact. However, necessary medication has to be encouraged to the teenagers including vaccination.
Government Concern and Ethical Concerns
The concern of the government is evident in the recommendation of the FDA for the vaccines for HPV while ensuring that the burden of HPV infection is reduced (Mayeaux, 2008). Further, this concern is made possible through enhanced health delivery systems and insurance while some states have adopted mandatory vaccine programs to ensure prevention of HPV (Rodriguez, 2010). The concerns of the government on the HPV virus, is influenced by the ethical issues surrounding the virus which limit the willingness of society to address it. Since the prevalence rates are high and its negative effects due to the relation with cancer related infections, the government then comes in to provide necessary measures for dealing with the HPV virus. The ethical issues in the HPV infection especially as affecting adolescents are evident in their myths surrounding it, the sexual nature of the infection and the religious beliefs (Rodriguez, 2010). The concerns are on the safety of the vaccine as well as the fact that it would make the adolescents be more sexually promiscuous.
Healthy People 2010 Objectives in Relation to HPV and Cervical Cancer
The Healthy People 2010 objective regarding the HPV infection is related to the aspect of vaccination of teenagers especially girls. This is also related to the objective of increasing the awareness of the virus among the teenagers. The objective targets at increasing the vaccination percentage coverage to 90% of the adolescent girls. The other objective is the developing of a vaccine that can prevent against all the types of HPV to ensure maximum protection to the teenagers. The Healthy people also have an objective of increasing the screening of cervical cancer and HPV especially among the teenage population (Hitt, 2010). The other objective is also on encouraging positive sexual behavior among the teenage population focusing on those who have never had a sexual intercourse to 56%, to those who were sexually experienced but not sexually active to 30% and to the sexually active to 65% with specific focus on grades 9 to 12 teenagers (Hitt, 2010). The other objective on the prevention of HPV is the encouragement of the increase in the use of condoms among the teenage population. Further, the Healthy People 2010 has an objective to increase the numbers of women and teenage girls that undergo a pap test. The other objective is reducing the proportion of the teenage population with HPV infection through minimizing the number of cases reported especially the risky types of HPV that are linked to causing cancer related infections specifically cervical cancer.
Strategies and Solutions to HPV and Cervical Cancer
The strategies on HPV infection are more focused on increasing the rates of vaccination and awareness and knowledge on the infection. Vaccination has to be encouraged to the teenagers with concerns for improving their health. Further, as Saslow (2007) argues, there is need for more research to ensure standardization of vaccines and diagnosis and detection. This is because the lack of standardized vaccines, diagnosis and detection increases the fears for safety as well as makes the understanding of the HPV virus difficult. He further points to the need for more education on HPV to be given to the adolescents, their parents, policy makers and providers of health regarding prevention, early detection and regular screening of HPV infection (Saslow, 2007). This education is necessary to ensure that they are aware of the virus. It is also necessary to address the controversies surrounding the HPV vaccination. This is because when medical practitioners differ on the necessity of vaccination, the implementation is quite limited. Further more strategies are on enhancing the support of the government in dealing with the HPV virus. This can be done through funding of research and set of effective measures of dealing with the virus. It is also important to encourage openness in addressing sexual behavior and myths surrounding it and also encouraging teenagers to be responsible in their sexual behaviors.
Conclusion
HPV infection has a high prevalence rate. There is a need for action to be taken for the protection of adolescents who are at high risk of infection. It is necessary to have effective measures for ensuring that the myths surrounding the infection are replaced with knowledge and awareness while the controversies are handled.
Reference List
American College of Obstetricians and Gynecologists (2010). Exceptions for Pap Screening in Adolescents: HPV Testing not recommended. Web.
Deresinski, S. (2007). Advisory Committee on Immunization Practices issues guidelines for Gardasil, HPV Vaccine. Infectious Disease Alert, 26(7), 75-78.
Garland, S., & Tabrizi, S. (2006). Methods of HPV Detection: Polymerase Chain Reaction Assays. Basel: Karger Publishing Company.
Hitt, E. (2009). CDC: Adolescent Vaccinations Increased Substantially From 2008 to 2009, Reaching Several Healthy People 2010 Immunization Goals. Web.
Krishnan, S. (2008). The HPV Vaccine Controversy: Sex, Cancer, God, and Politics: A Guide for Parents, Women, Men, and Teenagers. New York: Praeger Publications.
Mayeaux, E. (2008). Reducing the Economic Burden of HPV related Diseases. Journal of American Osteopathic Association, 108(4), 2-7.
Rodriguez, M. (2010). Is Increasing HPV Infection Awareness Promoting Increased Vaccine Compliance? The Internet Journal of Advanced Nursing Practice, 11(1), 1-24.
Saslow, D. (2007). American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. Cancer Journal of Clinicians, 57(1), 7-28.