Girls do not see HPV vaccine as green light for sex, study says

BMJ 2012; 345 doi: (Published 23 October 2012) Cite this as: BMJ 2012;345:e7159
  1. Janice Hopkins Tanne
  1. 1New York

Vaccination against human papillomavirus (HPV) does not promote sexual activity among young girls who receive it, as some have claimed, a study in Pediatrics concludes.1

Researchers from Kaiser Permanente, a large managed healthcare organization, and Emory University, both in Atlanta, Georgia, reviewed clinical markers of increased sexual activity—such as pregnancy, diagnosis of or testing for sexually transmitted infections, and contraceptive counseling—during the three years after girls were vaccinated against HPV. The study looked at 1398 girls aged 11-12 years between July 2006 and December 2007 and followed them up to December 2010.

Of the girls, 493 received the vaccine and 905 did not. Clinical markers of sexual activity were no more likely among the girls who received the vaccine than among those who didn’t (adjusted incidence rate ratio 1.29 (95% confidence interval 0.92 to 1.8); incidence rate difference 1.6 per 100 person years (0.03 to 3.24)).

The report says, “A frequently discussed concern, both in peer-reviewed literature and mass media, about vaccinating preteenage girls against HPV is that vaccination against an STI (sexually transmitted infection) could lead to increased promiscuity . . . Most teenage girls surveyed on knowledge, attitudes, and practices related to HPV vaccination reported they would not modify their present sexual behaviors after HPV vaccination.”

In 2006 the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommended vaccination of all US girls aged 11 and 12 (but also some as young as 9) with the vaccine against human papillomavirus. The aim was to develop immunity against the papillomavirus before sexual activity began.

“Early onset of sexual activity and multiple sexual partners are risk factors for HPV infection,” the authors say. About 27% of teenagers aged 15 to 17 are sexually active, about 3% of girls reported starting sexual activity before age 13, and nearly half of sexually active girls reported more than two sexual partners, the study says.

“This early initiation of sexual activity is accompanied by a high prevalence of adolescent genital HPV infection, with 33% of 14- to 19-year-olds infected with at least one HPV strain, and 12% infected with one of the four quadrivalent strains,” the report says.

Immunization with the vaccine requires three doses. Immunization rates among 13 to 17 year old girls rose from 25% in 2007 to 49% in 2010, but that is lower than the rate of immunization with other recommended vaccines for adolescents. The barriers are cost, the need for three doses, physicians not encouraging vaccination, and concerns about vaccine safety, the researchers say.

Three of the authors indicated that they or their institutions had received funding from Merck, Roche, the National Foundation for Infectious Diseases, and the National Institute of Allergy and Infectious Diseases.

In an editorial the New York Times endorsed vaccination against human papillomavirus. It said, “One of the most preposterous arguments raised by religious and social conservatives against administering a vaccine to girls to protect them from human papillomavirus, or HPV, has been that it might encourage them to become promiscuous. That notion has now been thoroughly repudiated . . . There was no difference between girls who had received the vaccine and those who had not . . . Parents should think of the vaccine as they would of a bicycle helmet: it is protection, not an invitation to risky behavior.”2


Cite this as: BMJ 2012;345:e7159