The Department of Health chose Cervarix on ?value? grounds for a national rolling campaign to vaccinate 12-year-old girls, which started in September 2008.
Dr Rogstad, a Sheffield-based consultant in genitourinary medicine, says that while cervical cancer was by far the more serious condition, the effect of genital warts on a person?s life should not be underestimated.
?As a genitourinary physician, I see lots of young people and adults with genital warts,? she said.
?Although it?s not a serious physical condition, psychologically it is very unpleasant. While warts don?t tend to cause pain, they are not nice to look at and cause a huge amount of emotional distress.?
Unsurprisingly, warts can put sufferers and their partners off sex, and disrupt relationships.
?Think how children with verrucas are stigmatised at school,? Dr Rogstad said. ?Now imagine the stigma of having something like that in your genital area.?
The verruca analogy doesn?t end there. One of the treatments for genital warts is to freeze them off. Another is to apply a cream that can be painful. Patients sometimes need repeated treatments to get rid of them. Even after treatment, the warts can come back in people who carry the HPV strains that cause them.
Given what she knew, the decision to get her daughter vaccinated with Gardasil was easy. However, Annabelle, who is studying for her A-levels at Cheltenham Ladies? College, took some convincing, especially as Gardasil is a course of three jabs spread over several months.
?I hate having needles, so I wasn?t too keen at first,? she says. ?But when I thought how it could affect my later life, I put on a brave face.?
Now she has been vaccinated, Annabelle has become something of an advocate: ?I strongly feel that all young people should get this vaccine, not just the one that protects against cervical cancer. Genital warts might not be life-threatening, but they are extremely unpleasant and can be passed on.?
Dr Rogstad dismisses the argument ? put forward by some faith groups ? that giving girls STI (sexually transmitted infections) vaccines in puberty makes them promiscuous. ?Headlines calling them ?sex vaccines? are extremely unhelpful,? she says. ?Sexual health education does need to go alongside vaccination programmes.?
She also points out that the virus that causes genital warts is very common. This means normal sexual activity throughout one?s young adult life will put people at reasonable risk of contracting it.
?Ninety per cent of the population will have been exposed to it,? she says. However, most people exposed to HPV do not go on to develop warts, which only tend to show when the body is stressed ? for example, when the immune system is compromised or occasionally during pregnancy.
Dr Rogstad is uncomfortable with the obvious truth that she was able to pay to protect her daughter, while most girls are denied Gardasil through lack of information or money.?Being in a position where I can have Gardasil given to my children but can?t give it to my patients is abhorrent to me,? she said. ?The burden of STIs tends to be in more disadvantaged people, and for them not to have access to this vaccine is disgraceful.?
While Dr Rogstad welcomes the cervical cancer vaccination programme, which in time could prevent 400 cervical cancer deaths a year, she thinks the decision to choose Cervarix on the grounds of cost was short-sighted.
?I was completely shocked that they didn?t go for Gardasil. I think they underestimated the cost of managing genital warts. In my own practice, it?s a huge burden on resources.?
A growing number of MPs agree: more than 20 have signed an Early Day Motion led by the Conservative Peter Bottomley, urging the Government ?to assess the quadrivalent HPV vaccine? [Gardasil] and ?take the opportunity to prevent both cervical cancer and genital warts?.
Across western Europe, most countries have chosen Gardasil, with only Italy and the Netherlands choosing Cervarix. Further afield, Australia started vaccinating women under 28 with the dual-purpose vaccine in 2007. Since then, cases of genital warts among young women have fallen to almost a quarter of pre-campaign levels. Among heterosexual men, cases have fallen by a third, due to herd immunity.
Some scientists believe boys should also be vaccinated against strains of the HPV virus, arguing it is behind a worrying rise in oral cancers among youngsters, transmitted by oral sex.
Since 1980, oral cancer rates among young people have more than doubled, with the HPV virus replacing smoking and drinking as the major cause.
A study has shown that people of both sexes who have had oral sex with more than six partners were 8.6 times more likely to develop the cancer than those who had never had it.
In February, Dr Maura Gillison, of Ohio State University, a researcher into HPV, told the American Association for the Advancement of Science conference in Washington, DC, said that it was time for policy-makers to consider the option. She said: ?If patients ask whether they should vaccinate their sons I say ?certainly?. The vaccine will protect them against genital warts and anal cancer [also associated with HPV] and as a potential by-product of that it may protect them against oral cancer caused by HPV.?
So what are the chances of Cervarix being replaced here? The Department of Health will review the choice of vaccine later this year. ?The Department chose Cervarix for the national HPV immunisation programme against cervical cancer as it offered the NHS best overall value,? said a spokesman.
?Subsequently, new research has been published that this vaccine provides cross-protection against more of the strains that cause cervical cancer, thus helping to prevent even more of the disease.
?The Department has commissioned an update to the cost-effective modelling for the HPV vaccine to support the next procurement exercise for the HPV immunisation programme in 2011.
?This model will take into account new data on the potential protection provided by the HPV vaccines against cervical cancer, other HPV-related cancers and genital warts.?
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