HPV vaccine _ What the ****!

'It will make you safe if he wants to put it inside you'.

The hushed chatter among the 13-year-old girls on the train, making their way homeward. Another school day done.

'Yeah, from, what's it called?

From 'HPV'.

'But not from the other nasties. At least that's what 'Huggie' (aka. Ms Huddlestone, school health and welfare counsellor) said'.

Each girl is carrying home a consent form for a parent to sign, pending the first of two Gardasil®9 human papillomavirus vaccinations. The vaccine is free in the government's national immunisation program. For both girls and (since 2013) boys.

I won't get warts or other funny stuff down there. That's great,' Amanda thinks, walking the last stage of her journey alone. Huggie said it would also stop me from getting womb cancer in about 20-40 years. Big deal'. Like most teens, Amanda's thought processes are grounded in the present; being an 'old' woman isn't on her radar.

It has been about 30 years since Drs. Zhou and Frazer at the University of Queensland's Department of Medicine at the Princess Alexandra Hospital (Brisbane) first stared at the electron micrograph showing the genetically-engineered HPV virus particles they had created. The discovery underpinned the development of the three HPV prophylactic vaccines (Gardasil, Gardasil®9 and Cervarix), the first of which was approved for human use by the Federal Drug Administration (FDA) in 2006. The latest, Gardasil®9, contains a composite immunogenic protein from nine of the HPV strains associated with 90% of cervical carcinomas and other anogenital cancers.

With the consent form in front of her, Amanda's mother checks out the HPV vaccine on the Web after her daughter has gone to bed.

'God, she hasn't even started menstruating yet'! she thought.

She called out to Amanda's father hovering in the background. 'It says here that the HPV vaccine could promote promiscuity among young girls if they think they are safe from sexually transmitted diseases. And transmission doesn't even need penetration if roving hands move from the boy's genitals to the girl's'.

'And vice-versa', her husband was quick to assert.

'Do we know how long the vaccine effect lasts'? he continued. And has this new vaccine been around long enough to be sure it prevents HPV genital warts? If it is 20-40 years before some of the warts progress to cervical cancer, how can they say for sure the HPV vaccine protects against that?

'What about the side effects'? Amanda's mother added. 'I met a mother of a girl a bit older than Amanda who had fever and headaches after the vaccine, which kept her from school for three days. There are some horror stories about side effects on the Web'.

The parents are voicing some of the arguments of the HPV vaccine naysayers, a well-organised and sizeable cohort on social media.

But data indicate no statistical increase in promiscuity among those who have received the vaccine.

Around 99 countries and territories around the world have now introduced HPV vaccination programs. Sixty million individuals followed for up to 8 years post-vaccination showed a substantial decrease in HPV infections, anogenital wart disease, and CIN2+ (cervical intraepithelial neoplasia), a frequent precursor of cervical cancer. Other studies showed efficacy of HPV vaccination up to 15 years, and evidence of herd immunity. Consistent results suggest 90% HPV vaccination coverage of girls may lead to cervical cancer elimination in most low-middle income countries within the next century, particularly where cervical screening programs are in place.

Upstairs, Amanda whispers about the HPV vaccine to her older sister, with whom she shares a bedroom.

'Yeah. Look, the vaccine is no big issue. What some girls in my class are doing to avoid genital stuff is 'goblin' their boyfriends'.

'Goblin?'

'Yeah, you know, sucking their dicks'.

Sexual behaviour is an established risk factor for HPV-associated mouth and throat lesions, with a strong association observed between number of lifetime oral sex partners and incidence of the disease.6 Risk of oral HPV infection is associated with an increased number of recent (within the past three months) oral and vaginal sex partners.

The signed consent form, neatly folded in an envelope, awaits Amanda at her place at the breakfast table the following morning.

She is so pleased her mother has permitted vaccination. Why? Because she would be protected from the possible outcomes of anogenital and oral HPV infection? No! Amanda's primary concern is she doesn't want to be an outsider among her peers who would be receiving the vaccine.

When the time came to roll up her sleeve, the sexual activity issue barely comes to her mind. Nor, apparently, to her classmates waiting with her in the vaccination queue.

'Oh my god, how painful is this jab going to be' is the predominant chatter.