[Question #324] Gardasil Advice

35 months ago

This is a follow up to a question answered by Dr. Handsfield a month or two ago.  I’m old (60s) and I’ve been recently tested for HSV2 (genital herpes) and found to be negative.  I want to see a couple women who have had multiple partners.  I know if I get vaccinated with Gardasil I would have to pay for it out-of-pocket, but would it be advisable to get vaccinated with Gardasil 9 at my age?

Thank You,

Adam

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Hi Adam,
Dr. Handsfield assigned me this question.  Glad to hear you tested negative for HSV 2.  My answer about the benefits of garadsil 9 depend upon the number of sexual partners you've had in your lifetime.  Generally speaking, the vaccine has been approved for young people (26 or under for women and 21 or under for males) because once a person passes these ages, they have had enough sexual partners that they are likely infected with at least one of the HPV virus strains included in the vaccine.  The initial studies of the vaccine were, in fact, limited to people who have had no more than 4 partners and even then, many were already infected.  They were using age as a "marker" for likelihood of prior infection.  Our clinic did some of these studies.  For us, we are happy to vaccinate people over the approved ages if 1) they have had a very limited number of sexual partnerships and 2) they understand that insurance will not reimburse them for this if they are over the approved ages.  If you tell me the approximate number of sexual partners you've had in your lifetime, then perhaps I can help you estimate the benefit the vaccine might provide for you.

Best
Terri
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35 months ago
Hi Terri,

Thanks for your response.  I’m a rare bird.  I’ve been in a relationship with only one woman involving uncovered vaginal intercourse and oral sex.  She had several partners before me.  The relationship is over and now I want to see other women. 

The thing that’s new since I asked this question of Dr. Handsfield is my negative test result for HSV2.  Isn’t that the only dangerous strain covered by the vaccine?

I do think I have had a very limited number of partners, just one.  BTW, if I’m negative for the dangerous strain, why would it matter how many partners I’ve had?  Also, I understand I would have to pay $500 or $600 for the vaccine.

Bottom line, how advisable is it to be vaccinated with Gardasil 9 now?  Is it worth it?  In other words, is it a very definite "yes", or is it barely worth it in my case.  Or, is it a "no", don’t bother in my case?

Thank You,

Adam


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
I think you might be confused here about the Gardasil vaccine.  The vaccine is for HPV, not HSV.  HPV causes genital warts and also can cause cervical, penile, anal and throat and mouth cancers.  Herpes is a completely different virus and it causes both oral herpes (cold sores) and genital herpes.  If you have had only one sex partner in your lifetime, then you might actually be a great candidate for the HPV vaccine, Gardasil 9. 
By the time a person has had five sex partners, most people are infected with at least one strain of HPV infection.  There are high and low risk types - low risk types cause genital warts but high risk types are the ones associated with the cancers that I listed.
Please let me know what other  questions you might have.
Terri
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35 months ago

Thanks much for your response.  Yes, you are right, I got my viruses mixed up.  My HSV test is irrelevant to this question. 

Gardasil seems worth it if it could prevent warts (an inconvenience), let alone some kind of cancer (a devastating diagnosis).  Dr. Handsfield thought it wasn’t worth it.  At least part of his thinking was that my immune system (at my age) would not be guaranteed to respond as effectively to produce antibodies as a young person’s would. 

So plan A might be to get the vaccine and use condoms for the 6 months that it took for the vaccine to be fully effective.

So, do you think it’s worth the expense and effort to get the vaccine.  And does “plan A” sound like I have my head on straight now.

Thank You,

Adam

 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Hi Adam,
I know that there are concerns about the efficiency of the immune system in older people in general but I'm not aware of any studies of people of your age with these HPV vaccines to know that.  So what would be the down side?  Cost.  You would most certainly have to pay for this yourself.  Time.  You would have to go back in three times for the vaccine.  The upside of course would be perhaps protection against 9 strains of HPV.  You have to weigh the pros and cons for yourself, Adam.  I like plan A.  And I'm happy that you plan to pursue a sexual life into the future. 
Best
Terri
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