Should female sex workers be offered HPV vaccination?
Prophylactic vaccines are efficacious in preventing Human Papillomavirus (HPV) infection and anogenital cancers and warts. Female sex workers (SW) are at increased risk for sexually transmitted infections, including HPV. There are several reasons to offer HPV vaccination to SW: they are at high risk for HPV and often unvaccinated, and the immunogenicity of the vaccine is also excellent in previously HPV exposed women. Women with disease caused by HPV may still benefit from vaccination and the efficacy in women >26 years is good. SW may yet not have been exposed to all vaccine-included hrHPV types. Vaccine-induced mucosal immunity with neutralizing antibodies may prevent transmission to clients.
Some considerations argue against offering vaccination to SW. Current vaccines are prophylactic, so do not affect current HPV infections. Women who have previously cleared HPV infections may do so again and may not need vaccination. Vaccinating well after sexual debut may be too late, as infections have already occurred.
Maarten Schim van der Loeff is a physician and an epidemiologist. He studied medicine at VUmc in Amsterdam, and epidemiology at the London School of Hygiene & Tropical Medicine (LSHTM). His PhD thesis (University of Amsterdam) studied the epidemiology and natural history of HIV-2 in West Africa. He has worked as a clinician, a public health physician and an epidemiologist in Zambia, The Gambia and Guinea-Bissau. He did epidemiological research at the MRC Laboratories in The Gambia and taught at the LSHTM. He is senior epidemiologist at the Amsterdam Public Health Service (GGD Amsterdam) and professor at the Amsterdam University Medical Centres. His research focuses on HIV, human papillomavirus, and other sexually transmitted infections.