Recommendation for Human Papillomavirus Vaccine after Abnormal Pap Smear in Unvaccinated Active Duty Women

Human Papillomavirus (HPV) is the most common sexually transmitted infection globally, with millions of new cases reported each year. Human Papillomavirus is associated with cervical, anal, vulva, penile, and esophageal cancer. Cervical cancer is a significant threat to women because of its insidious nature; thus, cervical cancer screening remains crucial for early detection and intervention.The most effective method to protect against HPV-related cancers is through vaccination with the HPV vaccine. The Human Papillomavirus vaccine targets the most common high-risk HPV strains. Vaccination is recommended for both males and females between the ages of 9-26. Vaccination reduces the risk of infection and contributes to the prevention of HPV-related cancers, representing a crucial public health initiative in battling HPV. The active duty military population has low HPV vaccination rates. A visit for a pap smear, the screening for cervical cancer, is an optimal time for providers to discuss the HPV vaccine. This research aims to understand the low HPV vaccination rate among active duty women and whether providers are maximizing opportunities to promote vaccination against HPV.

A retrospective medical chart review was performed at a single military treatment facility (MTF) of active duty women between the ages of 21-26, who had an abnormal pap smear, and no record of receiving the HPV vaccine. A chart review was conducted for the visit in which the pap smear was performed, as well as the follow-up visit/phone call to discuss the abnormal pap smear results.

Seven hundred fifty-one charts were reviewed from 2005 to 2021 of unvaccinated active duty women with an abnormal pap smear. 46.3% of the abnormal pap smears were low-grade squamous intraepithelial cells (LGSIL), whereas 3.3% were high-grade squamous intraepithelial cells (HGSIL). Of the charts reviewed, 8.3% of the patients noted they had been vaccinated; 13.8% of the charts had documented recommendations for the HPV vaccination; and 77.9% had no documentation regarding the patient's HPV status or recommendation for vaccination.

Although the HPV vaccine is effective in reducing the risk of HPV-related cancers, our results indicate the need for increased awareness and education practices amongst providers in promoting the HPV vaccine.A limitation of the study was that it was conducted at a single MTF. The study was not able to distinguish between provider types or clinic settings. Possible proposals for future studies include evaluating why the HPV vaccination rates amongst the active duty population are low. Pap smears are a prime opportunity for providers to engage in discussion of the importance of the HPV vaccine and encourage adherence.