Amy Doran

Missing cohort: Inflammatory bowel disease patients at increased risk for cervical dysplasia may be undervaccinated for HPV.

To the Editor: The human papillomavirus (HPV) is strongly associated with cervical dysplasia. In the United States up to 5% of women have cervical dysplasia on Pap smears. The HPV vaccine is recommended for girls starting at age 11, with ‘‘catch-up vaccination’’ offered for the 13–26 age group. Women with inflammatory bowel disease (IBD) have increased risk for cervical dysplasia and there are no specific guidelines addressing HPV counseling and vaccine administration among these patients. Notably, many young women with IBD in adult gastroenterology practices were no longer receiving care from their pediatricians when the HPV vaccination became available. This study evaluated the rate of HPV vaccine counseling and administration in young adult women with IBD at an urban university medical center. Medical records of consecutive women with IBD age 18–26 years old managed at an IBD center at an urban university during a 2-year period were evaluated. There were no exclusion criteria. Patient age, physician specialty, HPV counseling status, and HPV vaccine administration were obtained. A database was created using Microsoft Excel, with deidentification to ensure anonymity. Medical records of 35 women were evaluated. In addition, all gastroenterologists had an internist and seven had a gynecologist. Documented HPV counseling occurred in six patients (17.1%). Three patients were counseled by gynecologists, with only one receiving HPV vaccine. Two patients were counseled by their internist without HPV vaccine administration. One patient was counseled by a gastroenterologist without documented HPV vaccine administration. There was no documentation of HPV assessment, counseling, or administration in medical records from previous physicians. This study suggests that women with IBD in early adulthood may not have received the HPV vaccine if it was released after they graduated from their pediatrician’s care. This is concerning, as women with IBD have increased risk for development of cervical dysplasia. Assumptions about previous HPV administration by pediatricians may have a role in physician assessment and counseling of HPV vaccine. The known relationship of the HPV vaccine and cervical dysplasia risk must be recognized by all physicians in the care of women with IBD to ensure optimal management.