Response

Extract

The comments of Bautista et al. about positive predictive value (PPV) and likelihood ratio positive (LR+) go to the heart of why we strongly believe that human papillomavirus (HPV) vaccination among middle-aged adult women should not be routinely recommended in private practice or as a public health message.

It is well accepted by the scientific community and health-care professionals that 1) HPV infection is acquired as a sexually transmitted infection; 2) the vast majority of HPV infections will resolve within months after acquisition; 3) persistent infections with carcinogenic HPV types cause virtually all cases of cervical cancer, but only after several years (even decades) have elapsed after a persistent infection is established; 4) most cervical intraepithelial neoplasia (CIN),stages CIN2 and/or CIN3, found in a given population is the result of HPV infections that were acquired within a few years of sexual debut; and, 5) HPV vaccines prevent the acquisition of new HPV infections ( 1–4 ).