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In addition to the ART, we have also discussed on the website and Forum why it might be prudent to consider taking the three-shot series of Gardasil injections (not interlesional, but using the standard prophylactic protocol). ??

While we are in no way proposing that Gardasil can cure existing cases of HPV disease such as RRP--this was thought unlikely by many experts, based on genital studies of Gardasil and also based on the adjuvant and VLP (viral like particle) composition of the vaccine--many unanswered questions do exist about Gardasil that cannot completely rule out a therapeutic effect in the respiratory tract (see Dr. Steinberg's remarks on Learn>Novel Therapies).

There is evidence that so-called VLP vaccines like Gardasil can be used successfully in laryngeal RRP treatment (Schlegel, Frazer). Moreover, genital HPV is arguably not the same as respiratory HPV. This has been thoroughly discussed elsewhere [e.g., Learn>RRP Focus Sessions>2007 RRP Focus Session>RRP ISA presentation, etc.]

RRP ISA has speculatively suggested that the effect of ART might possibly be enhanced if the Gardasil vaccine somehow "turned on the lights," allowing patient's immune system to "see" those infected cells.

Here, we must be more specific. Could it mobilize the local immune system? It cannot be ruled out, and Merck's own medical director in charge of Gardasil (Dr. Richard Haupt) has himself concurred.

It is understood that the metaphor of "turning on the lights” is very simplistic, especially in describing early or chronic infections, but a synergistic effect between Gardasil and ART cannot be ruled in or out until more data is collected.

What we can say is that the conclusions resulting from Merck's genital studies seem flawed in that they are based on the notion that the respiratory tract functions similarly to the genital tract.

That assumption, as suggested by HIV/AIDS epidemiological data, is probably untrue [for more, see this writer's argument in the 2007 RRP Focus Session and also see Dr. Steinberg's remarks under Learn>Novel Therapies].

If patients do decide to use Gardasil, however, three things must be said.

First, we're seen reports suggesting that RRP may become more active in the lungs following the use of Gardasil. It's not supposed to happen and we have not observed this at RRP sites that are not pulmonary. Patients may wish to take care with this.

Second, do not rely on your physician to know the proper timing of the doses. Patients and parents need to adhere to Merck's recommended injection schedule and make sure their physicians are aware of it. As with many things connected to RRP, waiting for your physician to educate you is often ill-advised.

Third, do not ask for Gardasil for treatment. Gardasil was not designed to treat, but to prevent. You'll do much better getting your physician to offer you Gardasil if you tell him or her that you're sexually active (assuming you're an adult) and wish to prevent getting yet another strain of RRP through oral sex.

Or if you are a parent, you might tell your child's physician that you're hoping that Gardasil will prevent any further manifestation of RRP in their lungs or trachea.

These reasons actually have merit. Saying that you want Gardasil for treatment is only likely to elicit a refusal.