DEAR DR. ROACH: I read your recent column stating that the HPV vaccine is recommended up to age 45. Are people older than 45 years no longer susceptible to HPV? Asking for a 52-year-old friend (who thinks he's Wolverine). -- C.F.
ANSWER: Wolverine has a mutant healing ability (that's how he was able to survive having his bones replaced with adamantium), so he has nothing to worry about. However, non-mutants do have to worry about HPV, which can come from any kind of skin-to-skin contact with a person who has HPV.
Having the virus often means having warts, but sometimes people can have contagious HPV without having any visible lesion. It's been estimated that 90 percent of people with HPV don't know they have it.
People of any age are susceptible to HPV. Most people have been exposed by age 45, which is why the recommendations are the way they are now, but vaccination might make sense in some situations. The clearest example is someone who has had very few sexual partners and is about to become more sexually active (for example, a person recently divorced or widowed).
Although the vaccine is not indicated by the Food and Drug Administration in this situation and the person is likely going to have to pay out of pocket, it might still be worth it to get the vaccine to reduce the risk of acquiring a new sexually transmitted HPV infection. I received several letters from people who acquired new genital warts in just this situation who were upset that their doctor did not offer the vaccine.
If people have already been exposed to HPV, the vaccine will not harm them. In fact, there is some anecdotal evidence that the vaccine might help people with difficult-to-treat warts by boosting the immune system specifically for HPV.
DR. ROACH WRITES: A recent column on fructose malabsorption in adults may have been confusing. I also mentioned the condition hereditary fructose intolerance, which is a very different condition from the fructose malabsorption I discussed.
HFI is a potentially serious disease, which is usually diagnosed in children and is often unrecognized. It is caused by deficiency of an enzyme called fructose-1-phosphate aldolase, isozyme b. This disorder is diagnosed through sophisticated testing or by genetic analysis. Treatment is complete elimination of fructose from the diet, which is a difficult task.
Fructose malabsorption in adults is a much milder condition. As I stated, it's treated by avoiding large amounts of fructose by itself (such as in honey, fructose-sweetened foods and fruits containing high net amounts of fructose, such as apples, pears, sweet cherries, prunes, and dates), and avoiding the artificial sweetener sorbitol.