Two years ago, Rebecca Baessler found out she had human papillomavirus. She noticed bumps on her genitals, and her sexual partner also showed symptoms.

“I was a little bit confused and shocked, I didn’t know how I got it or from who,” she said. “I didn’t know what it meant… I didn’t know anything about it.”

Baessler’s gynecologist, Dr. Manuel Veloso, assured her that HPV is very common and that not all strains are precancerous. The now 22-year-old Cornell University student was still worried, however, especially because women in her family have a history of cervical cancer.

“I thought, ‘I’m going to die from this,’” she said.

A pap smear can reveal the presence of the human papillomavirus: On the left, normal cells. On the right, cells infected with the virus.

Baessler is not alone. At least half of sexually active adults will contract HPV, according to the Centers for Disease Control and Prevention. Some doctors compare its prevalence to that of the cold virus. Though most carriers show no symptoms and clear the virus from their bodies naturally, HPV can have serious consequences; for example, the virus may linger and cause precancerous cells in the cervix.

Baessler is now receiving the new vaccine Gardasil, which protects against the four strains of HPV responsible for 70 percent of cervical cancers and 90 percent of genital warts. Though the vaccine is only a preventative measure, it can protect against strains she may not have.

The US Food and Drug Administration approved Gardasil in June 2006 for use in women between the ages of 9 to 26. The vaccine is given in a series of three shots over a six month period. Even with the virus’s ability to cause cancer and startling statistics about its prevalence, many college-aged women remain unvaccinated. College women who want the vaccine face several obstacles, including cost. They also may have misconceptions, like thinking that they are too old for it to work, or that they have to be a virgin to get the vaccine.

Though HPV testing is relatively easy (in fact, it is sometimes paired up with the ever-present Pap test), gynecologists do not routinely test college-aged women for HPV because of the test’s high cost. Even though Northwestern’s health services offers the vaccine at a slightly lower price than doctors in the Evanston community, Gardasil is still too expensive for many college students.

Dr. Donald Misch, director of Health Services at Northwestern, estimates that only 100 women have received or begun to receive the vaccine at the university’s health services, most likely due to price. The university’s insurance plan, Aetna Chickering, does not cover Gardasil.

When Sarah Lang, a Northwestern graduate student, heard about Gardasil, she wanted to get the vaccine as soon as possible. At 26, she will soon pass the FDA’s range of approved ages. She called the school’s health services and made an appointment. At the last minute, Lang thought to ask about a copay. The answer shocked her: Health Services charges $150 for each of the three shots.

“For a graduate student on a fellowship, that is a huge chunk of our monthly wages,” she said. “It is enough to deter a lot of people.”

Though some women whose insurance plans do not cover the vaccine simply skip the trip to the doctor’s office, others pay the full out-of-pocket price. When Lang discovered that Northwestern’s student health insurance did not cover the vaccine, she wrote, called and emailed anyone she could think of to find out why not, and to and try to get the policy changed. She contacted the presidents of Aetna and Northwestern, the Graduate Student Association and the William Banis, the Vice President for Student Affairs. When the vice president of Aetna told Lang that the decision was up to the school, not the insurance company, she contacted Northwestern’s Office of Risk Management, who said that they did not want to raise the insurance premium.

Lang also considered various vaccine programs, including Medicaid, but as a 26-year-old Canadian citizen she did not qualify for any of them. So, she ended her search and got the vaccine — paying the full cost herself.

“It’s on my credit card, and I’ll pay for it,” she said. “But how do you weigh that… $450 or cervical cancer?”

Students on Boise State University’s health insurance plan can get the vaccine without the financial burden facing students at many other schools. United Healthcare, the insurance company that provides Boise State’s student health plan, has a contract with the university that requires it to fully cover all of the services the health center offers.

Student health insurance assistant Marika Butler said that women on Boise’s campus have been requesting the vaccine specifically.

“Every time we have a student who comes in for an annual exam, the HPV vaccine is discussed with them,” she said. “We try to tell as many girls as we can.”

Just three weeks after the vaccine gained FDA approval, the Advisory Committee on Immunization practices (ACIP) of the CDC recommended routine vaccination of 11 and 12-year-old girls and unvaccinated 13 to 26 year olds, regardless of previous HPV or Pap test result history. The Society for Adolescent Medicine endorses these recommendations and “supports coverage of vaccination costs by third-party payers as well as federal and state programs that finance vaccination for low-income children.”

Indiana University School of Medicine professor Dr. Gregory Zimet, PhD, who contributed to the Society’s position paper on the vaccine, says college-aged women often don’t consider the vaccination when they think about their health care.

“You’re asking people to do something about their health that is a little out of the ordinary,” he said. “They may feel there’s no benefit to be gained from the vaccine. There may be people who feel they are not at risk for some reason.”

Many women also have misconceptions about the vaccine. Some think the vaccination won’t work if they are already sexually active. This is a myth, though the vaccine does only work preventatively and won’t help if someone already has one of the four strains that Gardasil protects against. Even if someone already has one or more strains of HPV, the vaccine can protect against the other cancer-causing strains and still be beneficial.

Northwestern student Julia Harris, 21, personally experienced the consequences HPV can have, though chooses to remain unvaccinated. At age 19, she went for a routine Pap test that came back with abnormal results. Though the pre-med Weinberg senior said she never had unprotected sex, she still blamed herself for assuming that condoms would protect her from HPV.

“It really hit me hard, and I felt like I had done something wrong,” she said. “I felt really stupid and… irresponsible.”

When the nurse from health services called with the Pap results, Harris was not prepared for the news.

“She told me over the phone and she used the word ‘precancer,’ and I think that is really what threw me off,” she said.

Next she went for a colposcopy and had a biopsy, which revealed some malignant cells. Her doctor scraped away the malignant cells, and at a follow-up exam saw that the first treatment had worked. Harris had several follow up Pap tests with normal results, and one minor cancer scare about eight months later turned out not to be a serious concern.

Even after all she has been through, Harris plans to remain unvaccinated and continue her regular Pap tests.

“I was thinking about it, but the problem is the whole thing’s so complex because… what if I have a strand that’s not included?” she said.

She doesn’t like the awareness campaigns, and thinks they will not help because they focus too much on the vaccine and not enough on the necessity for continual Pap tests.

“I wouldn’t recommend just jumping to the vaccine because I don’t think that that is the only solution,” she said.

None of her doctors have recommended the vaccine to her or even brought it up, and she said she would have considered it if they had, or if her health insurance covered it.

Dr. Kevin Ault, a researcher at Emory University, says that though Harris’s approach is valid, it is misguided. Getting annual Pap tests is one way to keep cancer away, but, as he said, “that is an expensive way to do business.” Not all women have access to Pap tests, and of all Pap tests performed, only 7 percent come back as abnormal. For that percentage, the necessary extra treatment and tests costs between $3 billion and $6 billion every year.

“There are lots of other things we could spend that money on in women’s health care,” Ault said.

Merck & Co., Inc., the pharmaceutical company that markets Gardasil, has developed an aggressive advertising campaign that has worried some students and parents about the prevalence of HPV. Elizabeth Simpson, 20, said she didn’t know that HPV causes cervical cancer until she saw commercials for Gardasil. Soon after seeing them, the Boston University undergraduate student got her first of the three shots.

Some universities also have established campaigns informing students about the vaccine. At Cornell University, the health promotion department endorses the vaccine and advertises it through different programs, puts up ads and distributes informative brochures about Gardasil and HPV. Though the school’s health services has offered it since the fall, demand has been low. The school has no plans to cover the vaccine, however, even though 40 to 50 percent of the students are on the school’s Chickering plan.

“Gardasil is an amazing breakthrough,” said Nina Cummings, Cornell health educator. “It will change the course of gynecology 10 years from now.”

Some estimate that Gardasil could reduce cases of cervical cancer by 70 percent, and greatly reduce numbers of abnormal Paps, colposcopies, and the medical costs and emotional stress of dealing with HPV and cervical cancer. Future generations of the vaccine may cover more types, eventually making Pap tests less necessary. These newer vaccines may also cost less, which will broaden the range of women with access. Zimet even forsees the vaccine possibly eradicating cervical cancer in the United States.

Denise Buckley, director of nursing at Boston University, hopes Cummings’s and Zimet’s predictions will come true.

“It’s very heartwrenching to say to a woman that she has had an abnormal Pap smear, and that the cause is usually HPV, and that HPV can be precancerous,” she said.

The lack of concern about HPV and Gardasil in the women she knows distresses Lang.

“It’s a vaccine against cancer,” she said. “I don’t know why it’s not so important to everyone else. A vaccine that prevents against 70 percent of a cancer… it boggles my mind that I can’t get more women to see that it’s not only important for them to get it, it’s necessary.”

Sarah Lang has been doing her part, telling every woman she knows to get the vaccine, emailing the entire literature department at Northwestern, posting signs in the graduate students’ office and talking about it in her classes. Baessler encourages her friends to get the vaccine.

“I think it should be a very open thing for all women to get,” she said. “It’s a cancer vaccine, not just an HPV vaccine. Every woman should get it… Because you never know.”