Anogenital human papillomavirus (HPV) infection is the most prevalent viral sexually transmitted infection (STI) in the world today . Infection is extremely common, most prevalent among sexually active young adults and usually follows a benign course. Persistent infection with “high risk” (HR) HPV causes cervical disease that can lead to cervical cancer . HR-HPV types, of which there are 15, cause over 99% of cervical cancers .
September 2008 saw the introduction of a UK nationwide HPV immunisation programme . The vaccine is now offered routinely in secondary school, to girls aged 12 – 13 years. A three-year “catch up” campaign, delivered in GP surgeries and dedicated vaccination centres, has allowed older girls up to the age of 17 and 364 days access to the vaccine. Boys are not vaccinated. In the UK, between 2008 and 2012, the bivalent Cervarix vaccine  was used to protect against the two HR-HPV types, HPV 16 and 18, that cause around 70% of cervical cancers . The vaccine was provided in three doses over six months to elicit a protective immune response in vaccinees prior to exposure to the virus .
Vaccine uptake in the UK has been excellent, at > 90% for 12–13 year-old girls. However, uptake rates for the catch-up programme are lower at less than 60% overall . Vaccination is accompanied by targeted public health information (PHI), in the form of leaflets and/ or information sharing sessions directed by trained school nurses. Details of HPV infection and its association with cervical cancer are explained: HPV is sexually transmitted, HPV causes all cervical cancers, HPV vaccine protects against two types of HPV. Therefore, young women who have been vaccinated may be expected to have increased knowledge of HPV and its association with cervical cancer compared to the unvaccinated population. At the launch of the vaccination programme these routine information sources were supplemented by an extremely intensive media campaign as well as a specially developed Scottish website (http://www.fightcervicalcancer.org.uk/) and associated literature. The website has now been withdrawn and replaced with information on immunisation (http://www.immunisationscotland.org.uk/vaccines-and-diseases/hpv.aspx). Although these efforts were largely targeted to women, young men would also have been expected to have some exposure to the media campaign because of its intensity and range (cinema, television, radio, billboards, newspaper adverts) in 2008 .
Correct knowledge about HPV infection and cervical cancer could be important to inform decision making regarding uptake of the vaccine. Prior to vaccine roll out many studies revealed a lack of awareness of HPV (i.e. whether respondents had heard of the virus) and a lack of knowledge of the association between HPV and cervical cancer in the UK and a range of other countries [9–14]. Recent studies have demonstrated increased awareness of HPV following the introduction of the vaccine [15, 16]. However, fewer studies have investigated acquisition of detailed knowledge of HPV infection. Those that have, indicate low levels of more detailed knowledge of HPV infection and links to cervical cancer [17–20]. Such knowledge appears to be greatest in those with higher education levels .
This study was conducted at the University of Glasgow, Scotland. Prospective medical students at this university are admitted to study on the basis of interview where depth of knowledge of current topics in medicine is assessed. The HPV vaccine was one of the main topics for 2008 and 2009 so new medical students at the university could be expected to acquire some knowledge of HPV. HPV knowledge was assessed in two groups of first year medical students, mean age range 17–20 years of age. The timings of the surveys were specifically chosen. The first survey was carried out in November 2008 immediately following the roll-out of the HPV vaccine and a summer’s intensive media campaign that aimed to inform the public about HPV and the HPV vaccine. The second cohort was surveyed one year later when many more females had received the vaccine and associated PHI. The multimedia PHI campaign was sustained over this one year period. Moreover, media interest in the death from cervical cancer of the celebrity Jade Goody [21, 22], and increased discussion of HPV in the media, at the start of 2009 coincided with the timing of interviews for medical school of the 2009 student cohort.
We sought to answer three research questions. The first question we addressed was knowledge about three specific details of HPV infection that could be acquired from reading of PHI leaflets accompanying the HPV vaccination programme and from PHI in an intensive media campaign between 2008 and 2009. The second research question was whether vaccination of females in the group and a year’s PHI campaign had any bearing on HPV knowledge. In contract to policy in the rest of the UK where screening starts at age 25, from age 20, Scottish (and Welsh) women are offered three-yearly cervical screening for the detection of HPV-associated cervical disease. 73.7% of eligible women were screened in the past three and a half years (as of March 31st, 2010), which is a rise in uptake of around 4.5 percent in comparison to previous years . Arguments for and against screening before the age of 25 can be found at http://www.cks.nhs.uk/cervical_screening/management/scenario_when_to_offer_cervical_screening/. The final research question was to find out if men and women acquired similar levels of knowledge about HPV from the same or different sources. This study is among the first to compare knowledge of details of HPV of an educated mixed gender cohort at a time of an extremely intensive media campaign then exactly one year later in a similar cohort where most of the females had received at least one dose of the HPV vaccine and following a sustained PHI campaign.