In the United States, human papillomavirus (HPV) infects approximately 20 million people, one-half of whom are between the ages of 15 and 24 years. More than 6 million new cases of HPV infection occur each year, many from sexual contact. With the demonstration of cervical cancer as a sexually transmitted disease, effective risk reduction through HPV immunization has been achieved among women. However, immunization rates remain low.

Women are only half the story. Males were previously considered only from the perspective of the burden of infection and how that may relate to transmission events, infection, and disease in their female partners. Although the published literature contains little information on the natural history of infections in males, there has been a significant paradigm shift in the last 5 years of how infection in males is perceived. Beyond penile warts, the demonstration of HPV-associated anal disease in men has opened up the possibility of HPV immunization as a risk reduction strategy for anal cancer as well as anal warts. Furthermore, the identification of persistent HPV infection in head and neck cancers in nonsmokers has advanced our understanding of the extent of HPV-associated disease.

Prevention is important, yet relatively few teenagers and preteens have been immunized against HPV. This discussion explores the range of HPV-associated disease in both males and females, and presents strategies for improving vaccination rates before sexual debut, as part of appropriate medical care for adolescents.

Perhaps in no other arena is the dual role of the general pediatrician as primary care provider and specialist more evident than in the care of children with complex medical problems. During training, it is so common to provide care for this population that pediatricians often lose sight of the fact that routine illnesses in these children are far from "routine." Although caring for a healthy child is rewarding, participating in the care of a child with special healthcare needs allows for a rich, and often, life-long relationship with the child and family that is unmatched in any other field of medicine.

Current trends toward the medical home dovetail perfectly with the care of the child with complex needs, but reimbursement models have yet to catch up with this movement. Pediatricians, often somewhat jaded to the fact that a complex child with a common illness still requires more time and thought, often fail to bill appropriately for their work, perpetuating further poor reimbursement. As advocates for the care of this overlooked population, pediatricians can help to assure families receive the benefits and support they are due, while at the same time motivating local, state, and national governing bodies to provide improved comprehensive care.

This issue of Pediatric Annals provides a comprehensive review of the salient issues surrounding the care of medically complex children. Having reviewed the contents of this issue, the participant will be better prepared to share in the unique story of each child’s life while supporting the family and community as a better advocate for their care.