HPV Vaccines - American Sexual Health Association

HPV Vaccines

Human papillomavirus is a common infection–more than half of sexually active men and women are infected with HPV at some time in their lives. But HPV vaccines can help prevent infection from both high risk HPV types that can lead to cervical cancer and low risk types that cause genital warts.

HPV vaccines are recommended for girls and boys ages 11-12. Catch up vaccination is recommended for girls and young women ages 13-26 who have not been previously vaccinated. Young men can get vaccinated through age 21. The vaccine is also recommended for men who have sex with men, as well as for men with compromised immune systems (including HIV) through age 26.

While vaccination rates among girls and young women are still low (as of 2010, only 49% of girls between the ages of 13 and 17 had received at least one dose of the vaccine, and only 32% completed all three doses), rates of infection with strains of HPV covered by the vaccines have dropped significantly. Researchers comparing HPV infections rates among females ages 14-19 in years before (2003-2006) and after (2007-2010) the first HPV vaccine became available found a 56% drop in infection rates for the HPV types covered by the vaccine.


Why are HPV vaccines important?
  • HPV is very common. Most sexually active people have HPV at some point in their lives. The infection is usually harmless and the body most often clears it in a short time.
  • HPV can lead to cervical cancer. Some types of HPV can infect a woman’s cervix and cause the cells to change. Most of the time, HPV goes away on its own. When HPV is gone, the cervix cells go back to normal. But sometimes, HPV does not go away. In a few people, high-risk HPV and related cervical cell changes last for many years and can lead to cancer if they aren’t found. Being vaccinated against HPV can lower the chance a woman will develop cervical cancer.
  • HPV can other types of cancer. Some types of HPV can cause cancers of the penis, anus, or oropharynx (back of the throat, including base of the tongue and tonsils).
  • Low-risk types of HPV can cause genital warts.The types of HPV that can cause genital warts are not the same as the types that can cause cancer. Genital warts may cause problems during pregnancy.

What HPV vaccines are available?
There are currently three HPV vaccines available:

  • Gardasil® is vaccine available for both males and females. Developed by Merck, Gardasil® is close to 100% effective at preventing infection associated with HPV types 6 and 11(types associated with 90% of all genital warts) and types 16 and 18 (types associated with 70% of all cervical cancers, and many anal, vulvar and vaginal cancers).
  • Cervarix®, developed by GlaxoSmithKline (GSK) is a vaccine just for women. This vaccine is also close to 100% effective at preventing infection associated with HPV 16 and 18 (associated with 70% of all cervical cancers). Studies suggest Cervarix® also offers cross-protection against other “high risk” HPV types.
  • Gardasil 9® was approved in December 2014. The new vaccine covers nine HPV types: the two low-risk types that cause most cases of genital warts (HPV 6 and HPV 11) along with seven high-risk types (HPV 16, 18, 31, 33, 45, 52, and 58) found in a number of cancers, including about 90% of cervical cancers around the world as well as most anal, vulvar, and vaginal cancers.

Experts recommend that all females between the ages of 9 and 26 get an HPV vaccine. About half of all new infections are diagnosed in girls and young women between 15 and 24 years of age, so early vaccination is important. Males are at risk for HPV and related diseases, too, so boys and young men are also recommended to be vaccinated.

How many doses are required?

Youth between ages 9 and 14 only need two doses of the HPV vaccine. In October 2016, the Food and Drug Administration (FDA) approved a 2-dose schedule for Merck’s Gardasil-9® HPV vaccine for males and females ages 9-14. The schedule calls for the second dose of the vaccine to be given 6-12 months following the first. Studies show the antibody response generated with the 2-dose regimen is not inferior to that observed with the three doses previously recommended for all age groups.

For older teens and young adults who start the series later, aged 15 through 26, three doses are still required. In this cases, the second shot should be given one to two months after the first, and the third shot should be given six months after the first. The goal is to get all three shots within six months.

Ideally, people should complete all doses of the vaccine before they become sexually active. However, those who are eligible and are sexually active should still get the vaccine.

Are HPV vaccines safe?
HPV vaccines have been used in many countries around the world for several years, and both vaccines appear to be safe and well tolerated. There have been some mild to moderate reactions reported from people who have received the vaccines, the most common of which is pain, redness, and swelling around where the shot was given. Other mild reactions reported include fever, headache, fatigue, nausea and vomiting. Some people have experienced fainting as well.

As with any vaccine or medication, there is always a possible of a serious problem, such allergic reaction. However, such reactions are rare and HPV vaccine continue to be monitored for any safety concerns.

Is the HPV vaccine mandatory for school enrollment?
Each state decides whether or not to require vaccinations for enrollment in childcare or school attendance.

According to the National Conference for State Legislators (NCSL), legislators in at least 42 states and D.C. have introduced legislation to require the vaccine, fund or educate the public about the HPV vaccine since 2006, and at least 22 states have enacted legislation. Currently, only Virginia and the District of Columbia have requirements for HPV vaccination for school. However, parents can opt out of vaccination requirements.

See the NCSL website for up to date, state-specific information.

Does insurance pay for the vaccine?
The vast majority of health insurance plans report including most or all of the ACIP recommended vaccines in their benefits for children adolescents and adults.

For those that qualify, HPV vaccines are also available through the federal Vaccines for Children (VFC) program. The VFC program provides free vaccinations for children aged 18 and under who meet at least one of the following criteria: 1) Medicaid eligible; 2) uninsured; 3) underinsured; or 4) Native American or Alaska Native. More information on the VFC program is available here.

Do HPV vaccines to lead to increased sexual behavior?
While some parents have expressed a concern that vaccinating their children against HPV will lead to increased sexual behavior, several studies have shown this not to be the case. While many studies relied upon self-reported behavior about sexual activity, a 2012 study published in the journal Pediatrics instead looked at medical data, including pregnancy, sexually transmitted infection testing or diagnosis, and contraceptive counseling as evidence of sexually activity. The researchers found that HPV vaccination in the recommended ages was not associated with increased sexual activity.

Do females who receive the HPV vaccine still need to get regular Pap tests?
Yes! HPV vaccines will not eliminate all HPV or cervical cancer. The vaccines prevent the HPV types that cause 70% of cervical cancer cases, but there are other types of HPV (not covered in the vaccine) that could cause disease.

In addition to regular Pap tests, women 30 and over can also request an HPV test along with their Pap. Unlike a Pap test, which only detects abnormal cell changes, an HPV test can be used to find one or more of the high-risk types of HPV that are most commonly found with cervical cancer. Most women under 30 with HPV will get rid of the virus, so the HPV test for younger women isn’t helpful.

For an additional resource check out ASHA’s brochure: HPV and Cervical Cancer Screening. 

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