Answers to common questions about the HPV vaccine

Co-author: Wendy Chen (Pharm. D. Candidate) & Dr. Bernard Ho (MD)

1. What is HPV

Human papillomavirus (HPV) is the name of a group of sexually transmitted viruses. They are common and most people will get some form of HPV in their life. HPV spreads through sexual contact (oral, vaginal, anal) and intimate skin-to-skin contact with an infected person. Most of the time, HPV does not cause any symptoms. However, in certain cases, high risk HPV types can cause genital warts and cancer such as cervical cancer, vaginal cancer, anal cancer and penile cancer.

2. What does HPV vaccine do? Does it protect against all HPV types?

There are more than 100 types of HPV and the HPV vaccine does not protect against all of them. Instead, the vaccine targets the specific high-risk virus strains that cause most cases of cervical cancer and genital warts ——types 6, 11, 16 and 18. Types 16 and 18 cause 70% of all cervical cancer, while types 6 and 11 account for 90% of genital warts. HPV vaccines can prevent most cases of cervical cancer if given to women or girls who have not been exposed to the virus. In addition, it can also protect against genital warts, some mouth and throat cancers, as well as the cancers of the anal and genital area.

There are three types of HPV vaccines currently available in Canada: Gardasil®, Cervarix™, and Gardasil®9. Cervarix™ or HPV2 vaccine protects against HPV type 16 and 18. Gardasil® or HPV4 vaccine protects against HPV type 6, 11, 16 and 18. Gardasil®9 or HPV9 vaccine protects against five additional HPV types (HPV 31, 33, 45, 52 and 58). In other words, all three vaccines protect against anogenital cancers. Gardasil® and Gardasil®9 also protect against genital warts.

3. Who should receive the HPV vaccine? Should men/boys get the HPV vaccine? If I am not sexually active, do I still need to get the vaccine?

Both men and women can benefit from the HPV vaccine. Although males are less likely to develop genital cancer from HPV, the vaccine can protect them from genital warts and further benefit the female population by decreasing transmission of the virus.

To achieve maximum protection, people should receive the HPV vaccine before they become sexually active. The ideal age to be vaccinated is around 9 to 13 years old. However, the vaccine is still recommended for women age 13 to 26 who have not yet received it. For women who are 27 years of age or older, the vaccine may still be administered as a second peak of HPV prevalence is observed in women 45 years and older. HPV vaccine after the onset of sexual activity can still be beneficial because it protects against multiple types of HPV.

While you may not be sexually active now, you may be at some point in your life. In this case, you should still consider receiving the HPV vaccine. Therefore, if you have not yet been vaccinated, it would be beneficial to speak with your family doctor about it, regardless of your age or gender.

4. Are there any side effects of the vaccine? Who should not get the vaccine?

Common side effects of the HPV vaccine include:

- Pain, redness or swelling in the arm where the injection was given

- Fever

- Nausea

- Muscle or joint pain

- Mild headache

- Fatigue

- Dizziness

These side effects should be short-lasting and should not significantly impair your daily function. If you feel that the side effects that you are experiencing are severe, please seek medical help immediately.

There are also certain populations who should not get the vaccine or should speak to their doctor before receiving one:

- Anyone who has had a life-threatening allergic reaction to any component of the HPV vaccine, or to a previous dose of the vaccine should not get it

- Pregnant patients are not recommended to get the HPV vaccine as there is limited data in this population. However, the vaccine has not been shown to be dangerous in pregnant patients

- Anyone with a moderate or severe illness (ex. high fever) should wait until they are better to receive the vaccine

5. Is HPV vaccine covered for everyone?

In Ontario, all students in grade 7, 8 and 9 can receive the HPV vaccine for free. Men who have sex with men, under the age of 27 are also eligible for the free vaccine. In addition, many private insurances also cover parts of or all the costs of the vaccine.

6. Other ways to prevent HPV and cervical cancer.

-Delaying first sexual encounter

-Limiting the number of sexual partners

-Avoiding sexual activity with people who have had many partners

-Avoiding sexual activity with people who are infected with genital warts or other symptoms.

-Smoking cessation

Also, two screening tests can help prevent cervical cancers:

-Pap test, which looks for precancer cells in the sample

-HPV test, which looks for HPV in the sample

It is recommended that women at age of 25 who have been sexually active should start getting Pap test.