Who Should Get the HPV Vaccine?
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Human papillomavirus (HPV) infection of the cervix can lead to cervical cancer. A vaccine designed to prevent cervical cancer and other diseases caused by infection with HPVs was approved for use in the U.S. in June 2006. This was the first vaccine to be developed against a known risk factor for the development of a cancer.
While some HPV types infect the skin and cause benign warts and other lesions, about 40 types of HPVs can infect the genital tract. Genital HPV infection is very common in the general population; estimates suggest that up to 50% or more of all sexually-active people will be infected at some point in their lives. In the majority of cases, the infection does not cause any symptoms, but in some women, HPV infection can progress to cause precancerous and cancerous lesions of the uterine cervix. HPVs that infect the genital area are also associated with other less common genital cancers in men and women such as cancers of the anus, vagina, penis, and vulva. HPV infection also causes genital warts in both men and women.
The most common HPV types that infect the genital area are HPV types 6, 11, 16, and 18. Among these, HPV types 6 and 11 are most commonly associated with benign lesions, such as genital warts and mild precancerous changes of the cervix. In contrast, HPV types 16 and 18 are the types found in the majority of cancers as well as in severe precancerous changes of the cervix. The vaccine, called Gardasil, targets these four common HPV types.
Gardasil, developed by Merck & Co., has been shown to be safe and 100% effective in preventing infection by these four common HPV types in young people who have not been previously infected with HPV. Its effectiveness is lessened for those who have already been exposed to the viruses.
Another vaccine directed at HPV types 16 and 18 (the two HPV types most commonly associated with cervical cancer), known as Cervarix, manufactured by GlaxoSmithKline, was the second HPV vaccine to be developed.
Both vaccines are effective against diseases caused by HPV-16 and HPV-18 and can prevent cervical precancers in women as well as cancers of the cervix, vulva, vagina, penis, anus, and oropharynx. Only Gardasil has been tested and shown to prevent precancers of the vulva, vagina, and anus. Only Gardasil protects against HPV-6 and HPV-11, the virus types that commonly cause genital warts.
Ideally, vaccination should occur before youth become sexually active, since those who have not yet been infected with any HPV types will get the full benefit of the vaccine. Therefore, it is recommended by the CDC that 11- to 12-year-old girls receive three doses of either vaccine. Young women ages 13 through 26 should get the vaccine if they did not receive any or all doses when they were younger. Gardasil is also approved for use in males aged 9 to 26. The CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years who did not receive the full three vaccination series. Men up to age 26 may receive the vaccine. The HPV vaccine is recommended for any men who have sex with men or men with compromised immune function, up through 26 years of age.
Research is ongoing to determine whether the vaccine has any beneficial effects in older women, and its safety for use in pregnant women has not yet been determined. It is also not known if the vaccine confers lifelong immunity, since long-term study results are not yet available.
Since Gardasil only targets the four major types of HPV that infect the genital tract, it cannot protect against all causes of HPV. HPV types 16 and 18 are the causes of about 70% of all cervical cancers, and HPV types 6 and 11 cause about 90% of genital warts. All women, even those who have received the vaccine, should still undergo regular cervical cancer screenings.
Both vaccines are given as a three-dose series over a period of 6 months.
Last Editorial Review: 1/13/2014