Exploring HPV Vaccines, Updated Guidelines, and Preventive Measures

HPV Vaccines

HPV vaccines are available to help protect against these health issues. According to the Committee on Adolescent Healthcare, HPV vaccines are among the most effective vaccines available worldwide, with unequivocal data demonstrating greater than 99% efficacy when administered to women not exposed to that particular type of HPV.

The US FDA has approved three HPV vaccines, all of which safeguard against the types (types 16 and 18) that are responsible for most HPV-related cancers:

• the 9-valent HPV vaccine (Gardasil 9, 9vHPV)
• the quadrivalent HPV vaccine (Gardasil, 4vHPV)
• the bivalent HPV vaccine (Cervarix, 2vHPV)

However, as of late 2016, only Gardasil-9 (9vHPV) has been distributed in the US since this particular vaccine offers protection against the greatest number of HPV types (6, 11, 16, 18, 31, 33, 45, 52, and 58).

According to Merck & Co., the manufacturer of Gardasil 9, the dosing recommendation for its vaccine typically involves a two-dose or three-dose series depending on the individual’s age.

The standard recommendation for individuals aged 9–14 is to receive two doses, administered with a minimum interval of 6 months between them. This two-dose series is considered effective for achieving immunity.

Individuals aged 15 and older, or those with a compromised immune system, are typically advised to receive a three-dose series of Gardasil 9. The doses are administered following the 0-, 2-, and 6-month schedule, with the second and third doses given 2 and 6 months after the initial dose, respectively.

The vaccine is recommended for preteens, including boys and girls — starting at age 11 or 12 — but can be given as early as age 9. Additionally, everyone through the age of 26 who has not yet been vaccinated is recommended to receive the vaccine.

Although the vaccine is not recommended for everyone older than age 26, some adults (27–45 years old) who are not vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination. Because most people have already been exposed to HPV by age 26, HPV vaccination may provide minimal benefit to this subpopulation.

HPV Vaccine Guideline Updates

Following the WHO Strategic Advisory Group of Experts on Immunization (SAGE) in early 2023, the organization released updated HPV vaccine guidelines after data revealed that a single-dose series could prevent cervical cancer:

• One or two doses for individuals aged 9–20
• Two doses administered within 6 months for those over 25

The WHO's announcement also highlights a 10% decline in HPV vaccine coverage between 2019 and 2021. These new recommendations aim to facilitate higher vaccination rates globally, as ongoing studies suggest that a single dose of the HPV vaccine may protect against HPV for up to three years.

It is important to note that having a new sex partner at any age is a risk factor for getting a new HPV infection. As a result, people who are in a long-term, mutually monogamous relationship are less likely to get a new HPV infection. Vaccination is vital in preventing infections and subsequent cancer development as STIs continue to increase.

HPV-Related Cancers

Although the body's immune system clears most HPV infections (90%) within two years, some may persist and lead to certain types of cancers, including cervical, vaginal, vulvar, penile, anal, and oropharyngeal. National Cancer Institute (NCI) data shows that nearly all cervical cancers are linked to HPV infection. Worldwide, cervical cancer is the fourth-deadliest cancer among people with a cervix.

At the 2023 American Association for Cancer Research Annual Meeting, Eric Adjei Boakye, PhD, shared survey data revealing that most Americans do not fully understand the link between HPV and cancer. Although most respondents acknowledged the association between HPV and cervical cancer, many did not fully understand how many kinds of cancer were linked to HPV infection.

In the US alone, HPV is responsible for approximately 36,000 cancer cases in all genders annually. Ongoing research will continue to shed light on the mechanisms and extent to which HPV contributes to the development of these cancers.

HPV Testing

Because there is no clinical test to determine a person's HPV status, routine cervical cancer screenings are recommended for people with a cervix aged between 21 and 65 years old during pap smears. While samples can be easily derived from the cervix, it is difficult to get a good sample from the thick skin on the penis, as stated by the American Sexual Health Association.

Because embarrassment, aversion to doctor visits, or lack of time are common reasons why many people choose not to undergo routine testing, several companies now provide an array of at-home testing and treatment options for STIs and STDs.

At-home STI testing companies are normalizing testing and treatment by offering convenient, affordable, and private testing for STIs without visiting a doctor's office or clinic and providing discreet online consultations and treatment options.

HPV Prevention

According to information provided by the NIH, most sexually active individuals contract a genital HPV infection at some stage of their lives, with over 50% being affected. However, many remain unaware of their infection, potentially unknowingly transmitting the virus to others.

“An HPV vaccine is your best opportunity to protect your child or yourself against HPV infection and subsequent disease,” said Carolyn Deal, PhD, Branch Chief, Sexually Transmitted Diseases Branch Division of Microbiology and Infectious Diseases National Institute of Allergy and Infectious Diseases, to NIH News in Health reporters.

In addition to receiving the HPV vaccine, people can reduce their risk of developing genital warts and other HPV-related genital lesions by doing the following:

• Delaying sexual activity until adequately educated and equipped with relevant resources
• Engaging in a mutually exclusive sexual relationship
• Limiting their number of sexual partners
• Using a latex condom to reduce the risk of HPV transmission

HPV Treatment

Because is no cure for HPV, treatment options focus on managing the symptoms and preventing the development of health problems. The treatment for HPV depends on the type of HPV infection and the symptoms it causes. In cases that do not clear up on their own, treatment may be necessary, including the following:

1. Wart removal through various methods such as cryotherapy (freezing), electrocautery (burning), or surgery
2. Antiviral medications, such as imiquimod, that can be applied to the affected area to stimulate the immune system and help the body fight off the virus
3. Cervical cancer treatments, such as surgery, radiation therapy, chemotherapy, or a combination.
4. Monitoring low-risk HPV infections that are not causing any symptoms

Ultimately, HPV vaccination, adherence to preventive measures, regular screenings, and ongoing research are crucial in combating HPV and reducing its associated health risks. By prioritizing education, awareness, and access to vaccines and screenings, healthcare professionals can lower HPV infection rates and improve overall health outcomes.