The human papillomavirus or HPV is the most common sexually transmitted infection. In fact, it is so common that just about all sexually active males and females will contract it at some point in their lives. About 79 million Americans are now infected with HPV. The association between HPV and genital warts and cervical cancer is well established. So, it should surprise no one that every year, about 360,000 people in the United States are diagnosed with genital warts and about 11,000 women are diagnosed with cervical cancer.
HPV may be transmitted via vaginal, anal, or oral sex. There are many different varieties of this virus. Some types are not associated with health problems. However, others have been found to be related to the previously noted genital warts and cervical cancer as well cancers of the vulva, vagina, penis, anus, tongue, and/or back of the throat (oropharyngeal cancer). And, symptoms may appear shortly after exposure or take years to emerge. At present, it is unclear why certain people with HPV develop symptoms and others do not. It is thought that people with weakened immune symptoms are at increased risk. Most people with HPV do not realize they are infected until symptoms appear.
The U.S. Advisory Committee on Immunization Practices (ACIP) recommends that male and female preteens, aged 11 or 12 years, be vaccinated with a licensed HPV vaccine. Vaccination is also recommended for females aged 13 through 26 years and males 13 through 21 years. 1 2
The vaccines are given in three separate shots over a six-month period of time. To obtain the maximum effectiveness, you must have all three shots. There are also “catch-up” vaccines, which are recommended for males up to 21 years and females through 26 years. These are for males and females who were not vaccinated when they were younger. 3 According to an article published in 2015 in Primary Care: Clinics in Office Practice, the vaccines “have been shown [to] be highly efficacious.” But, they are expensive. At present, each dose costs between $130 and $170, which does not include administration charges. While most health insurance plans cover these costs, there are some that do not. Eligible uninsured and underinsured children under the age of 19 may be covered by the U.S. Government’s Vaccines for Children Program. 4
In a study published in 2014 in Pediatrics, researchers from New York City, Ohio, and Indiana commented that some people have raised concerns that the use of the HPV vaccine will trigger higher rates of risky sexual behaviors. The cohort consisted of 339 females between the ages of 13 and 21 years who were patients at a hospital-based adolescent primary care center. They completed questionnaires immediately after HPV vaccination and two and six months later. However, not everyone returned for the follow-ups. There were 280 (82.6 percent) for the two-month follow-up and 258 (76.1 percent) for the six-month follow-up. The researchers found no association between risk perceptions immediately after vaccination and sexual risk behaviors over the subsequent six months in sexually experienced and inexperienced young women. The researchers commented that their study offered “reassuring evidence that changes in risk perceptions after vaccination are not associated with riskier sexual behaviors, providing additional support for the increasing evidence that HPV vaccination does not lead to changes in sexual behaviors among adolescents.” 5
In a study published in 2013 in Human Vaccine & Immunotherapeutics, researchers from Italy wanted to learn more about the safety of the HPV vaccine. So, they recruited 271 women who were all 25 years old to have the HPV vaccines. Only 213 of these women received all three doses of the vaccine. Still, there were no serious adverse events related to the vaccine. The most common side effect was localized pain at the vaccination site. That was followed by localized swelling and the elevation of body temperature (fever). The researchers noted that their results were similar to previous studies conducted on preadolescent Italian girls. “Fever and local pain were however more frequently registered in our sample of adult women.” 7
In an article published in 2011 in Cancer Epidemiology, Biomarkers & Prevention, researchers from Ohio and North Carolina conducted one-time HPV education sessions with groups of people who have close contact with adolescent females. These included sessions with 376 parents, 118 healthcare staff, and 456 school staff. And, the participants completed self-administered surveys. Before the sessions, the participants knew little about HPV and HPV vaccines. Following the sessions, all the participants knew a great deal more. In fact, more than 90 percent of the school staff members “believed HPV and HPV vaccine education is worthwhile for school personnel and that middle schools are an appropriate venue for this education.” And, 97 percent of parents and 85 percent of school staff members noted that they would support school-based vaccination clinics. “Education interventions represent a simple yet potentially effective strategy for increasing HPV vaccination and garnering support for school-based vaccination clinics.” 8
In a study published in 2014 in Pediatrics, researchers from several locations in Massachusetts investigated the reasons parents or guardians give for delaying the administration of the HPV vaccine in their daughters aged 11 to 17 years. The researchers conducted interviews with 124 parents/guardians in one public clinic and three private practice settings. The research also included 37 providers. The most often cited reason for not vaccinating their daughters was the lack of a physician recommendation. Apparently, providers were delaying the recommendation in girls whom they perceived to be at a low risk for sexual activity. On the other hand, providers who vaccinate more people described the HPV vaccine as a routine vaccine with a proven safety record used to prevent cancer. When presented in that framework, parents responded positively. According to the researchers, by connecting HPV vaccination to the onset of sexual activity, providers miss opportunities to vaccinate. “Routine recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates.” 10
1. Advisory Committee on Immunization Practices, www.cdc.gov/vaccines/acip.
3. Centers for Disease Control and Prevention, www.cdc.gov.
4. Lisa S. Gilmer, “Human Papillomavirus Vaccine Update,” Primary Care: Clinics in Office Practice 42 (2015): 17-32.
5. Allison Mayhew, Tanya L. Kowalczyk Mullins, Lili Ding et al., “Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents,” Pediatrics 133 (2014): 404-11.
6. Louise Baandrup, Maria Blomberg, Christian Dehlendorff et al., “Significant Decrease in the Incidence of Genital Warts in Young Danish Women After Implementation of a National Human Papillomavirus Vaccination Program,” Sexually Transmitted Diseases 40, no. 2 (2013): 130-35.
7. Miriam Levi, Paolo Bonanni, Elena Burroni et al., “Evaluation of Bivalent Human Papillomavirus (HPV) Vaccine Safety and Tolerability in a Sample of 25 Year Old Tuscan Women,” Human Vaccines & Immunotherapeutics 9, no. 7 (2013): 1407-12.
8. Paul L. Reiter, Brenda Stubbs, Catherine A. Panozzo et al., “HPV and HPV Vaccine Education Intervention: Effects on Parents, Healthcare Staff, and School Staff,” Cancer Epidemiology, Biomarkers & Prevention 20, no. 11 (2011): 2354-61.
9. Patricia Jeudin, Elizabeth Liveright, Marcela G. del Carmen, and Rebecca B. Perkins, “Race, Ethnicity and Income as Factors for HPV Vaccine Acceptance and Use,” Human Vaccines & Immunotherapeutics 9, no. 7 (2013): 1413-20.
10. Rebecca B. Perkins, Jack A. Clark, Gauri Apte et al., “Missed Opportunities for HPV Vaccination in Adolescent Girls: A Qualitative Study,” Pediatrics 134, no. 3 (2014): e666-e674.
11. Nadereh Pourat and Jenna M. Jones, “Role of Insurance, Income, and Affordability in Human Papillomavirus Vaccination,” American Journal of Managed Care 18, no. 6 (2012): 320-30.
Baandrup, Louise, Maria Blomberg, Christian Dehlendorff et al. “Significant Decrease in the Incidence of Genital Warts in Young Danish Women After Implementation of a National Human Papillomavirus Vaccination Program.” Sexually Transmitted Diseases 40, no. 2 (2013): 130-35.
Gerend, Mary A., and Janet E. Shepherd. “Correlates of HPV Knowledge in the Era of HPV Vaccination: A Study of Unvaccinated Young Adult Women.” Women & Health 51, no. 1 (2011): 25-40.
Gilmer, Lisa S. “Human Papillomavirus Vaccine Update.” Primary Care: Clinics in Office Practice 42 (2015): 17-32.
Jeudin, Patricia, Elizabeth Liveright, Marcela G. del Carmen, and Rebecca B. Perkins. “Race, Ethnicity and Income As Factors for HPV Vaccine Acceptance and Use.” Human Vaccines & Immunotherapeutics 9, no. 7 (2013): 1413-20.
Kharbanda, Elyse Olshen, Emily Parker, James D. Nordin et al. “Receipt of Human Papillomavirus Vaccine Among Privately Insured Adult Women in a U. S. Midwestern Health Maintenance Organization.” Preventive Medicine 57 (2013): 712-14.
Langer-Gould, A., L. Qian, S. Y. Tartof, S. M. Bara et al. “Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases.” JAMA Neurology 71, no. 12 (2014): 1506-13.
Levi, Miriam, Paolo Bonanni, Elena Burroni et al. “Evaluation of Bivalent Human Papillomavirus (HPV) Vaccine Safety and Tolerability in a Sample of 25 Year Old Tuscan Women.” Human Vaccines & Immunotherapeutics 9, no. 7 (2013): 1407-12.
Mayhew, Allison, Tanya L. Kowalczyk Mullins, Lili Ding et al. “Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents.” Pediatrics 133 (2014): 404-11.
Perkins, Rebecca B., Jack A. Cark, Gauri Apte et al. “Missed Opportunities for HPV Vaccination in Adolescent Girls: A Qualitative Study.” Pediatrics 134, no. 3 (2014): e666-e674.
Pourat, Nadereh, and Jenna M. Jones. “Role of Insurance, Income, and Affordability in Human Papillomavirus.” American Journal of Managed Care 18, no. 6 (2012): 320-30.
Reiter, Paul, Noel T. Brewer, Annie-Laurie McRee et al. “Acceptability of HPV Vaccine Among a National Sample of Gay and Bisexual Men.” Sexually Transmitted Diseases 37, no. 3 (2011): 197-203.
Reiter, Paul L., Brenda Stubbs, Catherine A. Panozzo et al. “HPV and HPV Vaccine Education Intervention: Effects on Parents, Healthcare Staff, and School Staff.” Cancer Epidemiology Biomarkers & Prevention 20, no. 11 (2011): 2354-61.
Topan, Aysel, Ozlem Ozturk, Hulya Eroglu et al. “Knowledge Level of Working and Student Nurses on Cervical Cancer and Human Papilloma Virus Vaccines.” Asian Pacific Journal of Cancer Prevention 16, no. 6 (2014): 2515-19.
Advisory Committee on Immunization Practices. www.cdc.gov/vaccines/acip .
Centers for Disease Control and Prevention. www.cdc.gov .