Human papillomavirus (HPV) is a sexually transmitted infection (STI) that is part of the Papillomavirus family of DNA, nonenveloped viruses.1 HPV is currently the most common STI in the United States.2 The virus resolves on its own in 90% of people but in about 10%, the virus remains and puts those individuals at risk for cancers later in life.3 HPV can cause cervical cancer in females and skin warts, genital warts, anal cancer, and head and neck cancer in females and males.4
HPV is highly prevalent in cervical carcinomas.5 98% of cervical cancers have been attributed to HPV. There are several different genotypes of HPV and some are considered more high risk than others.6 HPV-16 and 18 are the main cause of cervical cancer.5 HPV-16 and 18 also cause about 84% of anal cancers,7 while HPV-6 and 11 cause a significant portion of genital warts.8 There can also be co-infections with several different types of HPV, with HPV 16 and 18 being the most common co-infection.5
There are three types of HPV vaccines: the 9-valent (Gardasil® 9, 9vHPV), quadrivalent (Gardasil®, 4vHPV), and bivalent vaccines (Cervarix®, 2vHPV).9 All three have been approved by the FDA and protect against HPV-16 and 18, but currently, only the 9-valent vaccine is available in the US. The 9-valent HPV vaccine is a virus like particle vaccine and protects against types 6, 11, 16, 18, 31, 33, 45, 52, and 58.10 The vaccine is not a live virus and cannot cause HPV in vaccinated individuals.11
Currently, about 42 million people are infected with HPV and 13 million people will acquire a new HPV infection in the US.12 This vaccine can protect females against cervical cancer, vulvar and vaginal cancers, anal cancer, head and neck cancers, and genital warts.13 The vaccine can protect males against anal cancer, head and neck cancers, and genital warts. The 9-valent HPV vaccine has been found to produce very strong immune responses against all 9 genotypes of HPV.14 Most individuals have greater than 99% seroconversions for all 9 types of HPV after taking the 9-valent vaccine.10 The vaccine has reduced the number of HPV infections that are highly associated with cancers and genital warts by 88% in teenage girls.15
The HPV vaccine is found to be most effective in individuals that have never had HPV, so it is offered as early as age 9 in girls and boys.16 However, there is a reduction in HPV related pre-cancerous lesions when the vaccine is given to individuals with and without HPV. More patients have been getting the HPV vaccine between ages 18-26 every year with an increase of 17.8% getting vaccinated between 2013 and 2018.17 The percentage of males getting vaccinated tripled in the same time period.
- Dunne EF, Park IU. HPV and HPV-associated diseases. Infect Dis Clin North Am 2013; 27 (4): 765-778.
- Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40 (3): 187-193.
- Centers for Disease Control and Prevention. Human Papillomavirus (HPV): HPV Infection. 2021; https://www.cdc.gov/hpv/parents/about-hpv.html. Accessed 19 Dec 2021.
- Egawa N, Doorbar J. The low-risk papillomaviruses. Virus Res 2017; 231: 119-127.
- Huang LW, Chao SL, Chen PH, et al. Multiple HPV genotypes in cervical carcinomas: improved DNA detection and typing in archival tissues. J Clin Virol 2004; 29 (4): 271-276.
- de Cremoux P, de la Rochefordière A, Savignoni A, et al. Different outcome of invasive cervical cancer associated with high-risk versus intermediate-risk HPV genotype. Int J Cancer 2009; 124 (4): 778-782.
- Alemany L, Saunier M, Alvarado-Cabrero I, et al. Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide. Int J Cancer 2015; 136 (1): 98-107.
- Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 2009; 199 (6): 805-814.
- Centers for Disease Control and Prevention. Vaccines and Preventable Diseases: Human Papillomavirus (HPV) Vaccination: What Everyone Should Know. 2021; https://www.cdc.gov/vaccines/vpd/hpv/public/index.html. Accessed 19 Dec 2021.
- Petrosky E, Bocchini JA, Jr., Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 2015; 64 (11): 300-304.
- The American College of Obstetricians and Gynecologists. Human Papillomavirus (HPV) Vaccination. 2021; https://www.acog.org/womens-health/faqs/hpv-vaccination. Accessed 19 Dec 2021.
- Lewis RM, Laprise JF, Gargano JW, et al. Estimated prevalence and incidence of disease-associated human papillomavirus types among 15- to 59-year-olds in the United States. Sex Transm Dis 2021; 48 (4): 273-277.
- GARDASlL 9 Vaccine [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2021.
- Lopalco PL. Spotlight on the 9-valent HPV vaccine. Drug Des Devel Ther 2017; 11: 35-44.
- Centers for Disease Control and Prevention. Human Papillomavirus (HPV): Reasons to Get HPV Vaccine. 2021; https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html. Accessed 19 Dec 2021.
- Braaten KP, Laufer MR. Human papillomavirus (HPV), HPV-related disease, and the HPV vaccine. Rev Obstet Gynecol 2008; 1 (1): 2-10.
- Boersma P, Black LI. Human papillomavirus vaccination among adults aged 18-26, 2013-2018. NCHS Data Brief 2020; (354): 1-8.