What is HPV?

HPV is a very common virus. Nearly all sexually active people have HPV at some time in their lives. The virus is spread commonly through vaginal or anal sex. It can also be spread through oral sex or other close skin-to-skin touching during sex.
There are many different types of HPV and these are divided into “high risk” and “low risk” types. In most cases, a person’s immune system clears the infection and HPV does not cause any health problems. When an infection persists, the low risk types of HPV can cause genital warts and the high risk types can cause cervical and other cancers, including cancer of the vulva, vagina, penis, anus and back of the throat. Cancer usually takes years, even decades, to develop after a person is infected with HPV.
HPV vaccines are very effective and can protect both men and women from getting the infection. Using condoms correctly every time you have sex can also lower your chances of getting HPV, but HPV can infect areas that are not covered by the condom. Although Pap tests cannot protect you against HPV, regular screening is important to detect changes on the cells of the cervix that can become cancer.
What are the benefits of the HPV vaccine?
There are 3 HPV vaccines available in Canada – Cervarix®, Gardasil® and Gardasil 9®. Cervarix® protects against HPV types 16 and 18. These 2 types of HPV cause about 70% of cervical cancers. In addition to this, Garadasil® offers protection against HPV types 6 and 11 which causes 90% of genital warts. Gardasil 9® is the newest HPV vaccine and protects against an additional 5 high-risk HPV types that in total are responsible for about 90% of cervical cancers.

Who should get the vaccine?

Cervarix® is approved for females aged 9 to 45 for the prevention of cervical cancer.

Gardasil® and Gardasil 9® are approved for:
• Females aged 9 to 45 for the prevention of anal, cervical, vaginal and vulvar cancers and genital warts.
• Males aged 9 to 26 for the prevention of anal cancers and genital warts.

Individuals outside of these age groups may also benefit from the HPV vaccine and should speak with their healthcare provider. In particular, the vaccine is recommended for men having sex with men because they are at greater risk for anal cancers.

Who should not get the vaccine?

You should not get the vaccine if you are allergic to yeast or any other component of the HPV vaccine or if you are pregnant. If you have a fever or are ill with something more severe than a cold, delay the vaccine until you feel well.

Are there possible side effects?

The HPV vaccine is very safe. The most common side effect is a brief soreness at the site of the injection. Other less common side effects include mild to moderate fever and itching at the injection site. A serious allergic reaction (anaphylaxis) after the HPV vaccine is very rare (2.6 per 100,000 doses of vaccine).

Routine vaccination

In Ontario, the HPV vaccine is offered at no cost to girls and boys in grade 7. A catch-up program for the vaccine is also available at no cost to any female who is still enrolled in high school. Beginning in the 2017/2018 school year the catch-up program will also be available to males in grade 8, in 2018/2019 to males in grade 8 and 9 and so forth.
Ontario also provides the HPV vaccine at no cost to men who identify as gay, bisexual and some trans individuals and who are 26 years old and younger (men who have sex with men).

Vaccine schedule and missed doses

All three HPV vaccines are given as 3 separate injections, but on slightly different schedules:

• For Cervarix®, the second dose is given 1 month after the first dose and the third dose is given 6 months after the first dose (0, 1, 6 months).

• For Gardasil® and Gardasil 9®, the second dose is given 2 months after the first dose and third dose is given 6 months after the first dose (0, 2, 6 months).

For people 9 to 13 years old, Cervarix® and Gardasil® can also be given as 2 doses separated by 6 months.

If any doses of the HPV vaccine are missed, the vaccine series does not need to be restarted. Get the next dose as soon as possible. Presently, it is believed that there is no need for a booster dose for any of the HPV vaccines.

Vaccine cost

The cost for all 3 doses of Cervarix® is approximately $300. For Gardasil® and Gardasil 9® it is about $500 and $550, respectively. Many private insurance plans will cover some or all of the cost.
More information
• The HPV vaccine is most effective if it is given before any type of sexual contact. The vaccine will not cure an infection a person has already acquired.
• Use condoms consistently to reduce exposure to HPV and other sexually transmitted infections. This will decrease the risk of developing cervical cancer and genital warts.
• Limit the number of sexual partners you have.
• Delay unprotected vaginal or anal sex until you are older. Vaginal sexual activity at an earlier age during adolescence makes it easier for high-risk types to infect the cervix since the cervix is not usually mature.
• Get regular Pap tests, as appropriate, even if you have had the HPV vaccine.
• Avoid smoking tobacco.

Adapted from Toronto Public Health