Monday, January 16, 2017

Questions and Answers About HPV and the Vaccine

Many people have questions about human papillomavirus (HPV) and the vaccine that prevents it. Here, you can find a compilation of some common questions. Can't find what you're looking for? 

HPV infection - general

How long does an HPV infection last?

HPV infections can last up to 24 months before the immune system overcomes the infection. During this time, most people do not know they are infected. This is why it is difficult to stop transmission of the virus.

How long does it take for symptoms of HPV to appear?

People can be infected with HPV for years, or even decades, before they experience any symptoms of infection. This is why women should get regular Pap screenings. Because Pap screenings show early signs of changes in cells of the cervix (precancerous changes), treatment is often more successful than once physical symptoms, such as bleeding and pain, appear.

If someone has genital warts, does that mean HPV virus is still present?

Yes. If a person has outward signs of infection, such as genital warts, he or she can transmit the virus. However, it is important to realize that people can also transmit HPV when they do not have any symptoms. Additionally, even if someone has genital warts removed, they may still be infected and able to transmit the virus.

What does it mean when people say an HPV infection “cleared”? Is the infection gone or is it dormant? Can it still be spread to someone else?

HPV infections cause persistent infections. This means that when a person is infected, the virus is reproducing in the cells that line the infected area. It does not live silently inside of cells like herpes viruses. This means that when the immune system “clears” the infection, it is no longer present, and therefore it cannot be spread to someone else.
However, what is important to understand is that many people have HPV infections without symptoms; so they do not realize they are infected. Further, since a Pap test checks for cellular changes and not the presence of virus, a “negative” Pap test does not mean that no HPV infection is present. It only means that the cells that line the cervix do not currently show signs of damage caused by a persistent HPV infection. This is why it is important to get regular Pap tests.

I have heard HPV can be transmitted by skin-to-skin contact. So, if a woman has HPV, can I or my children get it by being around her?

No. HPV is not transmitted by simply being near or touching someone who has it. The reference to skin-to-skin contact refers to intimate interactions, such as genital-to-genital or oral-to-genital contact.

I have never been diagnosed with HPV or genital warts, so how could my child have recurrent respiratory papillomatosis?

Recurrent respiratory papillomatosis, or RRP, is primarily caused by two types of HPV that also commonly cause genital warts, types 6 and 11. Most children diagnosed with RRP before 5 years of age are believed to get it from their mom while passing through an infected birth canal. Because many people are infected with HPV and never have symptoms, they do not know they had an HPV infection. Therefore, unfortunately, it is possible that you could have had an undiagnosed HPV infection during pregnancy that led to your child’s infection.

I have been in a monogamous relationship for more than 20 years; however, I was recently diagnosed with genital warts. My wife has never had them. How could I have gotten them?

Your question is a common one. Almost everyone who is sexually active will be infected with HPV at some point. For many, they may never know when or how they were infected for a few reasons. First, symptoms can appear years after the initial infection. Second, the disease can be transmitted without having intercourse. Skin-to-skin contact or oral sex can also transmit the virus. Finally, even people who do not know they are infected and those who do not have any symptoms may still transmit the virus.

Even though I got the HPV vaccine, I got genital warts. Will I always have them?

Even if you had the HPV vaccine, you could still develop genital warts if you were infected with a strain of HPV not contained in the vaccine. You may want to consider visiting your healthcare provider to confirm the diagnosis since what you think is genital warts could be something else. If you do have genital warts, your doctor can go over treatment options with you depending on your particular situation. You can read the information about treating genital warts from the Centers for Disease Control and Prevention.

If a woman is exposed to HPV through oral sex with a man who has had genital warts, can she get HPV and if so, will her infection occur in the oral or genital region?

Yes. A woman can be exposed to HPV if she has oral sex with a man who has an HPV infection (with or without current symptoms). If this happens, the infection will occur in the mucosal areas of her mouth, such as in cells in her throat. In most cases, the woman’s immune system will clear the infection without any symptoms. In very rare cases, the virus will persist and cause a condition known as recurrent respiratory papillomatosis (RRP). People with RRP develop warts in their throat which can become large enough that they cause hoarseness or trouble breathing.

How does HPV cause cancer?

HPV infects epithelial cells that line mucosal surfaces of the body. When HPV enters these cells, such in the throat, genital tract or anus, it causes the cells to produce HPV proteins. In most cases, the immune system recognizes the cells that are infected and eliminates them, clearing the infection. However, in some instances a persistent infection occurs causing the cells to mutate, or change. These mutations can ultimately lead to cancer.

Can you get HPV from someone who does not have any symptoms of HPV?

Yes, in fact, most people do not know when they are infected with HPV. So, even if your partner does not have any symptoms of an HPV infection, he or she can still pass the virus to you.

How soon will genital warts appear if I get infected with HPV?

Genital warts typically develop four weeks to eight months after contracting one of the types of HPV that cause genital warts. However, HPV can also remain dormant for several years before genital warts appear.

Am I really at risk of getting HPV?

HPV is spread through genital contact, most often, but not always, during sex. Most people don’t know they have HPV, so they often don’t realize they are spreading the virus. Since HPV is so common, the best way to reduce your chance of getting infected is to be vaccinated with the HPV vaccine.

How common is HPV?

HPV is one of the most common sexually transmitted diseases among both men and women in the United States. Currently, about 20 million Americans are infected with HPV and every year, about 6 million new infections occur.
HPV causes cervical cancer, one of the most common cancers in women. Every year in the United States, 11,500 women get cervical cancer and about 4,000 women die from the disease. Worldwide, the total number of deaths from cervical cancer every year is about 300,000. HPV is also known to cause genital warts as well as cancers of the penis, vagina, vulva, anus and oropharynx.

How soon after an HPV infection does cervical cancer develop?

Progression from an initial HPV infection to cancer requires prolonged infection with a type of HPV that causes cancer. For this reason, cervical cancer typically develops 20 to 25 years after the initial HPV infection. Regular Pap tests and HPV tests will help your doctor monitor for precancerous changes to the cells of the cervix.

I have heard that you do not need to have intercourse to get HPV. Is that true?

Yes. Although most infections occur following intercourse, HPV may also be passed on during oral sex and genital-to-genital contact. Even more rarely, a mom can transmit the virus to her baby during birth.

How do I know if my partner or I have been exposed to HPV?

Because most people do not develop symptoms of infection, they do not know they are infected. To avoid or decrease the chance of exposure, you can abstain from sexual activity, limit the number of sexual partners you have and use condoms. Unfortunately, other than abstinence, none of these methods offers complete protection.

Is HPV deadly?

Yes, in some people the virus causes changes in cells that lead to the development of cancer.

Is there a treatment for HPV?

Most HPV infections clear on their own in a few years without causing any health problems. While there are no treatments for the infection, there are supportive treatments for the health problems caused by HPV, such as genital warts and cancers.

If there are no screening tests for men, how can they tell if they have HPV and if so, what is the treatment?

Although there is no approved test for men to know their "HPV status," most HPV infections resolve without causing any problems. The problems caused by HPV in men can include genital warts, anal and penile cancers, or cancers of the oropharynx. There are ways to check for those:
  • Genital warts - If you notice abnormalities in the area of your penis, scrotum or anus, such as warts or blisters, see your healthcare provider.
  • Anal cancers - Gay, bisexual, and HIV-positive men may consider annual screening. Although it is not a formal recommendation, these men are at higher risk.
  • Penile cancers - There are currently no screening tests, but early signs can include color changes or build-up or thickening of the tissue.
  • Cancers of the oropharynx - Signs include issues associated with the throat including pain, constant coughing, voice changes or hoarseness, lumps or masses in the necks, and trouble swallowing or breathing.
Although there are not treatments for HPV, there are supportive treatments for the health problems caused by HPV.
The CDC has an excellent fact sheet related to men and HPV that can provide you with a wealth of additional information.

Once a person has HPV, can he or she get rid of it?

Yes, in fact, most people (9 of every 10) do clear the infection within two years, often never having symptoms. For those who don't clear the infection (the remaining 1 of every 10 people), they may suffer from genital warts, cervical cancer or other cancers.

Can a woman pass HPV to a male partner through intercourse?

Yes, a woman can pass the infection to a partner as well as to her baby during birth, although the latter is fairly uncommon. While the infection is most commonly transmitted through intercourse, the virus can also be passed to one's partner during genital-to-genital contact or oral sex.

Can someone be infected with more than one type of HPV?

Yes, you can be infected with more than one type of HPV at a time.
HPV and pregnancy

HPV and pregnancy

Does having HPV put my unborn baby at risk?

In rare instances, mothers with genital HPV can pass the virus to their baby during vaginal delivery. A small number of these babies go on to develop recurrent respiratory papillomatosis (RRP), a condition in which tumors grow in the throat, sometimes causing hoarseness and difficulty breathing, talking and swallowing. While the tumors can be surgically removed, they tend to grow back. Some people with RRP require regular surgical intervention. RRP can also cause a disease of the lungs that resembles cystic fibrosis.
A link between HPV and miscarriage, premature delivery or other complications has not been found.
Consult your doctor if you have any concerns.

Can I get the HPV vaccine if I am pregnant?

Although the HPV vaccine has not been found to cause harm to a woman or her fetus, it is recommended to wait until after delivery to start or continue with the series.
If you got the vaccine while you were pregnant, you do not need to take any special precautions. However, you or your doctor should report the exposure to the appropriate registry that has been established to keep track of these occurrences:

  • Receipt of Gardasil® should be reported to 877-888-4231

I started getting the HPV vaccine and now I am pregnant. Can I still get the other doses of vaccine?

You should wait until after you deliver to get the remaining doses of vaccine. There is no indication that the vaccine causes harm to you or your unborn baby, but it is recommended to wait just to be safe. After you deliver, you can resume the process of getting the remaining doses.

HPV and Pap testing

HPV and Pap testing

The Centers for Disease Control and Prevention (CDC) has a helpful resource for understanding Pap and HPV tests.

Does a negative Pap test mean that I am not infected with HPV?

No. A Pap test is one in which cells isolated from the cervix are examined under a microscope for precancerous changes caused by a persistent, or long-term, HPV infection. So, a negative Pap test is good news in that it means the cervical cells appear normal, but it does not give any information about a person’s HPV status.
An HPV test is another type of test that is available. Although this test does measure the presence of HPV virus in the cervical cells, it does not provide information about whether that infection will remain long term or eventually cause cancer. Because many younger women get an HPV that is cleared by their immune systems, the HPV test can often be positive, causing unnecessary concern; therefore, it is not recommended for most women younger than 30 years of age.

I get regular Pap tests and they have always been normal, so how could my child have developed recurrent respiratory papillomatosis?

Pap tests identify changes to cervical cells that could lead to cervical cancer; however, the types of HPV that cause cervical cancer are rarely associated with recurrent respiratory papillomatosis (RRP). Therefore, you could have had an infection with one of the types that cause RRP and continue to have normal Pap tests. Also, HPV can infect cells without causing the types of precancerous changes that lead to an abnormal Pap smear.

My boyfriend recently had warts on his penis. When I went to the clinic and had a Pap test, the results were normal. Does this mean that I did not get infected, or is there still a chance I could get genital warts?

The types of HPV that cause genital warts typically differ from those that cause cervical cancer. Since a Pap test is meant to identify potential cellular changes that could lead to cervical cancer, it does not provide information about HPV infections with types that cause genital warts. For this reason, your Pap test results do not mean that you did not get infected with HPV when your boyfriend had it. The good news is that for many people, the infection will clear without any symptoms, so you may never experience genital warts like your boyfriend did.

What happens if my Pap test is abnormal?

If you have an abnormal Pap test, an HPV test may be suggested to determine if human papillomavirus DNA is present in the cells of the cervix. If the results of the HPV test are positive, your doctor will determine how frequently you should be tested. In addition to HPV and Pap tests, a colposcopy or biopsy may be suggested. A colposcopy magnifies the cells of the cervix and a biopsy takes a sample of cervical cells

How frequently should you get a Pap test?

According to the National Cancer Institute, women should get their first Pap test at age 21, and then once every three years until they turn 29. Women who are 30 to 65 years old should have both Pap and HPV tests performed every five years, or a Pap test alone every three years. Women who have an irregular Pap test or who are at risk due to other factors, such infection with Human Immunodeficiency Virus (HIV) or previous diagnosis of cervical cancer, may be required to get tested more frequently. Visit the National Cancer Institute website for more information.

Can HPV tests replace Pap tests?

No, HPV tests should not replace routine Pap tests for two reasons: 
  1. The tests are not measuring the same thing. Pap tests detect changes in the cells of the cervix that could lead to cancer, whereas HPV tests detect human papillomavirus DNA in the cells of the cervix. A positive HPV test could be the result of a recent infection or a chronic infection.
  2. The tests are recommended for slightly different age groups; routine Pap tests are recommended for all women 21 years and older, whereas HPV tests are recommended for women 30 years and older and only those women between 21 and 29 who have had an irregular Pap test.

Is there a test to determine if I have HPV?

Yes. The HPV test is used to determine if HPV DNA is present in the cells of the cervix. Positive results mean that your cervix has the types of HPV commonly linked to cervical cancer; however, a positive result does not mean you have cervical cancer. Based on the results, your doctor will determine how frequently you should be tested and whether other tests should be performed. Currently, HPV tests are recommended for all women 30 years and older and any woman 21 to 29 years old who has had an irregular Pap test.

What tests can a woman have related to HPV?

There are two tests women commonly have related to HPV:
  • Pap test - A Pap test is done by scraping some cells from the cervix and examining them microscopically. A normal result means your cells looked as expected; an abnormal result means that the cells appeared to have undergone some changes. This does not mean you have cervical cancer. In some cases the cell changes are minor and will return to normal when tested in the future. In other cases the cell changes are more dramatic and need to be monitored more closely.
  • HPV test - The HPV test determines if the human papillomavirus is present in the cervix.
The CDC has a great information page about the different test results and what they mean.

When a person is tested for STDs is HPV testing included?

STD testing is not the same for every person as it depends upon individual risk factors. For HPV, there is no test for males. For females, HPV can be detected by either Pap tests or an HPV test. The Mayo Clinic has a good discussion regarding how to determine what STD tests you may need and what is available.

I got all necessary doses of the HPV vaccine. Do I still need to get Pap tests?

Yes. The HPV vaccine does not contain all of the types of HPV that can cause cervical cancer; therefore, it is important to continue getting Pap tests.

If I have had an abnormal Pap test in the past, can I still get the HPV vaccine?

Yes. You should still get the HPV vaccine even if you have had an abnormal Pap test because even if you have been infected with HPV, it is not likely that you have been infected with all of the types that the vaccine protects against. So, you can still benefit from protection afforded by the HPV vaccine.
HPV vaccine

HPV vaccine

If someone already has HPV, does it help to get the HPV vaccine?

Yes. Typically, people with HPV have not been infected with all of the strains contained in the vaccine, so the vaccine could protect them from strains to which they have not been exposed previously. However, the vaccine will not help treat or protect against types of HPV to which the person has already been exposed.

Can the HPV vaccine cause cancer?

Because the HPV vaccine is made using only a single protein from each type of the virus, it can’t cause HPV, and, therefore, it can’t cause cervical cancer or other cancers.

My son received the first dose of HPV vaccine and then two months later he was ill with severe stomach pains, rash and a headache. Could this illness have been caused by the vaccine?

It is not likely that your son’s symptoms were the result of his HPV vaccination for a couple of reasons. First, the length of time between the dose and the appearance of symptoms is not what one would expect if the vaccine was the cause. Second, of the three symptoms you mentioned, the only one that was consistently reported in HPV vaccine recipients was headache, and that was typically reported within 15 days of the first dose.

Does the HPV vaccine cause infertility?

No. HPV infections do not cause infertility, except indirectly in cases when they progress to cervical cancer, so it is not biologically plausible that the HPV vaccine would lead to infertility. To the contrary, since the HPV vaccine decreases the number of cases of cervical cancer, it may indirectly decrease the number of women unable to have a baby.

How long does immunity last if you receive all doses of the HPV vaccine?

We do not know for sure whether immunity will last a lifetime; however, the data are reassuring. First, the vaccine has been studied for more than 10 years at this point, and there is not a sign of waning immunity in those who received the vaccine that long ago. Second, the immune responses generated by the vaccine are stronger than those invoked after natural infection. Finally, the hepatitis B vaccine, which uses similar technology, induces a memory response that lasts at least 25 years.

If I got all necessary doses of the HPV vaccine, can I still develop genital warts?

Yes, it is possible. Although the HPV vaccine protects against the two strains of HPV that most commonly cause genital warts, it will still only prevent about 9 of every 10 cases of genital warts. Therefore, someone could still get genital warts if they are infected with a type of HPV that causes genital warts but was not in the vaccine.

I have received two doses of the HPV vaccine, but missed my third dose. Do I need to start again?

No, you do not need to start the vaccine again, but you may or may not need a third dose depending on your age and the time between your previous doses:
  • If your previous doses were not separated by at least five months, you should get the third dose as soon as enough time has passed to separate the first dose from the third dose by at least six months.
  • If you are under 15 years old and your first two doses were at least six months apart, you do not need a third dose.
  • If you are 15 years or older, you still need the third dose; it should be separated from the first dose by six to 12 months.

I heard that the cervical cancer vaccine does not prevent all cases of cervical cancer. If this is true, aren’t people getting a false sense of security?

The strains of HPV included in the vaccine will prevent about 9 of 10 cases of cervical cancer. However, because there is still a possibility of getting cervical cancer from one of the types of HPV not contained in the vaccine, women should continue to get regular Pap tests. In addition, the vaccine does not protect against other sexually-transmitted diseases, so practicing safe sex is also important.

I have heard there is a new HPV vaccine that protects against more types of HPV, but my teens have already had the old one. Do they need to get it again?

The HPV vaccine protects against nine types of HPV (Gardasil 9®). To date, the CDC has not added any recommendation for giving this vaccine to people who already had the earlier HPV vaccines (Cervarix® or Gardasil®-4). However, because the vaccine protects against additional types of the virus, individuals may still wish to get the vaccine. In this case, the person should speak with his/her healthcare provider regarding the relative benefits associated with this choice.

I had two doses of the HPV vaccine a while ago. Now, I hear there is a different one that protects against more types of HPV. Should I get that one and if so, do I need to get all three doses of the new one?

The newer version, Gardasil 9®, is the only version currently available, so you can be protected against more types of the virus by getting the vaccine. The 9-valent vaccine can be used in place of either of the previous two HPV vaccines (Gardasil® and Cervarix®) to complete a vaccination series, so, you do not need to start over again. You would just get the last dose with the current vaccine option.
If you are younger than 15 years old and your first two doses were separated by five months or more, you do not need any additional doses.

How long after I get the HPV vaccine will it take for me to be protected?

As with other vaccines, the immune response will take about one to two weeks to develop and will become more complete after each dose. Best protection may not be realized until all doses of the HPV vaccine are completed.
Also realize that the HPV vaccine does not protect against all types of HPV or all STDs. Therefore, it will be important to continue practicing safe sex and getting regular Pap tests.

If my partner and I had the HPV vaccine, do we still need to use condoms?

Yes. The HPV vaccine does not prevent all types of HPV or other types of sexually-transmitted diseases. The Centers for Disease Control and Prevention (CDC) has a helpful fact sheet about the use of condoms.

I am in my early 20s and would like to get the HPV vaccine, but I don’t know where to get it. What do you suggest?

You should start by checking with your primary healthcare provider. If you cannot get the vaccine from their office, you should also check with your gynecologist, the local health department or a local pharmacy. The manufacturer, Merck, also has an adult vaccine locator on their website that might be of help.

I am concerned that giving the HPV vaccine to young girls will lead them to become sexually active at an earlier age. Has this been studied?

Yes. A few studies have looked at this and none has found that receiving the HPV vaccine causes girls to become promiscuous or engage in sexual activity at an earlier age. One such study by Robert Bednarczyk and colleagues, published October 2012 in Pediatrics, compared the medical records of 493 girls who received the HPV vaccine and 905 who didn’t. The study found no difference between the two groups in regards to incidence of pregnancies, tests for or diagnosis of sexually transmitted diseases (STDs), and contraceptive counseling. Based on these results, the authors of the study reported that the HPV vaccine “was not associated with increased sexual activity-related outcomes.”

Will an HPV booster shot ever be required?

HPV booster doses are not expected to be necessary; however, public health officials will continue to monitor rates of disease to watch for waning immunity.

Who should get the HPV vaccine and how many doses?

The HPV vaccine is recommended for adolescents between 11 and 12 years of age, and all teenagers and adults between 13 and 26 years of age who did not get the vaccine when they were younger. Children as young as 9 years old can also receive the HPV vaccine.
Two doses of the HPV vaccine are recommended for those younger than 15 years of age, with the second dose administered six months after the first one. Those 15 years and older should receive three doses of HPV vaccine with the second dose given one to two months after the first, and the third dose given six to 12 months after the first.

I heard that even people who have not received the HPV vaccine have less chance of getting HPV since the vaccine came out. Please explain how this occurred and why I need to get the HPV vaccine?

The HPV vaccine was introduced in 2006, and according to an article published in the July 2012 issue of Pediatrics, use of the HPV vaccine has resulted not only in lower rates of infection among those who were vaccinated, but also to some degree in those who have not been vaccinated. This phenomenon is commonly known as herd immunity.
You should still consider getting the vaccine for two reasons. First, additional studies are needed to reproduce these findings. Second, while herd immunity might lessen your chance of coming into contact with the virus, the vaccine will decrease your chance of infection if you do come into contact with it.

Can the HPV vaccine help me get rid of genital warts?

If you already have genital warts, the HPV vaccine will not treat them. However, the vaccine may still protect you against other types of HPV to which you were not previously exposed. Consult your doctor about medicines and procedures that may be used to treat genital warts.

I didn't get the last dose of the HPV vaccine. Do I need to start over again?

No. You can just resume where you left off.

I heard stories of girls developing different illnesses after getting the HPV vaccine. Are these stories true?

The known side effects of the HPV vaccine include pain, redness or swelling at the injection site. In addition, because teens tend to faint more easily, fainting has been associated with vaccines given to this age group. Because of this, your teen should remain seated or lying down at the doctor’s office for about 15 minutes after getting the vaccine.
Reports of blood clots, strokes, heart attacks, chronic fatigue syndrome, infertility or premature ovarian failure, and even death have occurred after receipt of this vaccine; however, reviews of individual cases as well as controlled studies looking at groups of people who did and did not get the vaccine have shown that none of these problems were caused by the HPV vaccine.

My daughter is afraid to get the HPV vaccine because one of her friends said it hurts more than other vaccines. What can I tell her?

HPV vaccines contain higher concentrations of salt than other vaccines, so they may hurt a bit more when they are administered. However, you can suggest one of the following to make your daughter more comfortable while getting the shot:
  • Relax the muscle and look away while the shot is given. Take a few short, deep breaths and then a few longer breaths during the vaccine administration.
  • Rub an alcohol pad on the opposite wrist right before the vaccine is given and then have her blow on it while the vaccine is administered.
  • Use a distraction — friends, music, books, cell phones, or electronic games may work to distract your daughter during the vaccine administration.
  • Finally, remind your daughter that the pain of the vaccine is minor compared to the pain associated with the disease.

My daughter is not sexually active. Why should I even consider getting her vaccinated against HPV now?

The HPV vaccine is recommended before the start of sexual activity for two reasons:
  1. Young people tend to get infected more frequently; in fact, about half of all new infections are diagnosed in girls and young women between 15 and 24 years of age.
  2. It takes at least six months to complete the series, so even though your daughter may not be active now, or even in six months, it is better to have the series completed sooner rather than later.

I am already sexually active; should I still get the HPV vaccine?

Yes. The reason to still get the HPV vaccine even if you are already sexually active is that you may not have been exposed to all of the types of HPV that are contained in the vaccine.

Why does my son need an HPV vaccine since I heard it prevents cervical cancer?

Although HPV is a known cause of cervical cancer, the virus can also cause other cancers of the reproductive tract, anal cancer, penile cancer, genital warts, and on occasion, cancers of the head and neck. In fact, about 1 of every 3 cases of HPV-related cancers are in boys or men. Because vaccinating boys will also decrease the spread of the virus, they will not only protect themselves, but also their sexual partners.

Can the HPV vaccine cause HPV?

No. The HPV vaccine is made using a protein from the surface of the HPV virus. Although the protein folds itself to look like a viral particle in a microscope, it does not contain any genetic material, so it cannot replicate and cause an infection. Because the proteins look like a viral particle, scientists refer to them as “virus-like particles.”

Does the HPV vaccine protect me against any other sexually-transmitted diseases (STDs)?

No. The vaccine does not protect against any other STD. In fact, since there are more than 100 types of HPV, it does not even protect against all types of HPV.

Can my 11-year-old get the HPV vaccine at the same time as other vaccines?

Yes. The HPV vaccine can be given at the same time as other vaccines recommended at this age, including the vaccine for tetanus, diphtheria, and pertussis (Tdap) and the one for meningococcus. If it is influenza vaccine season, this vaccine can be given as well.

Can I have the vaccine if I'm not a virgin anymore? And will it still be effective?

Yes, you can still get the HPV vaccine even if you have had sexual intercourse. While you may have been exposed to one or more types of HPV, it is unlikely that you would have been exposed to all of the types that the vaccine protects against, so it may still be of benefit for you.

I am 33 years old. Can I get the HPV vaccine?

Although the vaccine is currently only licensed for women up to 26 years of age, older women may discuss the potential benefits and risks with their provider. Some providers may offer the vaccine to older women even though it is not licensed for women of their age.

What are the reactions to an HPV shot?

The HPV vaccine may cause redness, swelling and tenderness at the site of the injection. Some people may faint when they get the vaccine, so people are advised to stay at the doctor's office for 15-20 minutes after getting the vaccine.

Friends and family often tell me the HPV vaccine is too new and it is difficult to find proper materials to answer this question. What do you tell parents who make this claim?

Because vaccines are given to healthy children, they are held to a strict standard of safety. What that means for us as consumers is that before a vaccine is ever recommended for the general population it has been tested in thousands and thousands of children through carefully controlled scientific studies. So while they are “new” recommendations, the vaccines have often been studied for years.
For example, HPV vaccines were tested in more than 30,000 women whose health was monitored for about seven years before the vaccine was approved and recommended. Long-term studies continued to monitor vaccine safety in about 190,000 women after the HPV vaccine was licensed. Similarly, the Centers for Disease Control and Prevention (CDC) has networks that continue to monitor all vaccines in real time, so that any safety concern would come to attention quickly. At this point, millions of HPV vaccines have been given.

Why did my son have to wait 15 minutes after getting the HPV vaccine?

Some teens are more prone to fainting after getting the vaccine; therefore, all teens are recommended to wait at the doctor's office for 15 minutes to be sure they are okay.

Do I need to worry about HPV if my boyfriend and I always use a condom?

If your boyfriend has an HPV infection (with or without symptoms), you can still be infected with HPV even when using a condom for two reasons. First, because condoms aren’t foolproof at containing the virus, you could still be infected and, second, while HPV is most often transmitted during sexual intercourse, it can also be transmitted during oral sex or during genital-to-genital contact.

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