Human papillomavirus (HPV) is a common cause of infection but usually causes no symptoms. Infection with some types of HPV can cause cancer of the neck of the womb (cervix), anus and penis. These cancers take many years to develop after the infection with HPV. Genital warts are also caused by HPV. HPV immunisation should dramatically reduce cervical, anal and penis cancer cases in the future and lead to fewer cases of genital warts. It may also reduce other cancers thought to be sometimes due to HPV.
HPV vaccines were introduced in the UK for girls in 2008 and for boys in 2018. Men who have sex with men can also access the HPV vaccine until the age of 45. Women are still advised to attend for cervical screening tests, even if they have been immunised against HPV.
What is HPV?
HPV stands for human papillomavirus, and it's a tiny germ that almost everyone gets at some point of their life. Usually it is fairly harmless: it causes warts on your fingers, for example. Sometimes it can cause warts on your genital area too: your penis or vagina. Although these can be unsightly, they're not painful or harmful. But they are very contagious. You can spread them to sexual partners, or catch them from someone.
Can HPV cause cancer?
Scientists began to realise that people with some types of cancer were more likely to have an HPV infection. They noticed this particularly with cervical cancer, vulval cancer, anal cancer, oropharyngeal cancer and penile cancer.
Eventually scientists made the link: in some people, HPV isn't harmless ... it can cause cancer.
Does everyone infected with human papillomavirus get cancer?
Thankfully not. Only about 1 in 500 people infected with HPV go on to get cancer. But because we're talking about millions of people with HPV, it leads to thousands of cancers.
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Why is there so much attention on cervical cancer?
Cervical cancer is the most common of the cancers that are caused by HPV. The others are all quite rare. But cervical cancer is the most common cancer in women aged under 35: there are about 3,000 new cases per year in the UK and sadly about 900 women die from it too (often older women who haven't benefited from the vaccine).
It is estimated that HPV causes 70% of cervical cancer, so if we can prevent young women getting HPV in the first place it should reduce their chances of getting cervical cancer.
How does HPV affect men?
In men, HPV infection can lead to anal cancer, oropharyngeal cancer and penile cancer. Although these cancers aren't as common as cervical cancer, they still affect hundreds of men a year in the UK. Preventing men from getting HPV should dramatically reduce the risk of these cancers.
The risk of HPV-related cancer is higher among men who have sex with men (MSM). For this reason, along with a national HPV vaccination programme for 12- to 13-year-olds, there is another national programme for MSM.
You can access HPV immunisation, if you have not been immunised:
- From sexual health or HIV clinics.
- If you are aged 45 or under.
- If you are MSM (assigned male at birth); or
- If you are a trans man (assigned female at birth).
Trans women (women who were assigned male at birth) are also eligible for HPV immunisation on the NHS if their risk of catching HPV is similar to the risk of MSM who are eligible for the vaccine.
What is the HPV vaccine?
A vaccine is a way to prevent you getting infected with something. It makes your immune system stronger so that it can fight off the infection from getting inside you. Scientists have made a human papillomavirus (HPV) vaccine that can stop you getting HPV.
The HPV vaccine is now offered to both boys and girls, and to MSM, as part of the NHS vaccination programme.
The HPV vaccine used for the NHS HPV immunisation programme is called Gardasil® or GARDASIL® 9 and you only need two injections of it (three if you have your first dose over the age of 15). It is really effective, stopping 99% of HPV infections.
There are many different strains or types of HPV. Two - 16 and 18 - are responsible for about 70% of cervical cancers. Two others - 6 and 11 - account for over 90% of cases of genital warts. GARDASIL® 9 protects against HPV infection with the same four HPV types (6, 11, 16, 18) as Gardasil®. However, it also protects against five additional HPV types (31, 33, 45, 52, 58).
During the 2021-22 school year, the vaccine given will change from Gardasil® to GARDASIL® 9.
How effective is the HPV vaccine?
A 2021 study looked at rates of cervical cancer before and since the introduction of the HPV immunisation programme. It showed that among women vaccinated at the age of 12-13, rates of cervical cancer were reduced almost tenfold, with 87% lower rates.
Among women vaccinated at age 16-18, rates were 34% lower compared to women who had not been vaccinated.
How many doses are there in the HPV vaccine?
The HPV vaccine works in two doses for most people, though in some circumstances three may be required.
- The first dose is in year 8 at school (school year 9 in Northern Ireland and S1 in Scotland), at age 12-13.
- The second is done between 6 and 24 months later.
- If you miss the first dose at age 12, you can get it at any age until 25, or until 45 for MSM.
- If you are over 15 when you have the first dose, or have a weakened immune system, you will need three doses instead of two. You have one, then a second one a month later, and a third five months after that.
At what age do I get HPV vaccine?
- Through the school vaccination programme, the first dose is given at age 12-13 and the second dose 6-12 months later.
- If you miss this vaccination, you can access the vaccine through your school or through your GP up to the age of 25 years.
- MSM can have the vaccine through an NHS sexual health or HIV clinic at any time up to 45 years of age.
What are the side-effects of the HPV vaccine?
- Like any injection, it is a bit painful and will be sore at the injection site for a few days.
- Very rarely, some people may have an allergic reaction (anaphylaxis) to the HPV vaccine, which the healthcare professional administering the vaccine will be fully trained to deal with.
- In the overwhelming majority of cases, there are barely any serious side-effects.
Do condoms prevent you from catching HPV?
- Condoms are generally a really good idea, because they prevent you catching sexually transmitted infections like chlamydia and HIV.
- Condoms don't prevent you catching HPV though, because you can catch HPV from close sexual contact without necessarily having sexual activity.
Is it too late to have the vaccine if I've already lost my virginity?
Thankfully not. It's still worth getting it done if you are under the age of 25, as long as you were invited through the NHS but missed your vaccine.
Do lesbian women still need the HPV vaccine?
Yes! The HPV infection has been found in women who have sex with women: they still benefit from the vaccination.
Do gay men still need the HPV vaccine?
Absolutely. Men who have sex with men (MSM) are at higher risk of anal cancer, and the number of men being diagnosed with anal cancer is increasing.
I thought the HPV vaccine was three doses, not two?
Scientists realised that two doses were just as good as three. So from September 2014 they started giving people just two injections. That's why you might know older girls who had three doses, but you're only getting two.
Is it just the UK that gives the HPV vaccine?
No. It's also given routinely to boys and girls in the USA, Australia, Canada and most of Europe. In fact, around 80 million people get vaccinated every year.
If I've had the HPV vaccine can I still get cervical cancer?
The chances of you getting cervical cancer are much lower, but you can still get it: 30% of cervical cancers aren't related to the types of HPV you'll be vaccinated against.
You should still have cervical smears, which check for the warning signs of cervical cancer.
If I've had the HPV vaccine can I still get anal cancer?
As with cervical cancer, HPV vaccination will greatly reduce your risk of getting anal cancer. However, it doesn't offer complete protection, so you should still be aware of the symptoms and get them checked out if you do develop them.
Further reading and references
Cervical cancer - UK mortality statistics; Cancer Research UK
HPV vaccination guide (easy to read leaflet as PDF on HPV vaccination); Public Health England
Changes to the vaccine of the HPV immunisation programme: Letter; NHS England and NHS Improvement Director of Public Health Commissioning and Operations and Public Health England, Head of Immunisation GOV.UK, July 2021
Falcaro M et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet 2021 Nov; https://doi.org/10.1016/S0140-6736(21)02178-4