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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 to some common questions. Questions are grouped into the following categories:

HPV Infection: General

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, 11,000 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 pre-cancerous 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:

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.

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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 athe appropriate registry that has been established to keep track of these occurrences:

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.

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HPV and Pap Testing

The Centers for Disease Control and Prevention (CDC) has a helpful resource for understanding Pap and HPV test results for women 30 and older.

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.

For more information about HPV and Pap tests, please visit “HPV testing: What you should know” in the Feature Article Archive section of the Parents PACK page»

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:

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 three 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

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 almost 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 three doses of the HPV vaccine, can I still develop genital warts?

Yes, it is possible. There are two HPV vaccines: Gardasil® and Cervarix®. Gardasil protects against four types of HPV while Cervarix protects against two types. Both vaccines protect against the two strains of HPV that most commonly cause cervical cancer; however, only Gardasil protects against two types of HPV that most commonly cause genital warts. Further, Gardasil only protects against 9 of every 10 cases of genital warts.

A female who got all three doses of Cervarix could still get genital warts because she was not protected against any of the types that cause genital warts. Males and females who receive Gardasil 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 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?

Both HPV vaccines currently available contain the two strains of HPV that most commonly cause cervical cancer. In fact, about 7 of 10 cases of cervical cancer are the result of infections with these strains, so the vaccine will help to significantly reduce a woman’s chance of getting 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.

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 three 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 of one of the HPV vaccines, Merck, also has an adult vaccine locator on their website that might also 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. Males can only get the version of the vaccine known as Gardasil®.

Three doses of the HPV vaccine are recommended. The second shot should be administered one to two months after the first shot. The third (final) shot should be administered six months after the first shot.

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.

Will the HPV vaccine prevent all cervical cancer?

The current HPV vaccines protect against two types of HPV that are the most common causes of cervical cancer. Together, these two types of HPV cause about 70 of every 100 cases of cervical cancer. Other HPV types that cause cancer have been identified, so it is still possible for people who have been vaccinated to get cervical cancer. This is one of the reasons why women should continue to get Pap tests.

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 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:

I heard something about my son needing a particular HPV vaccine. Why does it matter?

Two HPV vaccines are available. One, Gardasil®, protects against four types of HPV – two types that commonly cause cervical cancer and two types that cause genital warts. It was tested for safety in both girls and boys. The other, Cervarix®, protects against the two types of HPV that commonly cause cervical cancer, but does not protect against the types that cause genital warts. Therefore, boys are recommended to receive Gardasil.

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 six months to complete the series of three vaccines, 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. One of the vaccines (Gardasil®) protects against four of the most common strains of HPV, and the other (Cervarix®) protects against two types.

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?

No. Currently, the vaccine is only licensed for women up to 26 years of age because safety and efficacy studies in women older than that have not yet been completed.

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, more than 40 million doses 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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