About this disease

The HPV (Human Papillomavirus) is known to cause a variety of cancers.

Within three years of introducing in Australia, we have seen a decline in the spread of viruses in both males and females.

In Australia, the HPV vaccine is routinely available for girls and boys in high school.

 

 

 

What is Human Papilloma Virus (HPV)?

HPV is a common virus which affects both men and women. Around four in five Australians will get HPV at some point in their lives. HPV is named by the warts (papillomas) some HPV types can cause.[1] Some other HPV types can lead to cancer. These cancers include cervical cancer (cancer of the cervix which is the lower part of the womb) in women, and cancers of the genital area, anus (back passage), mouth and throat in men and women.[2]

There are over 100 types of HPV, they vary according to the site of infection. Around 40 types infect the anogenital area, they are known as genital HPV.[3] Depending on their ability to cause cancer, the HPV types are classified as low risk or high risk.

 

  • [1] Centers for Disease Control and Prevention What is HPV? Human Papilloma Virus https://www.cdc.gov/hpv/index.html (Accesssed 31st October 2017)

    [2] Victoria State Government Better Health Channel Human Papillomavirus Fact Sheet last updated July 2016 (Accessed 31st October 2017)

    [3] Australian Technical Advisory Group on Immunisation (ATAGI) The Australian Immunisation Handbook 10th ed (2017 update) Canberra: Australian Government Department of Health, 2017

Symptoms

Most HPV infections cause no symptoms and are cleared naturally from the body in one to two years.

Low risk genital HPV types (including types 6 and 11) can cause genital warts. Genital warts do not cause cancer. Infections caused by these HPV types are usually cleared from the body within a short time.

High risk types (including types 16 and 18) have a higher risk of significant cell changes which can progress to cancer if not discovered and treated. Infections with these HPV types remain in the body for a long time. HPV related cancers can take up to ten years to develop.

How it is spread

HPV is spread by skin to skin contact via tiny breaks in the skin. Genital HPV is spread through intimate genital contact.[4] You can be exposed to HPV as soon as you become sexually active even with just one partner. People with HPV infection may not realise they have it and can continue spreading it to others.

People with multiple sexual partners are at increased risk of developing HPV.

It is not very common but sometimes a pregnant woman can pass HPV to her baby during delivery. The child could develop a dangerous condition where warts develop inside the throat.[5]

  • [4] Cancer Council Australia What is HPV last updated May 2017 (Accessed 31st October 2017)

    [5] Tasca RA, Clarke RW. Recurrent respiratory papillomatosis. Archives of Disease in Childhood 2006;91:689-91.

Complications

Oral and upper respiratory lesions
Some HPV infections cause lesions (wounds) of the tongue, tonsils, soft palate (back part of the roof of the mouth), or within your larynx (voice box) and nose.

Cancer
Certain strains of HPV can cause cervical cancer. These strains may also contribute to cancers of the genitals, anus and upper respiratory tract (nose, mouth, throat and voice box).[6]

 

  • [6] Mayo Clinic Diseases and Conditions HPV infection Diagnosis and Treatment (Accessed 31st October 2017)

Prevention

Vaccination

Vaccinating against HPV with 4vHPV provides effective protection against HPV types 6,11,16 and 18. HPV types 16 and 18 cause up to 80% of all cervical cancers in women and 90% of HPV-related cancers in men. HPV types (6 and 11) cause 95% of genital warts in men and women.[7] Gardasil 9 replaces Gardasil in the 2018 National Immunisation Program (NIP). Gardasil 9 includes the HPV types covered by Gardasil (6,11,16 and 18) plus an additional five cancer producing HPV types (31,33,45,52 and 58). These five HPV types cause an additional 15% of all cervical cancers above those caused by HPV 16 and 18.[8]

Gardasil 9, HPV vaccine is free at school for all males and females aged 12-13 years through the National Immunisation Program. This is the best time to vaccinate before individuals become sexually active. If individuals have become sexually active and they have been infected with any of the nine types of HPV then vaccination will be less effective in reducing cancers and other diseases. This age group also has an improved immune response to the vaccine compared to older teenagers.[9]

Pap Tests/ HPV tests

The best way to prevent cervical cancer is to have the HPV vaccine at 12-13 years of age and then regular pap tests from 18 years of age or two years after first sexual activity whichever comes later. Pap tests can detect abnormal cells before they become cancerous so that they can be treated.

However, from 1st December 2017, under the renewed National Cervical Screening Program, the two-yearly Pap test for women aged 18 to 69 years will change to a five yearly human papillomavirus (HPV) test for women aged 25 to 74 years.[10]

Condoms

Condoms offer some but not complete protection against HPV as they do not cover all parts of the genital area.

Vaccine safety

Immunisation against HPV is safe and effective. Side effects after immunisation are usually mild and transient (occurring in the first few days after vaccination). Side effects may include: pain, swelling and redness around the injection site, mild fever, headache or nausea.[11]

Over nine million doses of the HPV vaccine have been given in Australia and over 200 million doses have been given worldwide. Studies continue worldwide and no serious side effects have been found.

  • [7] Australian Government of Australia Immunize Australia Program About Immunization Human Papilloma Virus (page last update January 2017)

    [8] Australian Government Department of Health Australian Technical Advisory Group on Immunisation (ATAGI) Clinical Practice Introduction of Gardasil 9 in a 2-Dose Schedule Under the School-Based National Immunisation Program (NIP)

    [9]Reisinger KS, Block SL, Lazcano-Ponce E, et al. Safety and persistent immunogenicity of a quadrivalent human papillomavirus types 6, 11, 16, 18 L1 virus-like particle vaccine in preadolescents and adolescents: a randomized controlled trial. Pediatric Infectious Disease Journal 2007;26:201-9.

    [10] Australian Government Department of Health National Cervical Screening Program (page last updated 27th October 2017

    [11] Lu B, Kumar A, Castellsagué X, Giuliano AR. Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review and meta-analysis. BMC Infectious Diseases 2011;11:13.

Treatment

Treatments are available for genital warts and for abnormal cells of the cervix.

Info for Clinicians

  • Three HPV vaccines are registered in Australia:

    • Cervarix, the bivalent HPV vaccine protects against persistent infection and cervical/genital disease due to HPV types 16 and 18. It is registered for use in Australia in females aged 10-45 years. Cervarix is not registered for males of any age.

     

    • Gardasil, the quadrivalent HPV vaccine, protects against four HPV types-6, 11, 16 and 18. It is registered in Australia for use in females aged 9-45 years and in males aged 9-26 years.[12] It was the HPV vaccine on the NIP between 2007 and 2017.

     

    • Gardasil 9, the nine-valent vaccine protects against the same HPV types as Gardasil plus an additional five types (31, 33, 45, 52 and 58). Gardasil 9 replaced Gardasil in the school-based immunisation program for 12-14 year olds in January 2018. Gardasil 9 will be given in two doses rather than three doses. The interval between the two doses should be 6-12 months. If a second dose is inadvertently received at less than 5 months after the first dose, a third dose is required.[13]

     

    For those that have missed the opportunity to vaccinate through the school program, there are catch up vaccines available for adolescents aged 10-19 years. Click here for more information.

     

    Gardasil 9 is also registered in Australia for use in females aged 9-45 years and in males aged 9-26 years.

     

     

  • The Australian Technical Advisory Group on Immunisation (ATAGI) instead recommends that some males aged >26 years, such as Men who have sex with men (MSM) and those who are immunocompromised, who are likely to derive an individual benefit from HPV vaccination, can be vaccinated with 4vHPV. The ATAGI also recommends that some females aged > 45 years, such as those who are immunocompromised, can be

    vaccinated with either 2vHPV or 4vHPV, based on their individual risk of future HPV exposure and disease.

    The ATAGI recommends 3 doses of Cervarix in girls who receive their first dose between 10-14 years of age whereas the product information suggests two doses in this age group.[3]

    Administration

    Recommended Schedules

    Formulation Number of doses Intervals administered
    Cervarix 3 0, 1 and 6 months
    Gardasil 3 0, 2 and 6 months
    Gardasil 9 2 for:

    • all individuals who commence vaccination at age 9 to 14 years except immunocompromised individuals
    0, 6-12 months
    Gardasil 9 3 for:

    • immunocompromised individuals (males and females) at any age
    • males and females who receive their first dose of 9vHPV after turning 15 years of age
    0,2 and 6 months

     

    Vaccine effectiveness

    In women who have never been infected with the HPV types, Gardasil (3 doses) has been shown to be highly effective (90-100%) at preventing persistent infection, cervical disease and external genital lesions associated with HPV types 6,11,16 and 18. Gardasil 9 and Cervarix are also highly effective at preventing type-specific infection and cervical disease.

    In HPV-naïve males aged 16-26 years, vaccination with Gardasil prevented more than 85% of persistent anogenital infections and external genital lesions.

    When vaccine efficacy is assessed in all clinical trial participants, regardless of baseline HPV status, the overall impact of the vaccine is lower, indicating reduced vaccine effectiveness in persons who are sexually active.[11]

    Interchangeability of vaccines

    It is recommended that a vaccination course with one HPV vaccine (either Cervarix or Gardasil) is completed with that particular vaccine. However, if a combination has been given inadvertently, then ensure the person has been fully immunised with 3 doses.[3]

    Co-administration with other vaccines

    Cervarix and Gardasil can be given concomitantly with dTpa or dTpa-IPV and hepatitis B vaccine (monovalent). The evidence around co-administration of either HPV vaccine with varicella vaccine is lacking although theoretically there don’t seem to be any issues as long as they are given using different injection sites.[3]

    Who should not be vaccinated?

    • pregnant women: however, no significant adverse effects have been noted among women who became pregnant during the course of 4vHPV clinical trials
    • people with previous anaphylaxis to a previous dose of the vaccine or any of the vaccine ingredients (including yeast for Gardasil)[3]
  • [3] Australian Technical Advisory Group on Immunisation (ATAGI) The Australian Immunisation Handbook 10th ed (2017 update) Canberra: Australian Government Department of Health, 2017

    [11] Lu B, Kumar A, Castellsagué X, Giuliano AR. Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review and meta-analysis. BMC Infectious Diseases 2011;11:13.

    [12] Human papillomavirus (HPV) vaccines for Australians/NCIRS Fact sheet: April 2016

    [13] Australian Technical Advisory Group on Immunisation (ATAGI) The Australian Immunisation Handbook 10th ed (2017 update) Canberra: Australian Government Department of Health, 2017 Last update 9th April 2018

Page published: 7 March 2017

Page updated: 9 May 2018

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