Around 90% of Australians will get Human Papilloma Virus (HPV) at some point in their lives. HPV is named by the warts (papillomas) some HPV types can cause. Some other HPV types can lead to cancer. These cancers include cervical cancer in women, and cancers of the genital area, anus, mouth and throat in men and women.
1 Centers for Disease Control and Prevention What is HPV? Human Papilloma Virus https://www.cdc.gov/hpv/index.html (Accessed 29 August 2021)
2 Victoria State Government Better Health Channel Human Papillomavirus Fact Sheet https://www.betterhealth.vic.gov.au/health/healthyliving/human-papillomavirus-hpv-immunisation (Accessed 29 August 2021)
Cause of HPV
HPV is a common virus with affects both men and women. 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. Depending on their ability to cause cancer, the HPV types are classified as low risk or high risk.
3 Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2018
Most HPV infections cause no symptoms and are cleared naturally from the body in one or 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. A further 11 types are classified as carcinogenic (types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) or probably carcinogenic (type 68). Infections with these HPV types remain in the body for a long time. HPV related cancers can take up to ten years to develop.
HPV is spread by skin to skin contact via tiny breaks in the skin. Genital HPV is spread through intimate genital contact. individuals can be exposed to HPV as soon as they become sexually active even with just one partner. People with HPV infection may not realise they have it and can continue to spread 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 known as recurrent respiratory papillomatosis where warts develop inside the throat.
4 Cancer Council Australia What is HPV last updated May 2017 https://www.cancer.org.au/cervicalscreening/about/whatishpv (Accessed 29 August 2021)
5 Tasca RA, Clarke RW. Recurrent respiratory papillomatosis. Archives of Disease in Childhood 2006;91:689-91
Who should be vaccinated?
HPV vaccine is recommended as a two-dose schedule on the National Immunisation Program (NIP) for boys and girls:
|Vaccine||When is it given?||1st dose||2nd dose|
|Gardasil 9||12-13 years of age |
|Gardasil 9||6-12 months after first dose||✔|
A catch-up program is funded under the NIP for (first 2 doses only):
- Children 9 -14 (2-dose schedule)
- Those 15 years or older (3 dose schedule – given at 0, 2 and 6 months)
- People 9 -18 years with significant immunocompromising conditions (3 dose schedule – given at 0, 2 and 6 months).
Men who have sex with men
Men who have sex with men are at increased risk of genital warts and anal cancer.
Women treated for high-grade cervical disease
HPV vaccination is recommended for women who have high-grade cervical disease to prevent re-infection (from a partner) with another HPV type.
Adults 19 years or older
Routine vaccination is not recommended in all adults aged 19 years and older, as they are likely to have been exposed to one or more HPV type through sexual activity.
Three HPV vaccines are registered in Australia:
- Gardasil (4vHPV): 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. Gardasil is registered for females 9-45 years of age and males 9-26 years of age. It was available on the NIP until 2018.
- Gardasil 9 (9vHPV): Gardasil 9 replaced Gardasil in the 2018 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. 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. Gardasil 9 is registered for females 9-45 years of age and males 9-26 years of age.
- Cervarix (2vHPV): Cervarix protects against HPV 16 and 18. It is registered for females aged 10-45 years of age and is available on private prescription.
Other prevention measures
Vaccination does not prevent infection against all HPV types therefore cervical screening remains an important preventative strategy against cervical cancer for women.
From 1st December 2017, under the renewed National Cervical Screening Program, the two-yearly Pap test for women aged 18 to 69 years changed to a five yearly human papillomavirus (HPV) test for women aged 25 to 74 years.
Condoms offer some but not complete protection against HPV as they do not cover all parts of the genital area.
6 Australian Government of Australia Immunize Australia Program About Immunization Human Papilloma Virus (page last update 29 September 2019)
7 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) 18 December 2017
8 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.
9 Australian Government Department of Health National Cervical Screening Program (page last updated 19 January 2021)
HPV Vaccine efficacy
In women who have never been infected with HPV types (6, 11, 16, 18, 31, 33, 45, 52 and 58), a three-dose schedule of Gardasil 9 is greater than 96% effective at preventing type specific disease and high grade cervical and vaginal disease.
10 Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. New England Journal of Medicine 2015;372:711-23.
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 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.