gynecology

The HPV Vaccine: Who Needs It, When, and How Many Doses

By Dr. Adeeb Alshahrour · May 3, 2023

The HPV vaccine prevents the great majority of cervical cancers, along with vulvar, vaginal, anal, penile, and oropharyngeal cancers, and genital warts. It is one of only two vaccines that prevent cancer.

Two corrections to what this page previously said, both worth knowing if you read the old version:

It stated that three HPV vaccines are available — Gardasil, Gardasil 9, and Cervarix. In the United States, Gardasil 9 is the only HPV vaccine available. Quadrivalent Gardasil and Cervarix were withdrawn from the US market around 2016–2017.
It gave only the age 9–12 recommendation, which wrongly implies that adults are ineligible. Catch-up vaccination is recommended through 26, and vaccination is available through 45 by shared decision-making.

Gardasil 9

Gardasil 9 protects against nine HPV types: 6 and 11, which cause about 90% of genital warts, and 16, 18, 31, 33, 45, 52, and 58, the high-risk types responsible for roughly 90% of cervical cancers.

Who it is recommended for

Routine at 11–12, and it can be given from age 9. Earlier is more effective, because the immune response is stronger and the point is to vaccinate before any exposure.
Catch-up through age 26 for anyone not adequately vaccinated.
Ages 27–45 — shared clinical decision-making. Not routinely recommended, because most adults have already been exposed to some HPV types, but benefit is possible depending on your circumstances — a new or changing relationship, for instance. Worth a conversation rather than an assumption.
All genders. This is not a vaccine for girls. Men get HPV-related cancers too, and oropharyngeal cancer in men is now the most common HPV-associated cancer in the US.

How many doses

The schedule depends on age at the first dose, not on current age:

Started before the 15th birthday: two doses, 6 to 12 months apart. If the second is given less than 5 months after the first, a third is needed.
Started at 15 or older: three doses, at 0, 1–2, and 6 months.
Immunocompromised, at any age: three doses.

If your schedule was interrupted, you do not restart — you resume where you left off, no matter how long the gap.

What it does not replace

Vaccination does not replace cervical screening. It does not cover every oncogenic type, and it does not clear infections acquired before vaccination. Vaccinated people follow the same screening schedule as everyone else. This is the most common misunderstanding about the vaccine, and it matters.

Common questions

Is it safe? It has an extensive safety record across hundreds of millions of doses and many years of surveillance. The most common side effects are a sore arm, brief headache, and occasional fainting shortly after injection — which is why you are asked to sit for 15 minutes, and which is common to injections in adolescents rather than specific to this vaccine.

Does it encourage earlier sexual activity? Studies have looked at this specifically and found no such effect.

Should I be tested for HPV before vaccination? No. Testing is not recommended before vaccination, and a positive result does not make you ineligible — the vaccine still protects against types you have not acquired.

Can I have it while pregnant? It is not recommended during pregnancy. If you become pregnant partway through the series, pause and complete it afterwards. No harm has been shown from inadvertent vaccination.

I am over 26. Is it worth it? Sometimes. That is exactly the shared-decision conversation, and it depends on your exposure history and circumstances.

Cost. Covered by most insurance without cost-sharing as a recommended preventive service, and by the Vaccines for Children program for eligible under-19s.

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Medical disclaimer

This article is general health information, not medical advice for any individual. Vaccination recommendations are updated periodically; your clinician will follow current ACIP guidance for your age and circumstances.