Human papillomavirus (HPV) infection Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) infects epithelial cells. Most of the > 100 subtypes infect cutaneous epithelium and cause skin warts; some types infect mucosal epithelium and cause anogenital warts... read more 
is the most common sexually transmitted disease. HPV can cause skin warts, genital warts Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) infects epithelial cells. Most of the > 100 subtypes infect cutaneous epithelium and cause skin warts; some types infect mucosal epithelium and cause anogenital warts... read more , or certain cancers, depending on the type of HPV. Vaccines are available to protect against many of the HPV strains that can cause genital warts and cancer. However, use of the HPV vaccine does not eliminate the need for continued Papanicolaou (Pap) test screening because some cervical cancers Cervical Cancer Cervical cancer is usually a squamous cell carcinoma; less often, it is an adenocarcinoma. The cause of most cervical cancers is human papillomavirus infection. Cervical neoplasia is often asymptomatic... read more 
are caused by HPV types not included in the vaccine.
For more information, see Human Papillomavirus (HPV) Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Human Papillomavirus (HPV) Vaccination Information. A summary of changes to the 2022 adult immunization schedule is available here.
(See also Overview of Immunization Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
Preparations of HPV Vaccine
Three vaccines protect against HPV:
A 9-valent vaccine that protects against HPV types 6 and 11 (which cause > 90% of visible genital warts), types 16 and 18 (which cause about 70% of cervical cancers and 90% of anal cancers), and types 31, 33, 45, 52, and 58 (which together cause 10 to 20% of cervical cancers [ 1 Preparations reference Human papillomavirus (HPV) infection is the most common sexually transmitted disease. HPV can cause skin warts, genital warts, or certain cancers, depending on the type of HPV. Vaccines are... read more ])
A quadrivalent vaccine (HPV4) that protects against types 6, 11, 16, and 18
A bivalent vaccine (HPV2) that protects against types 16 and 18
Only the 9-valent vaccine is now available in the US.
Recombinant DNA technology is used to prepare HPV vaccines from the major capsid (L1) protein of HPV. The L1 proteins self-assemble into noninfectious, nononcogenic virus-like particles (VLPs).
Preparations reference
1. National Cancer Institute: Human papillomavirus (HPV) vaccines. 2019.
Indications for HPV Vaccine
The HPV vaccine is a routine childhood vaccination ( see Table: Recommended Immunization Schedule for Ages 7–18 Years Recommended Immunization Schedule for Ages 7–18 Years 
). The U.S. Food and Drug Administration (FDA)–approved indication for the 9-valent vaccine has recently been expanded to include adults age 27 through 45 years for prevention of certain HPV-related cancers and diseases; the current recommendations from the Advisory Committee on Immunization Practices are
For both males and females up to age 26 years: HPV vaccine is recommended at age 11 or 12 years (can start at age 9 years) and for previously unvaccinated or not adequately vaccinated patients up through age 26 years.
For adults 27 to 45 years: Clinicians should engage in a shared decision-making discussion with patients to determine whether they should be vaccinated.
Alternatively (for consideration outside the US), the following may be used:
HPV4 or HPV2 for females
HPV4 for males, including those who have sex with men
Contraindications and Precautions of HPV Vaccine
Contraindications for HPV vaccine include
A severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) after previous dose or to a vaccine component
Pregnancy
Although HPV vaccines are not recommended for pregnant women, pregnancy testing is not needed before vaccination. If pregnancy is diagnosed after the vaccination series has been started, no intervention is needed, but the remaining doses of the series should be delayed until pregnancy is completed.
The main precaution with HPV vaccine is
Moderate or severe acute illness with or without fever (vaccination is postponed until the illness resolves)
Dose and Administration of HPV Vaccine
The HPV vaccine dose is 0.5 mL IM, given in a 3-dose or 2-dose series depending on age at initial HPV vaccination.
Initial dose at age 9 to 14 years: A 2-dose series is given at 0 and 6 to 12 months. Minimum interval between doses is 5 months. If a dose is given too soon (in < 5 months), the dose should be repeated ≥ 12 weeks after the invalid dose and ≥ 5 months after the first dose.
Initial dose at age ≥ 15 years: A 3-dose series is given at 0, 1 to 2 months, and 6 months. Minimum intervals are 4 weeks between the first and second dose, 12 weeks between the second and third doses, and 5 months between the first and third doses. If the second or third dose is administered too soon it should be repeated.
Some adults aged 27 to 45 years: Based on a shared clinical decision-making discussion, adults in this age group may be given the 2- or 3-dose series as above.
People with immunocompromising conditions, including HIV infection: People with immunocompromise are given the 3-dose series as above, regardless of age at initial vaccination.
Adverse Effects of HPV Vaccine
No serious adverse effects have been reported.
Mild effects include pain, redness, swelling, and tenderness at the injection site.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): Human Papillomavirus (HPV) ACIP Vaccine Recommendations
Centers for Disease Control and Prevention (CDC): Human Papillomavirus (HPV) Vaccination Information for Clinicians
