HPV Infection

HPV, the most common cause of a sexually transmitted infection, is transmitted when the virus enters the body through a cut, abrasion or small tear in the outer layer of skin and genital or oral mucous membranes. Some HPV infections may cause papillomatous, warty lesions on the tongue, tonsils, soft palate, or within the larynx and nose. High-risk HPV strains include HPV 16 and 18, which cause cervical cancer and contribute to cancer in the mouth and upper respiratory tract.28

Active Immunization: HPV Vaccines4,6,36,37

A recombinant 9-valent vaccine (Gardasil 9) protects against diseases associated with HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, including genital warts and cervical, vulvar, vaginal, and anal precancerous lesions and cancer. On June 12, 2020, Gardasil 9 was approved for the prevention of oropharyngeal and other head and neck cancers caused by HPV types targeted by the vaccine. It is licensed by the FDA for use in both men and women between 9-45 years of age. The bivalent vaccine (Cervarix), which protected against HPV types 16 and 18, and the quadrivalent vaccine (Gardasil), which protected against HPV types 6, 11, 16, and 18, have been discontinued. The duration of immunity is not known; however, booster doses are not currently recommended.

Table 6. HPV Vaccines.20,36,37
Vaccines Indications Schedules Adverse Effects
Gardasil9    Preexposure*    3 IM doses at 0, 1-2, and 6 months Injection-site reactions such as pain, swelling, and erythema.

Syncope in adolescents and young adults.
 * Previously unvaccinated females 15 - 26 years old and males 15 - 21 years old should receive a 3-dose series (0, 1-2, and 6 months). Unvaccinated females 27 -45 years old and males 21 – 45 years old should consider vaccination based on behavioral risk for HPV exposure.