What Is the HPV Shot?

The HPV vaccine (shot) protects against some types of human papillomavirus. HPV is the most common type of sexually transmitted infection (STI).

HPV is transmitted via penetrative sexual contact and intimate, skin-to-skin contact. The HPV vaccine may be most effective when given before any type of exposure to HPV. HPV infection can lead to certain types of cancer, such as cervical cancer, penile cancer, and anal cancer.

The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for children of any sex ages 11 to 12. HPV shots can, however, be given to children as young as 9 years.

For those who don't get vaccinated early, the CDC recommends HPV vaccination up until age 26. Adults may be viable candidates for vaccination up until age 45. This article will discuss the Gardasil HPV vaccine, who should get it, the dosing schedule, where it is mandatory, and weighing its risks and safety.

What Is Gardasil?

Gardasil is one of three HPV vaccines licensed by the Food and Drug Administration (FDA). Gardasil 9 is the only type distributed in the United States since 2016. The other two licensed vaccines, Gardasil 4 and Cervarix, are still used in other countries.

Benefits

Gardasil 9 protects against the nine HPV strains most likely to cause cancer and other health issues. These HPV strains are 6, 11, 16, 18, 31, 33, 45, 52, and 58.

There are more than 100 HPV strains. Only a few have the potential to cause health problems, such as cancer or genital warts. HPV-16 and HPV-18 are responsible for most HPV-related cancers. HPV-6 and HPV-11 cause around 90% of genital warts.

HPV infection can lead to certain types of cancer:

• Cervical cancer
• Vaginal and vulvar cancers
• Penile cancer
• Anal cancer
• Oropharyngeal cancer (back of the throat, including the tonsils and base of the tongue)

Vaccination against HPV significantly reduces the risk of getting cancer-causing infections and cervical precancers that can lead to life-threatening cancers.

Side Effects

HPV vaccination is considered very safe and effective. There is no evidence that Gardasil or any HPV vaccine causes serious side effects, such as ovarian failure.

Minor and transient side effects may occur after vaccination. The most common side effects associated with the HPV shot are:

• Pain, redness, or swelling in the injected arm
• Headache
• Nausea
• Dizziness
• Fainting
  

Recommended HPV Vaccine Schedule (by Age)

Your or your child's age will determine the appropriate schedule for when HPV vaccination should take place. It will also determine the recommended number of doses (shots) that should be given.

Boys and Girls (11–12)

Children of any sex should get the first dose of the HPV shot when they're between the ages of 11 and 12. The second dose should be given six to 12 months after the first shot was administered. Children of ages 9 to 15 can follow this two-dosing schedule.

Teens and Young Adults (15–26)

People in this age group should get three doses of the vaccine within a six-month period, as follows:

• The second dose should be given one to two months after the first dose.
• The third dose should be given six months after the first dose.
  

The three-dose schedule is also recommended for people with certain conditions that weaken the immune system.

Adults (27–45)

HPV vaccination is not routinely recommended for people in this age group. However, some adults aged 27 to 45 not adequately vaccinated when they were younger, may find vaccination helpful.

The CDC recommends that people over age 26 discuss HPV vaccination with a healthcare provider to determine if it is a viable choice for them.

Is the HPV Shot Mandatory?

Currently, only four U.S. jurisdictions require HPV vaccination, in order for children to attend school. They are:

• District of Columbia: Females entering grade 6, dosing not specified
• Hawaii: Students entering grade 7 or higher, dosing not specified
• Rhode Island: Males and females entering grade 7 (one dose), grade 8 (two doses), grade 9 (three doses)
• Virginia: Students entering grade 7 (two doses)

Where to Get the HPV Vaccine 

The HPV vaccine is available at pediatricians' offices, health departments, pharmacies, and medical clinics. Some school-based health centers also stock the vaccine.

Adults may also be able to get the HPV vaccine directly from a healthcare provider. If they don't stock the HPV vaccine, they may provide you with a referral or order the vaccine for you.

If you have trouble finding a location where you can get vaccinated, reach out to your state's health department or to your local state representative for more information.

Cost

According to Merck, the manufacturer of Gardasil, the list price for Gardasil 9 is $268.02 per dose. If you have private insurance, your plan will most likely cover all or most of the cost of the HPV vaccine. However, you may incur a copay. Check with your health insurance plan to find out what your out-of-pocket cost will be.

Medicare and Medicaid also cover the cost of the HPV vaccine.

The Vaccines for Children (VFC) program provides vaccines, free of charge, for uninsured children aged 18 or younger. Medicaid-eligible children and American Indian/Alaska Native children who don't have insurance are also provided free HPV vaccines through the VFC program.

HPV Vaccine in Adults: Weighing Risks and Safety

The ideal age for getting vaccinated against HPV is before exposure has had a chance to occur. That's why vaccination at a young age is recommended.

Since there are so many strains of HPV, getting vaccinated as an adult may also be beneficial, even if you've already had sexual contact with one or more partners. You may have been exposed to some, but not all, high-risk HPV types and may still reap some of the benefits of vaccination.

In addition, not every adult is or has been sexually active. If you are considering sexual or intimate activity for the first time as an adult, vaccination may be beneficial for you.

There are no risks specific to adults from the HPV vaccine. Pregnant people, people allergic to yeast, and those who have had a severe reaction to a prior HPV vaccine should talk to a healthcare provider before getting the shot.

Discuss the potential benefits of the vaccine in your specific case with a healthcare provider. Then you can make an educated decision about getting or not getting vaccinated.

Efficacy After HPV Exposure

HPV vaccination cannot be used to treat an existing HPV infection. The HPV shot is able to provide protection against the HPV types you have not as yet had contact with.

If you are or have been sexually active, you may get less benefit from vaccination. However, less and none are not the same thing. It's possible, or even likely, that you have not been exposed to all nine of the HPV types targeted by Gardasil 9. The vaccine will provide protection against any of the strains you have not as yet had exposure to.

Vulnerable Populations

HPV infection has been found to be higher in certain vulnerable population groups, such as:

• Immunocompromised people (those with a weakened immune system)
• Pregnant people
• Native Americans, especially Northern Plains American Indians assigned female at birth
• Other racial/ethnic groups

People with weakened immune systems, such as those with HIV, may have a harder time fighting off infection after exposure.

The immune system becomes suppressed during pregnancy, putting pregnant people at heightened risk. Gaps in knowledge about the impact of HPV infection or access to the vaccine may also make vaccination less likely in certain geographic areas or populations.

If you are concerned that your exposure level or vulnerability is high for any reason, talk to a healthcare provider about vaccination and what makes sense for you.

Routine Screening After HPV Shot

Gardasil 9 protects against the HPV types that cause around 90% of all cervical cancers. However, it does not provide protection against every single HPV type that may cause cancer.

People with a cervix should continue to be screened regularly for cervical cancer.

Summary

The HPV shot protects against infection from nine human papillomavirus types. These HPV types are the ones that most commonly cause genital warts and HPV-related cancers, such as cervical, penile, and anal cancer.

The only HPV shot available in the United States is Gardasil 9. The CDC recommends that a two-dose vaccination regimen be started in children of any sex aged 11 to 12. Children as young as 9 can get the first shot.

Vaccination is recommended in unvaccinated people up to age 26. People over 26 should discuss the benefits of vaccination with their healthcare provider.