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Human Papillomavirus (HPV)

Quick Facts

HPV 
  • Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the U.S. and there are more than 100 known HPV types, the majority of which are not harmful.
  • About 75% of HPVs have been associated with non-cancerous warts (papillomas) on the hands, chest, arms and feet, such as low-risk HPV types 6 and 11.
  • About 40 HPV types have been found in the mucosal surfaces of the cervix, vagina, vulva, anus, penis, mouth and throat, including the most common high-risk (cancer-causing) HPV types 16 and 18. High-risk HPV types are associated with development of cancer of the cervix and five other genital and oral cancers affecting women and men;
  • HPV infection is experienced by the majority of sexually active women and men and is naturally cleared from the body within two years by more than 90 percent of those, who become infected. Antibodies to the HPV type, which caused the infection, remain in the body to help prevent future re-infection with that same HPV type;
  • Sometimes HPV infection does not clear from the body naturally and the infection becomes chronic. Among high risk factors for development of HPV-related cancers are: smoking; multiple sexual partners; long term oral contraceptive use; multiple births; weakened immune system; co-infection with Chlamydia or HIV; poor nutrition; heavy drinking and smoking; chronic inflammation;
  • Women chronically infected with HPV for many years, who don’t get pre-cancerous cervical lesions promptly identified and treated, can develop cervical cancer and die. After Pap test screening became a routine part of health care for American women in the 1960’s, cervical cancer cases in the U.S. dropped 74 percent and continued Pap testing is recommended whether women do or do not get HPV vaccinations;
  • The Centers for Disease Control and National Institutes of Health estimate that about 12,000 American women were diagnosed with cervical in 2013 and that there were about 4,000 related deaths. Less than 3% of the nearly 1.6M diagnosed cancer cases and more than 550,000 cancer deaths that occur in the U.S. annually involve chronic HPV infection-associated cervical or other genital cancers in women and men. 
HPV Vaccine 
  • There are two FDA approved HPV vaccines marketed in the U.S. to prevent HPV infection with several different types of HPV: Gardasil vaccine, which contains high risk HPV types 16 and 18 associated with genital cancers and low risk HPV types 6 and 11 associated with genital warts was licensed in 2006 and is approved for use by females and males ages 9 to 26 years. Cervarix vaccine, which contains HPV types 16 and 18 was licensed in 2009 and is approved for use in females 9 to 25 years;
  • Merck’s Gardasil vaccine was studied for less than two years in about 1,200 children under age 16 before it became the first licensed HPV vaccine in the U.S. Gardasil was not studied in children with health problems or in combination with all other vaccines routinely given to American adolescents, such as Tdap and meningococcal vaccines;
  • Clinical trials did not use a true placebo to study safety but compared Gardasil against a bioactive aluminum containing placebo;
  • After Gardasil was licensed and three doses recommended for 11-12 year old girls and young women, there were thousands of reports of sudden collapse with unconsciousness within 24 hours seizures; muscle pain and weakness; disabling fatigue; Guillain Barre Syndrome (GBS); facial paralysis; brain inflammation; rheumatoid arthritis; lupus; blood clots; optic neuritis; multiple sclerosis; strokes; heart and other serious health problems, including death, following receipt of Gardasil vaccine;
  • GlaxoSmithKline’s Cervarix vaccine, which has been used in Europe since 2007 and was licensed in the U.S. in 2009, contains an AS04 adjuvant containing aluminum and MPL, which hyper-stimulates the immune system and has never been used in U.S. vaccines. Cervarix was studied for less than six years in fewer than 1200 healthy girls under age 15 and was not tested with a true placebo but was compared against Hepatitis A vaccine and other childhood vaccines that can cause adverse reactions;
  • As of Dec. 13, 2013, there were a total of 29,918 vaccine reaction reports made to the federal Vaccine Adverse Events Reporting System (VAERS) associated with Gardasil vaccinations, including 140 deaths. There were a total of 2,652 vaccine adverse reaction reports made to VAERS associated with Cervarix vaccinations, including 13 deaths. (Merck’s Gardasil vaccine, which was the first HPV vaccine licensed in the U.S., has the majority of the HPV vaccine market in the U.S.).
NVIC “Quick Facts” is not a substitute for becoming fully informed about HPV and HPV vaccines. NVIC recommends consumers read the more complete information following the "Quick Facts", as well as the vaccine manufacturer product information inserts, and speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child.

Food & Drug Administration (FDA) 

Vaccine Reaction Symptoms & Ingredients

Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more. Calculate vaccine ingredients for potential toxic exposures & print a vaccination plan with the Vaccine Ingredients Calculator

Search for Vaccine Reactions

 NVIC hosts MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more.

Reporting a Vaccine Reaction

Since 1982 NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS.VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS.

NVIC Referenced Commentaries on HPV Vaccine 

Centers for Disease Control (CDC)
 

Table of Contents 

What is HPV? Is HPV Communicable?
History of HPV Prevalence of HPV in Women
Prevalence of HPV in Men Can HPV Cause Injury and Death?
Who is Highest at Risk for Getting HPV? Who is at Highest Risk for Suffering Complications of HPV Infection?
HPV Prevention and Treatment Options Stories & Photos of Gardasil Vaccine Reactions
NVIC Press Releases, Statements, and Reports on Gardasil Vaccine Select Broadcast Media Reports on Gardasil Vaccine
Selected Print Media Reports Selected Medical Literature Articles
National Institutes of Health (NIH) American Cancer Society
Other Resources References

What Is HPV? 1 2 3 4 5 

Human papillomaviruses are double-stranded DNA viruses found in the squamous epithelial cells on the surface of the skin and also the mucous membranes of the body. There are more than 100 known types of human papilloma viruses (HPVs) and most are not harmful. In the majority of cases, the human immune system clears HPV infection without symptoms or complications.
More than 90 percent of those who become infected, naturally clear the infection from the body within two years. Antibodies to the HPV type causing the infection remain in the body to help prevent future infection with that same HPV type.
  
Low Risk HPV Types - About 75% of HPVs have been associated with non-cancerous warts (papillomas) on the hands, chest, arms and feet, such as low-risk (wart-causing) HPV types 6 and 11.  Low-risk HPV types associated with genital warts are different from the high-risk HPV types associated with development of cancer after years of chronic infection.
  
High Risk HPV Types - About 40 HPV types have been found in the body’s mucosal membranes, such as the mucosal surfaces of the cervix, vagina, vulva, anus, penis, mouth and throat, including the most common high-risk (cancer-causing) HPV types 16 and 18. High-risk HPV types are associated with development of cancer of the cervix and five other genital and oral cancers affecting women and men if HPV infection does not clear and becomes chronic. High-risk HPV types currently include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73, and 82.

The National Cancer Institute states that “Virtually all cervical cancers are caused by HPV infections, with just two HPV types, 16 and 18, responsible for about 70 percent of all cases. HPV also causes anal cancer, with about 85 percent of all cases caused by HPV-16. HPV types 16 and 18 have also been found to cause close to half of vaginal, vulvar, and penile cancers….In the United States, more than half of the cancers diagnosed in the oropharynx are linked to HPV-16.

Is HPV Communicable? 6

Yes but most HPV infections are asymptomatic and result in no clinical disease. The Centers for Disease Control (CDC) states that “HPV is transmitted by direct contact, usually sexual, with an infected person.”  
The CDC also acknowledges that there are gaps in scientific knowledge about how, why and when HPVs are transmissible:
 “HPV is presumably communicable during the acute infection and during persistent infection. This issue is difficult to study because of the inability to culture the virus. Communicability can presumed to be high because of the large number of new infections estimated to occur each year.”

History of HPV in America 7 8

HPVs are endemic in populations around the world and public health officials believe that HPV is the most common sexually transmitted infection in the United States with an estimated 6.2 million new HPV infections occurring annually. HPV is commonly found in adolescents and young adults and public health officials  estimate that 80 percent or more of sexually active women in the U.S. have  experienced HPV by age 50.

Prevalence in US Women - In one HPV prevalence study published in 2007 in JAMA,9 HPVs were detected in 26.8% of US females aged 14 to 59 with the highest prevalence (44.8%) among 20 to 24 year old women. Low-risk HPV types 6 & 11 and high-risk HPV types 16 and 18 were detected in 3.4% of females evaluated in the study.  Researchers concluded that:
  • HPV is common among U.S. females but the prevalence of HPV vaccine types is relatively low;
  • High-risk HPV types are detected in 99% of cervical cancers, and worldwide approximately 70% of cervical cancers are due to HPV types 16 and 18. Although HPV infection is common, studies suggest approximately 90% of infections clear within 2 years.
In the early 1960’s, after pap screening became a routine part of women’s health care in the U.S., cases of HPV associated cervical cancer dropped by more than 70 percent. By 2006, pap screening had driven the numbers of new cervical cancer cases to 9,700 annually with about 3,700 deaths in a U.S. population of more than 300 million people.10  

Prevalence in US Men - In a 2006 published review evaluating 40 studies reporting HPV prevalence among U.S. men, researchers found a male HPV prevalence rate ranging from 1.3% to 72.9%, depending upon the study.11  The researchers concluded that:
  • Few studies are available that have determined the frequency of acquisition and the duration of infection in men. There is a wide range of HPV DNA prevalence among men and most studies in men found prevalences as high as those reported in studies in women.
  • Screening for HPV infection is not recommended for men because infection is very common; no FDA-approved test is available, and finding HPV infection does not indicate an increased risk of disease or cancer in men or their sex partners.

Can HPV Cause Injury and Death?12 13

HPV infection usually causes no symptoms and most women and men clear the infection within one to two years. Antibodies to the HPV type causing the infection remain in the body to help prevent future infection with that same HPV type.
  
Most But Not All HPV Infections Resolve Spontaneously - However, sometimes HPV infection does not clear from the body and becomes chronic. After many years of undetected chronic HPV infection, cervical or other genital or oral cancers can develop and cause disability or death.The CDC states that “Although the incidence of [HPV] infection is high, most infections resolve spontaneously. A small proportion of infected persons become persistently infected; persistent infection is the most important risk factor for the development of cervical cancer precursor lesions.”

Persistent HPV infection associated with development of cervical cancer is clinically manifested in women by cervical intraepithelial neoplasia (CIN), which are also referred to as “pre-cancerous” lesions. Low-grade CIN (CIN 1) may spontaneously resolve when infection clears from the body or progress to CIN2 or CIN3, which may lead to cervical cancer if the pre-cancerous lesions are left undetected and untreated for years.

The American Cancer Society states “Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 20% of cases of cervical cancer are found in women over 65.”
  
Women Need Pap Screening - Whether women have gotten HPV vaccinations or not, routine pap screening is recommended for all womento detect high grade CINs and receive prompt treatment in order to prevent cervical cancer from developing.14  15   

Six HPV-Related Cancers - In addition to cervical cancer, there are five other cancers also associated with chronic HPV infection: mouth and throat (oropharyngeal); vaginal, penile, anal and vulvar. The American Cancer Society estimates that in the U.S. in 2013:
  • About 12,340 new cases of invasive cervical cancer will be diagnosed and about 4,030 women will die from cervical cancer.16   
  • About 36,000 people will get oral cavity or oropharyngeal cancer and an estimated 6,850 people will die of these cancers.17 
  • About 2,890 new cases of vaginal cancer will be diagnosed and about 840 women will die of this cancer.18  
  • About 1,570 new cases of penile cancer will be diagnosed and about 310 men will die of penile cancer.19   
  • About 7,060 new cases (4,430 in women and 2,630 in men) of anal cancer will be diagnosed with about 880 deaths (550 in women and 330 in men).20  
  • About 4,700 vulva cancers will be diagnosed and about 990 women will die of this cancer.21          
The CDC states, “About 10% of women with high-risk HPV on their cervix will develop long-lasting HPV infections that put them at risk for cervical cancer. Similarly, when high-risk HPV lingers and infects the cells of the vulva, vagina, penis, anus, or the oropharynx (back of the throat, including the base of the tongue and tonsils), it can cause cell changes called precancers. These may eventually develop into cancer if they're not found and removed in time. These cancers are much less common than cervical cancer. Much less is known about how many people with HPV will develop cancer in these areas.”22  

Low Number of HPV-Related Cancer Deaths - In the U.S. the estimated 14,000 annual deaths from the six cancers associated with HPV23 24  represent less than three percent of the more than 550,000 cancer deaths25  that occur every year.

Who is at Highest Risk for Getting HPV?26

HPVs are sexually transmitted viruses. It is estimated that more than half of sexually active people are infected with one or more HPV types at some point in their lives.

The CDC states that “risk factors for HPV infection are related to sexual behavior, including the number of sex partners, lifetime history of sex partners, and the partners’ sexual history. Most studies suggest that young age (less than 25 years) is a risk factor for infection.”
 

Who is at Highest Risk for Suffering Complications of HPV Infection?


Risk co-factors for developing cancer, including HPV-related cancers, differ depending upon the type of cancer and the health and choices (i.e., smoking, drinking, diet) of the person. Having one or more risk factors (or no risk factors) does not always determine whether or not cancer will develop.

Those at highest risk for suffering complications of HPV infection are the less than 10 percent of women and men, who do not naturally clear HPV infection caused by high risk HPV types, from the body and become chronically infected.
According to the National Cancer Institute, factors that can increase the risk of developing cancer following chronic infection with HPV types 11 and 16 or other high-risk HPV types, include: 27        
  • Smoking
  • Having a weakened immune system
  • Having many children (for increased risk of cervical cancer)
  • Long-term oral contraceptive use (for increased risk of cervical cancer)
  • Poor oral hygiene (for increased risk of oropharyngeal cancer)
  • Chronic inflammation
The American Cancer Society 28  lists the following risk factors for developing cervical cancer after years of chronic HPV infection with high risk HPV types that is undiagnosed and untreated:
  • Smoking
  • Immunosuppression
  • Chlamydia Infection
  • Poor Diet and Obesity
  • Long term oral contraceptive use
  • Multiple full term pregnancies (3 or more)
  • Young age (under 17 years old) at the first full term pregnancy
  • Poverty/lack of access to Pap tests
  • Women whose mothers took the hormonal drug Diethystilbestrol (DES) during pregnancy (1940-1971)
  • Family history of cervical cancer
Among risk factors for development of oral cavity and oropharyngeal cancers are:29     
  • Tobacco use
  • Alcohol use
  • Heavy drinking and smoking
  • HPV infection
  • Gender (men at greater risk)
  • Age (over age 55)
  • UV Light
  • Poor nutrition
  • Weakened immune system
  • Genetic syndromes
Among risk factors for developing anal cancer are:30   
  • HPV infection
  • Other cancers
  • HIV infection
  • Multiple sexual partners
  • Smoking
  • Lowered immunity
  • Race and gender
Among risk factors for developing vaginal and vulvar cancers are:31    
  • HPV infection
  • Cervical precancer or cervical cancer
  • Weakened immune system
  • Smoking
  • Chronic vulvar itching or burning
Among risk factors for penile cancer are:32    
  • HPV infection
  • Not being circumcised
  • Smoking
  • UV Light
  • Age (over age 55)
  • AIDS

HPV Prevention and Treatment Options


HPV infection prevention options focus on refraining from or limiting sexual activity in terms of numbers of partners, as well as consistent use of condoms. There are no recommended treatments for HPV infection, which usually clears naturally, but there are options for treatment of genital warts or pre-cancerous lesions that develop after chronic infection.
   
Treatment Options: The CDC states “Treatment is directed to the macroscopic (i.e., genital warts) or pathologic (i.e, precancerous) lesions caused by infection. Subclinical genital HPV infection typically clears spontaneously, and therefore specific antiviral therapy is not recommended to eradicate HPV infection. In the absence of lesions, treatment is not recommended for subclinical genital HPV infection whether it is diagnosed by colposcopy, acetic acid application, or by laboratory tests for HPV DNA. Treatment also is not recommended for cervical intraepithelial neoplasia 1 (CIN1).”33    

Prevention Options: In addition to recommending HPV vaccination, the CDC states that:34    
  • “HPV transmission can be reduced but not eliminated with the use of physical barriers such as condoms. Recent studies demonstrated a significant reduction in HPV infection among young women after initiation of sexual activity when their partners used condoms consistently and correctly;
  • “Abstaining from sexual activity (i.e., refraining from any genital contact with another individual) is the surest way to prevent genital HPV infection.
  • For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections.”
The National Cancer Institute lists the following HPV infection prevention options:35       

Avoiding or Limiting Sexual Contact: “The most reliable way to prevent infection with either a high-risk or a low-risk HPV is to avoid any skin-to-skin oral, anal, or genital contact with another person. For those who are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms it is hard to know whether a partner who has been sexually active in the past is currently infected with HPV.”
  
Use of Condoms: “Research has shown that correct and consistent use of condoms can reduce the transmission of HPVs between sexual partners. Areas not covered by a condom can be infected with the virus, though, so condoms are unlikely to provide complete protection against virus spread.”
  
HPV Vaccination: “The Food and Drug Administration (FDA) has approved two HPV vaccines: Gardasil® for the prevention of cervical, anal, vulvar, and vaginal cancer, as well as precancerous lesions in these tissues and genital warts caused by HPV infection; and Cervarix® for the prevention of cervical cancer and precancerous cervical lesions caused by HPV infection.” (Gardasil vaccine is FDA approved for prevention of low-risk HPV types 6 and 11 and high risk HPV types 16 and 18; Cervarix vaccine is FDA approved for prevention of high risk HPV types 16 and 18. Gardasil and Cervarix have not been FDA approved for the prevention of oropharyngeal or penile cancers).

Stories & Photos of Gardasil Vaccine Reactions

 Read Gardasil Reaction reports on Petition to Investigate Gardasil Risks

 

NVIC Press Releases, Statements, and Reports on Gardasil Vaccine

 

Select Broadcast Media Reports on Gardasil Vaccine

 

Selected Print Media Reports

 

Selected Medical Literature Articles

National Institutes of Health (NIH)

 

American Cancer Society

Other Resources

  •  PROVE (Parents Requesting Open Vaccine Education

References


1 Centers for Disease Control (CDC).  Human Papillomavirus. The Pink Book May 2012.
2 American Cancer Society. What Is HPV?  May 2, 2013.
3 National Institutes of Health (NIH). HPV and Cancer. National Cancer Institute May 15, 2012.
6 CDC.  Human Papillomavirus. The Pink Book May 2012.
7 CDC.  Human Papillomavirus. The Pink Book May 2012
8 FDA. Gardasil HPV Quadrivalent Vaccine: Background Document. Vaccines & Related Biological Products Advisory Committee (VRBPAC). May 18, 2006.  
9 Dunne EF, Unger ER et al. Prevalence of HPV Infection Among Females in the United States.JAMA 2007; 297(8): 876-878.
10 FDA. Gardasil HPV Quadrivalent Vaccine: Background Document. Vaccines & Related Biological Products Advisory Committee (VRBPAC). May 18, 2006.  
11 Dunne EF, Nielson CM et al. Prevalence of HPV Infection Among Men: A Systematic Review of the Literature. J Infect Dis 2006; 194(8): 1044-1057.
13 CDC.  Human Papillomavirus. The Pink Book May 2012
16 American Cancer Society. What are the key statistics about cervical cancer? April 11, 2013.  
18 American Cancer Society. What are the key statistics about vaginal cancer? Jan. 30, 2013.
19 American Cancer Society. What are the key statistics about penile cancer? Dec. 6, 2013.
20 American Cancer Society. What are the key statistics of anal cancer? Jan. 2, 2013.
21 American Cancer Society. What are the key statistics of vulvar cancer?Feb. 5, 2013
23 See References #16 – #22.
24 American Cancer Society. How Is HPV Related to Cancer? Feb. 2, 2013
25 CDC. Cancer Data (U.S.): Mortality. May 30, 2013.  
26 Centers for Disease Control (CDC).  Human Papillomavirus. The Pink Book May 2012.
27 National Institutes of Health (NIH). HPV and Cancer. National Cancer Institute May 15, 2012.
28 American Cancer Society. What are the risk factors for cervical cancer? April 11, 2013.
30 American Cancer Society. What are the risk factors for anal cancer? Jan. 2, 2013.
32 American Cancer Society. What are risk factors for penile cancer? Dec. 6, 2013.
33 CDC. Sexually Transmitted Diseases: Human Papillomavirus (HPV) Infection. Jan. 28, 2011.
34 Centers for Disease Control (CDC).  Human Papillomavirus. The Pink Book May 2012.
35 National Institutes of Health (NIH). HPV and Cancer. National Cancer Institute May 15, 2012. 

 
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