This is a vaccine to prevent infection with some strains of the human papilloma virus, HPV.

In the United States, about 15,000 women will get HPV related cancers (mostly cervical cancer) every year. This vaccine will prevent most cases of cervical cancer and genital warts. It is also protective against many vaginal and vulvar cancers.Girls who were not immunized at age 11-12 should be immunized as soon as possible and by age 26. HPV also causes genital warts and about 7000 cancers in men (anal, oropharyngeal, and penile) annually in the U.S. In 2009, the FDA approved the Gardasil® version to prevent male genital warts and in December of 2011 the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices formally recommended that all boys receive the vaccine series to help prevent genital warts and certain cancers. While the vaccine is approved for ages 9-26, the preferred age to begin the series is 11-12. Boys who have not been immunizaed at that age should have the series given between the ages of 13 and 21, and up to age 26 for men with HIV or men having sex with men.

In the future this vaccine may be recommended for older unvaccinated individuals, pending further research.

The vaccine is given in the deltoid muscle of the arm or the upper outer thigh muscle.

Safety in pregnancy and breastfeeding has not been proven. The vaccine can cause some reactions including pain, swelling, or itching at the site of injection; also fever, nausea, or dizziness can occur. Rare serious reactions including Guillain-Barré syndrome have been reported, but it is not yet clear if the vaccine was the cause.

Individuals with prior severe reactions to this vaccine may not be able to receive another dose. There is some controversy about giving this to people with yeast allergy. Check with your doctor regarding this issue and for any other contraindications for this vaccine. Also check with your doctor to find out what other ingredients may be in the vaccine, its container, or any diluent in case of allergies or other concerns. Immunization is usually postponed for individuals with a moderate or severe acute illness.

Gardasil®, by Merck, is a vaccine that protects against 4 different strains of HPV: 16 and 18 (which cause 70% of cervical cancer) and 6 and 11 (which cause 90% of genital warts cases). Cervarix®, by GlaxoSmithKline, is another version that protects agains HPV: 16 and 18. This vaccine is recommended for girls as a series of 3 shots, with the first shot preferably between 11 and 12 years of age. The 2nd dose should be given 1-2 months after the first dose and the 3rd dose 6 months after the 1st dose. Gardasil is also licensed for boys aged 9 to 26 years and may given on the same dosing schedule to prevent genital warts. Adult dosing follows the same schedule.

In theory, it is best to be immunized prior to sexual activity to get optimal protection from the vaccine, but the CDC recommends that females already sexually active still get the vaccine. Individuals who have already been infected with one or more strains covered by the vaccine may get less benefit from the vaccine, but should still receive it. Immune response may not be as effective in people with immune compromise.

• Multiple sex partners
• Early age at first sexual activity
• Smoking
• Alcohol use
• Stress and other infections like herpes or HIV concurrently

• Gardasil® approved for ages 9-26 in females and males
• Cervarix® approved for girls ages 9-25