(from the February 2017 ACP Internist)
At some point in their lives, most people who have sex become infected with a genotype of human papillomavirus (HPV), the most common sexually transmitted infection in the United States. Before the HPV vaccine became available, the average lifetime probability of acquiring the virus among U.S. men and women with at least one partner of the opposite sex was about 91% and 85%, respectively, CDC researchers estimated in a 2014 article published in Sexually Transmitted Diseases.
Although most people who acquire HPV generally resolve it without health problems, certain persistent types of HPV cause most cervical cancers and many cancers of the genitals, anus, rectum, and oropharynx. HPV vaccination can prevent most of these cancers from ever developing by preventing infections with cancer-causing HPV types, according to the CDC.
While HPV immunization is recommended during adolescence and might seem less useful in older adults, internists practicing in the postvaccine era have their own host of considerations: namely, screening for cervical cancer and providing catch-up vaccination.
In the U.S., three vaccines are licensed to prevent HPV infection: a bivalent vaccine (Cervarix, approved by the FDA in 2009), which protects against types 16 and 18; a quadrivalent vaccine (Gardasil, approved in 2006) against types 6, 11, 16, and 18; and a nine-valent vaccine (Gardasil 9, approved in 2014) against types 6, 11, 16, 18, 31, 33, 45, 52, and 58. As of 2017, only the nine-valent vaccine is distributed in the U.S., according to the CDC.
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