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Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. There are over 100 types of HPV, with more than 40 able to affect the genital area (CDC.gov). Nearly 20 million people in the United States are infected, and about 6.2 million more become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
Most HPV infections do not cause any symptoms, and go away on their own. However, HPV can cause cervical cancer in women. The National Cancer Institute estimates that in 2011 alone, 12,710 new cases of cervical cancer will be diagnosed with 4,290 deaths from the disease.  It is the second leading cause of cancer deaths among women around the world.

HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women. HPV is also associated with several less common types of cancer in both men and women. There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

The HPV Vaccine

There are 2 FDA approved HPV vaccines on the market; Gardasil and Cervarix. The HPV vaccine Gardasil, protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11 which cause 90 percent of genital warts. Cervarix is protective against HPV 16 and 18.

Protection from the HPV vaccine is expected to be long lasting, but vaccinated women still need cervical cancer screening (such as Pap tests and HPV tests) because the vaccine does not protect against all HPV types that can cause cervical cancer.

The HPV Vaccine and Cancer Prevention

The HPV vaccine is approved for girls and boys ages 9-26.  Only Gardasil has been approved for use in males.

The CDC recommends that all girls aged 11 to 12 years old receive vaccination with either brand of HPV vaccine to protect against cervical cancer. (CDC) They also recommend that girls and young women ages 13 through 26 get the HPV vaccine if they have not received any or all doses when they were younger.

The CDC recommends Gardasil vaccine for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not receive any or all of the recommended doses when they were younger. It is recommended that all men receive the vaccine through age 26. (CDC)

The vaccine is given in a three-dose series with the second dose given two months after the first dose and the third given six months after the first dose.

Why is the HPV vaccine given at this age?

It is important for girls and boys to receive the HPV vaccine before their first sexual contact — when they have not been exposed to HPV. For these girls and boys, the vaccine can prevent almost 100 percent of diseases caused by the four types of HPV targeted by the vaccine. However, if a girl or boy is already infected with a type of HPV, the vaccine does not prevent disease from that type of the virus and will not cure a current HPV infection.

Catch–up HPV vaccinations

The vaccine is also recommended for those between the ages of 13 and 26 who did not receive it when they were younger. No booster doses are recommended at this time. The HPV vaccine may be given at the same time as other vaccines.

Who should not get the HPV vaccine?

Anyone who has ever had a life-threatening allergic reaction to yeast, latex, to any other component of the HPV vaccine, or to a previous dose of the HPV vaccine should not get the vaccine. People with severe allergies should tell their doctor before receiving the vaccine.

Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and the unborn baby, but it is still being studied. Receiving the HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breastfeeding may safely get the vaccine.

People who are mildly ill when the shot is scheduled can still get the HPV vaccine. People with moderate or severe illnesses should wait until they recover

What are the risks of the HPV vaccine?

The HPV vaccine does not appear to cause any serious side effects. However, vaccines, like any medication, may cause problems such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small. If side effects do occur, they happen within a few minutes to a few hours after the vaccination.

Mild problems that may occur with the HPV vaccine:

• Pain at the injection site (eight of 10 people)
• Redness or swelling at the injection site (one in four people)
• Mild fever (100 degrees F) (one person in 10)
• Itching at the injection site (one person in 30)
• Moderate fever (102 degrees F) (one person in 65)
• These symptoms do not last long and go away on their own.

These are just some of the side effects that may occur. It's best to speak with your physician about side effects from the HPV vaccine.

What to do for severe reaction to the HPV vaccine

Any unusual condition, such as a high fever or behavior changes could indicate a severe reaction. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat or dizziness.

If you believe you or your child is having a severe reaction to the HPV vaccine, call a doctor or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened and when the vaccination was given.

Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form or you can file this report through the VAERS website or by calling 1-800-822-7967.

Learn more about the HPV vaccine

Ask your doctor or nurse. They can show you the vaccine package insert or suggest other sources of information.

Call your local or state health department.

Contact the Centers for Disease Control and Prevention (CDC).

Call 800-232-4636 (1-800-CDC-INFO).

Visit the CDC’s website http://www.cdc.gov/std/hpv.

Learn more about cervical cancer and other gynecologic cancers at the Abramson Cancer Center’s Focus On Gynecologic Cancers Conference.

Learn more about cervical cancer treatment at the Abramson Cancer Center.

There are over 100 types of HPV, and more than 40 strains that can infect the genital areas of men and women, as well as the mouth and throat. HPV is passed through genital contact through vaginal and anal sex, and can also be passed through oral sex.

HPV and Head and Neck Cancer

The connection you should know about

In recent years, the human papilloma virus (HPV) has been linked to cervical, anus and skin cancers.

“HPV is the most common sexually transmitted infection in the United States,” says Ann Honebrink, MD, associate professor of clinical obstetrics and gynecology at Penn. “Even without showing symptoms of HPV, people can transmit the virus and barrier methods like condoms don’t work as well to prevent HPV transmission as they do other infections like HIV.”

While HPV can cause symptoms, a person can go for years without ever knowing they have the virus. That, along with the ability of the HPV virus to remain present in a person for a long time, make this virus so prevalent — people continue to spread the virus through sexual contact without knowing they carry the virus. In most cases, the body fights off HPV naturally and eventually the virus is cleared. However, when the body cannot fight off HPV, the virus can persist and also can trigger cellular changes that may lead to cancer.

“Some types of HPV must be present in order for a women to develop squamous cell cancer of the cervix, the most common type of cervical cancer,” says Dr. Honebrink.

Oral cancer – HPV’s new connection

While HPV has most been linked to cervical, anus and skin cancers, recent studies suggest the same strain of HPV can also cause oropharyngeal (head and neck) cancer.

“We are seeing more cancer located at the base of the tongue and in the tonsils,” says Jason Newman, MD, assistant professor of otorhinolaryngology, and head and neck surgeon at Pennsylvania Hospital.

Oropharyngeal cancer develops in the part of the throat including the back of the tongue, back part of the roof of the mouth, the tonsils, and the side and back wall of the throat.

“Historically, people who get head and neck cancer are older – over 70 – and have been heavy smokers or drinkers,” says Dr. Newman. “But we are seeing an increase in young, otherwise healthy men and women who develop head and neck cancer related to the HPV virus.”

Treatment for head and neck cancer may include trans-oral robotic surgery (TORS). TORS is the world’s first group of minimally invasive robotic surgery techniques enabling surgeons to remove tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

Surgeons at Penn Medicine created da Vinci TransOral Robotic Surgery (TORS) in 2005. The adoption of this highly advanced robotics technique demonstrates Penn Medicine’s commitment to providing world-class health care.

“It’s important to know the signs of head and neck cancer, and to not ignore symptoms that do not go away,” says Dr. Newman. “Treatment options and outcomes improve greatly when cancer is found early.”

Preventing HPV

The good news is that there is protection for both girls and boys who have not yet encountered the HPV virus. There are two FDA approved HPV vaccines on the market: Gardasil and Cervarix.

Gardasil protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11,which cause 90 percent of genital warts.

Cervarix protects against HPV 16 and 18.

HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases, and they offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. This is why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Facts about HPV

• Nearly 20 million people in the United States are infected with HPV.
• 6.2 million Americans become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
• Most HPV infections do not cause any symptoms and go away on their own.
• HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women.

There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

Learn more about the latest HPV vaccine recommendations, and treatment for head and neck cancer at Penn.

January is cervical cancer awareness month. The human papillomavirus (HPV) is the most common sexually transmitted virus in the United States, and also a risk factor for cervical cancer. In this blog post, we discuss a new type of cancer associated with HPV- head and neck cancer. 

There are over 100 types of HPV, and more than 40 strains that can infect the genital areas of men and women, as well as the mouth and throat. HPV is passed through genital contact through vaginal and anal sex, and can also be passed through oral sex.

HPV and Head and Neck Cancer

The connection you should know about

In recent years, the human papilloma virus (HPV) has been linked to cervical, anus and skin cancers.

“HPV is the most common sexually transmitted infection in the United States,” says Ann Honebrink, MD, associate professor of clinical obstetrics and gynecology at Penn. “Even without showing symptoms of HPV, people can transmit the virus and barrier methods like condoms don’t work as well to prevent HPV transmission as they do other infections like HIV.”

While HPV can cause symptoms, a person can go for years without ever knowing they have the virus. That, along with the ability of the HPV virus to remain present in a person for a long time, make this virus so prevalent — people continue to spread the virus through sexual contact without knowing they carry the virus. In most cases, the body fights off HPV naturally and eventually the virus is cleared. However, when the body cannot fight off HPV, the virus can persist and also can trigger cellular changes that may lead to cancer.

“Some types of HPV must be present in order for a women to develop squamous cell cancer of the cervix, the most common type of cervical cancer,” says Dr. Honebrink.

Oral cancer – HPV’s new connection
While HPV has most been linked to cervical, anus and skin cancers, recent studies suggest the same strain of HPV can also cause oropharyngeal (head and neck) cancer.

“We are seeing more cancer located at the base of the tongue and in the tonsils,” says Jason Newman, MD, assistant professor of otorhinolaryngology, and head and neck surgeon at Pennsylvania Hospital.

Oropharyngeal cancer develops in the part of the throat including the back of the tongue, back part of the roof of the mouth, the tonsils, and the side and back wall of the throat.

“Historically, people who get head and neck cancer are older – over 70 – and have been heavy smokers or drinkers,” says Dr. Newman. “But we are seeing an increase in young, otherwise healthy men and women who develop head and neck cancer related to the HPV virus.”

Treatment for head and neck cancer may include transoral robotic surgery (TORS). TORS is the world’s first group of minimally invasive robotic surgery techniques enabling surgeons to remove tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

Surgeons at Penn Medicine created da Vinci TransOral Robotic Surgery (TORS) in 2005. The adoption of this highly advanced robotics technique demonstrates Penn Medicine’s commitment to providing world-class health care.

“It’s important to know the signs of head and neck cancer, and to not ignore symptoms that do not go away,” says Dr. Newman. “Treatment options and outcomes improve greatly when cancer is found early.”

Preventing HPV

The good news is that there is protection for both girls and boys who have not yet encountered the HPV virus. There are two FDA approved HPV vaccines on the market: Gardasil and Cervarix.

Gardasil protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11 which cause 90 percent of genital warts.
Cervarix protects against HPV 16 and 18.

HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases, and they offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. This is why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Facts about HPV

• Nearly 20 million people in the United States are infected with HPV.
• 6.2 million Americans become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
• Most HPV infections do not cause any symptoms and go away on their own.
• HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women.

There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

Learn more about the latest HPV vaccine recommendations, and treatment for head and neck cancer at Penn.

Vaccines are now available that protect against four major types of HPV, including the two types that cause about 70 percent of cervical cancer cases and two types that cause about 90 percent of genital warts.

The HPV vaccine is expected to be long-lasting, but because the vaccine does not protect against all HPV types that cause cervical cancer vaccinated women still need cervical cancer screening (Pap tests and HPV tests). The vaccine does prevent HPV, but does not protect against HPV exposure before vaccination. The HPV vaccine is not a cure for HPV.

Condoms do not protect completely against HPV because they don't cover all of the potential HPV-infected areas of the body. However, condoms do provide some protection against HPV, and they protect against HIV and other sexually transmitted diseases.

Although penetrative intercourse is not necessary to get and spread HPV women can do the following to decrease their risk of cervical cancer:

• Stay up-to-date with recommended paps and exams.
• Avoid smoking
• Avoid early onset of sexual activity and sexual activity with people who have had several sexual partners.
• Use condoms
• Try to maintain a healthy immune system
• Limit the amount of sexual partners

Women may avoid HPV, and therefore prevent cervical cancer, by waiting to have sex until they are older and limiting the number of sexual partners. They should also avoid having sex with anyone who has had multiple sexual partners.

Learn more about cervical cancer treatment at the Abramson Cancer Center.

Learn more about the Jordan Center for Gynecologic Cancer.

Learn more about the MacDonald Women’s Cancer Risk Evaluation Center.