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HPV Rates Skyrocket Despite Safe, Effective Vaccine

June 26, 2023 – The human papillomavirus (HPV) vaccine may now be as critical as ever, though young people are taking the shot in fewer and fewer numbers. An epidemic of sexually transmitted HPV is now swirling around the U.S. And the U.K., with some serious cases leading to oropharyngeal cancer, which can affect the back of the throat, tonsils, and tongue.

HPV is the leading cause (70%) of this oropharyngeal cancer, according to the CDC. It is the most common sexually transmitted disease (STD) in the nation, and around 3.6% of women and 10% of men report oral HPV specifically. But over the past decade, oropharyngeal cases have been steadily falling a little under 4% and 2%, respectively, according to the National Cancer Institute.

HPV is often undetectable and can clear up within a few months. But unfortunately for some, serious disease, such as throat cancer, can develop if HPV isn't treated. 

Studies show the HPV vaccine to be extremely effective in lowering sexually transmitted HPV cases. Yet, only 54.5% of young people ages 13-15 have taken the recommended two to three doses, according to the National Cancer Institute. 

Why Aren't More Young People Taking the Vaccine? 

Low public awareness of the dangers of HPV may be behind young people's poor vaccination rates, according to Teresa Lee, MD, an assistant professor at the Fox Chase Cancer Center in Philadelphia. "For example, while the link with head and neck cancers have been well-studied, the FDA labeling was not changed to reflect this as an indication until 2020," she said.

Other reasons can include one's socioeconomic background, poor health literacy, cultural or religious stigmas around vaccines, and lack of quality, low-cost health care, says Emmanuel Aguh, MD, a board-certified family medicine doctor. "Some individuals and families are still resistant to vaccines and the noted lack of uptake."

Doctors and other health care professionals should also be sure to tell patients of all ages about the risks of HPV infection and how well the vaccine works, Lee said. "Not everyone who is now eligible may have been offered the vaccine as a child, and the first time young adults may receive counseling on this subject may not be until they are entering a very busy period of their lives with many responsibilities – when it may be hard to fit in things like health maintenance."

How Safe Is the HPV Vaccine?

The FDA and CDC have studied the HPV vaccine for years to find out how safe it is and how well it works, Aguh said. No major side effects have been reported, and the most common side effect is soreness where you get the shot (which is normal after most vaccines). Some dizziness and fainting in adolescents can also occur, so young people are usually asked to sit or lie down during the shot and for 15 minutes afterward, he said. 

 "Serious adverse events have not been reported at higher rates than expected following HPV vaccination, meaning there is no clear evidence they are related to the vaccine," Lee said. "The vaccine is highly effective in decreasing rates of detectable infection with the high-risk HPV strains responsible for HPV-associated cancers."

The HPV vaccine is largely recommended for people ages 9 to 26, and sometimes up to age 45, depending on the individual, Aguh said. If you are over 26, talk to your doctor about whether you should consider getting the vaccine.

"It is usually given in two doses for complete protection if taken before the 15th birthday," Aguh said. "If taken afterward, or in those with a weak immune system, they might require three doses to be fully protected."

The vaccine produces antibodies that can stop HPV from infecting cells and lowers your chances of catching an HPV-related cancer, such as throat cancer or cancer of the cervix, he said.

While the vaccine is not guaranteed to protect you from the more than 100 strains of HPV, it can protect you from HPV 16 and HPV 18 – two high-risk strains that cause around 70% of cervical cancers. 

What Is Fueling the Rise of HPV Cases? 

A misconception that oral sex is somehow a "safe and risk-free" alternative to anal or vaginal sex could be one reason, Aguh said.

"It is important to know that with oral sex, you are exposed to many of the risks associated with vaginal intercourse, especially if you do not take any measures to protect yourself and/or your partner," Aguh said. "[With oral sex] it is possible to end up contracting an infection like chlamydia, gonorrhea, and even HPV, leading to an increased risk of HPV-associated oropharyngeal cancers."

A lack of public awareness of what can cause throat cancer could also explain this phenomenon. The number of people you have oral sex with, along with the age you begin sexual activity, can greatly determine your risk of the disease, according to Lee. She echoes a report by Hisham Mehanna, PhD, in The Conversation.

"For oropharyngeal cancer, the main risk factor is the number of lifetime sexual partners, especially oral sex," wrote Mehanna, a professor at the Institute of Cancer and Genomic Sciences at the University of Birmingham in England. "Those with six or more lifetime oral-sex partners are 8.5 times more likely to develop oropharyngeal cancer than those who do not practice oral sex."

What Are Symptoms of Oropharyngeal Cancer?

Labored breathing or swallowing, a cough that won't go away, and crackling or hoarseness of your voice could all be signs of throat cancer. Other symptoms include earaches, swelling of the head or neck, and enlarged lymph nodes, among others, Aguh said.

"The signs and symptoms of HPV-related throat cancers can be difficult to identify and recognize, as they can be vague and are also associated with other medical conditions. Sometimes, there are no signs at all, or they are not easily noticeable due to the location," he said. 

You should go see your doctor if you have any of these ailments for an extended period.

How to Reduce Your Risk

In addition to having six or more oral-sex partners, smoking and drinking heavily could also raise your risk of throat cancer, said Lee. Proper dental health – like seeing your dentist regularly and practicing proper oral hygiene – can also shave your risk.

"[Good dental health] can help not just with head and neck cancer risk, but with many other inflammation-related diseases," Lee said. 

Using dental dams and condoms can also be a good method of protection, Aguh said. A dental dam is a stretchy sheet of latex, or polyurethane plastic, in the shape of a square that is made for blocking body fluid to lower your risk of contracting an STD via oral sex. 

Keep in mind: Even with these protections, make sure you and your partner discuss each other's sexual history, any prior or current STDs, and their preferred protection from STDs, said Aguh.

If you or your partner is being treated for an STD, consider opting out of oral sex and consulting a doctor.

The HPV vaccine is another common method of protection. The shot is "approved for prevention of nine of the most high-risk strains of HPV," or those that are most commonly linked to cancer, according to Lee. The vaccine "reduces the frequency of infection" with these viruses, which can ultimately lower the risk of cancers linked to HPV, including cervical, anal, and vulvar and vaginal cancers, she said.

"The best time to receive treatment for prevention of disease is prior to onset of sexual intercourse," said Lee.  

To get your HPV vaccine, head to your family doctor, school- or community-based health center, or state health department, suggests the CDC.

Click here learn more about the HPV vaccine and here for more information about oral HPV and cancer.

Do You Know What HPV Actually Is? I Didn't When I Was Diagnosed

It's time to talk (Picture: Metro.Co.Uk/Tanyel Mustafa)

Lying on a hospital bed in London with my legs up in stirrups, a wave of loneliness washed over me.

My stomach dropped and my eyes watered as I looked away from the screen broadcasting my cervix to a room of medics. With no one by my side, I gripped on to my own hand tightly. Then, I felt a sharp cut.

A month before, I'd been told I had human papillomavirus (HPV) and abnormal cells after my first cervical cancer screening aged 25. I didn't know who to talk about it with and hid the result from friends and family, worried about what this all might mean.

This memory, of a biopsy being taken, happened in 2021 during a colposcopy to examine those pre-cancer cells detected in my cervix.

It involved the use of a camera and special liquid to turn any abnormal cells white so they were easier to spot. I told myself I wouldn't look at the screen, but, curiosity got the better of me. When I looked, the screen was nearly all white.

It's an image I'll never forget and one that haunts me still.

Here I am, a week after my colposcopy on a trip to Edinburgh trying to put it out of my mind (Picture: Tanyel Mustafa)

HPV is the name for a very common group of viruses that are in most cases unproblematic, but can develop into greater issues such as cancer. HPV is often spread through sexual contact, is generally symptomless, and isn't picked up in standard sexual health screenings so many people have it and are none the wiser as the body can clear it on its own.

Even with the reassurance that because I'm young and don't smoke my odds of clearing the HPV and dodgy cells are high, I often think about what might be happening to my cervix at any given moment – whether the cells are mutating, if the HPV has gone, and how I can't know or control any of that until I'm next invited to an appointment.

After weakly climbing off the hospital bed and putting on a sanitary towel (which is necessary as a colposcopy comes with days of rust-coloured crap falling out of you), the health practitioner sketched out the various stages of pre-cancer cell development on a scrap piece of paper with a biro, indicating where mine were.

Apparently there wasn't a leaflet I could take home.

Why there wasn't a standard diagram for patients to see, I have no clue, but I got lucky; my practitioner was kind enough to go over our allotted time to explain it all because without that, I'd have left completely uneducated on what was happening to my own body – which, I now know, is how many people leave a colposcopy and HPV diagnosis.

It's one thing to feel betrayed by your own body, and it's another to feel this way about the healthcare system that's supposed to help you get better.

The more research I've done on this subject, the less faith I have in the provisions available or the treatment of patients.

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Trans men aren't invited to screenings; it's seen as a women's issue – even though men are getting HPV derived cancers; women are being told they can't be helped when they have abnormal bleeding; and some experts don't believe the current cervical cancer screening process is up to scratch.

HPV and its possible complications are seldom spoken of, so I didn't know who to talk to when it was my turn to be impacted by it (as 80% of us will be) and that lack of shared experience and knowledge was terrifying.

Since I've been more open about my experience, others have returned the favour – friends I didn't even realise were also silently scared about pre-cancer cells.

The truth is, HPV is so common and most people won't have complications, but the shame and confusion around this virus means we often don't get the information we need.

Let's talk about this and make it less taboo (Picture: Tanyel Mustafa)

Anecdotally, the common theme among friends is they didn't feel clear on what to do after contracting HPV. Do they tell their partners? Should they be worried? Should they change aspects of their lifestyle? Can they still have sex?

The success of the HPV vaccine has been sung far too loudly and this is making us complacent in finding out more.

While it's saved lives and been a major gamechanger, it's not the be-all and end-all – though public health officials often speak about the vaccine as though it is.

We're forgetting about women over the age of 28 who won't have been offered the vaccine, men who joined the programme late, doctors who believe extending to five years between cervical screenings is too long, the fact the vaccine doesn't protect against all 100+ strains of HPV, nor is it lifelong protection… and the list goes on.

By and large HPV isn't something to worry about, but the most severe repercussions of HPV have devastating impacts upon people's lives, so it's time we learned more about one of the most common viruses we'll pass between each other.

To listen to Metro.Co.Uk's podcast episode on HPV, head to the Smut Drop on Spotify and Apple Podcasts.

This week, Metro.Co.Uk is looking at HPV and its related cancers from a range of perspectives.

By and large HPV isn't something to worry about - but it is something to be aware of.

HPV is something that eight in 10 of us will encounter at some stage of our lives. It's spread through skin-to-skin contact, not just penetrative sex. There is even some evidence to suggest it can spread through deep kissing.

It isn't tested for in a standard sexual health screening, so it's near impossible to know when or where a person might have contracted it or who they might have passed it onto.

For most people, their bodies will fight the virus off in around one to two years without any lasting effects. For some people however, it can make them more vulnerable to cancers of the cervix, anus, head and neck, penis, vagina and vulva.

Over this week, we'll be exploring the human issues that come with HPV and its related cancers.

For more health information, please visit Jo's Cervical Cancer Trust, The Eve Appeal, the No Man campaign and The Anal Cancer Foundation.

MORE : People who've had HPV vaccine 'may only need one smear test in their lives'

MORE : Who is eligible for the free HPV jab and how much does it cost for others?

MORE : Cervical cancer cut by nearly 90% by breakthrough HPV vaccine

I Have HPV. What Should I Do?

Got an HPV diagnosis? Don't panic. Here's everything you need to know about the extremely common virus.

HPV stands for human papillomavirus. There are over 100 different types of HPV. (Cavallini/BSIP/picture alliance) What is HPV?

HPV stands for human papillomavirus. There are over 100 different types of HPV. The majority are harmless, but around 14 strains can cause cancer, which is why so much focus has been placed on eradicating the virus over the past three decades. (Also read: India accounts for the highest number of cervical cancer cases. Watch out for these warning signs)

Estimates say around 11.3% of women and 21% of men have HPV globally. Around 604,000 people were diagnosed with cervical cancer linked to HPV in 2020 and 342,000 people died, according to the World Health Organization.

90% of these cases and deaths occurred in low-income countries, where screening capacity and vaccine supply is low.

According to the US government's Centers for Disease Control and Prevention, nearly everyone will get HPV at some point in their lives, so you can rest assured that you are not alone.

What are the symptoms of HPV?

The vast majority of people with HPV won't experience any symptoms, but a minority will notice genital warts — small growths in the genital region or the mouth.

It's important to know that genital warts are the only clinical manifestation of HPV, and the strain that causes these warts is not the type that causes cancer, says Diane Harper, a professor of medicine at the University of Michigan who specializes in HPV and served as an investigator in the clinical trials of the HPV vaccines Gardasil and Cervavix.

"The high risk types that go into cancer really don't have any signs or symptoms at all," says Harper. "You have absolutely no idea that you're infected with it…That's what makes it really disturbing when you get the piece of information from your doctor that you tested positive because you're like, where did this come from?"

How do you get HPV?

You can get HPV through skin-to-skin contact, generally during sex — even non penetrative. Although a condom helps prevent it, it doesn't fully protect you, because it doesn't cover all skin around the genitals.

With that said, the notion that you can only get HPV from sex is a misconception, Harper says, adding that between 10 and 15% of children are born with the virus. This happens when the mother carries the infection during pregnancy.

"If you've never had sex, it's highly likely you probably won't have had exposure, but it's not impossible," she says.

That's part of the reason people can never truly know the origin of their HPV infection. The other reason is the fact that HPV may not make itself visible immediately after a sexual encounter with an infected person. It is possible that a HPV infection only presents on a test years after exposure.

"For women to develop cervical cancer, they have to be exposed to HPV, but that exposure isn't just from the partner they were with," Harper says. "The partner's partners bring a lot to the bedroom. Men often have a lot of partners, especially early on as they're maturing and going through adolescence…every single one of those partners that they have they bring to the woman that they're now with."

What happens when I have HPV?

In the vast majority of cases, HPV won't turn into anything.

"When a woman is infected with HPV, and it's the first time that she's been found to have HPV, I will tell my patients that 90% of women will clear it on their own, which is why we're not testing really young girls anymore," says Harper.

The older a woman gets, the more worrisome HPV can become, but the risk is still small. If you have genital warts, you will be prescribed medication or a cream to heal them, or you can get them removed using different types of therapies, like electrocautery, freezing or laser treatment.

Even when the warts go away, you will remain a carrier of the strain that caused them, which means you can still spread them and they can still come back in the future. Like other strains, warts can come shortly after exposure or months to years after. Or you can carry the strain without ever developing them at all.

But what about cancer?

In a minority of cases, HPV can turn into cancer. Only a handful of HPV strains are cancerous.

If you have one of these strains, Harper says you will need to stay in screening to ensure it doesn't develop into cancer. In the rare case it does, it will take years to develop after the initial exposure, which is why screening is so important.

The most common type of cancer caused by HPV is cervical cancer, which occurs in the cells of the cervix, the lower part of the womb that connects the uterus to the vagina. The trademark sign of cervical cancer is abnormal vaginal bleeding, Harper says. But it's essential to get into screening before these symptoms develop, because by then, there's little doctors can do.

HPV is also thought to cause 70% of oropharyngeal cancers in the United States, according to the US Centers for Disease Control and Prevention, likely due to strains spread through oral sex. This number has been rising over the course of the past decades. However it's still unclear whether HPV is the only cause or if it's a mixture of HPV and something else, like smoking.

It can also cause other types of genital cancers in men, although this is very rare. The presence of these cancers is why men need to pay close attention when their female partners get an HPV diagnosis and get screened themselves.

Do I need to tell my partner? My past partners?

Harper says she only advises people to tell their current partners about an HPV diagnosis, partly for the sake of supporting the woman as she goes through follow-up exams and partly because partners can choose to use condoms to prevent spreading the virus back and forth between each other.

Although condoms can stop the spread of some HPV, Harper says they are not necessary for monogamous couples in which both partners are already infected, and leaves it up to her patients to decide for themselves.

"Condoms will prevent about 60% of HPV transmission. So it's like, is that good enough for you? I think that's a personal decision," she says.

She doesn't advise patients to tell their past sex partners because "unlike something like syphilis or gonorrhea or chlamydia, we have no treatment for it."

If there was a treatment, she says, it would make sense to tell past partners, because they could tell their female partners, who could get tested and treated. But since that doesn't exist, she says it's not necessary.

What about the HPV vaccine?

The best way to prevent HPV is by getting the vaccine, but the vaccine doesn't offer 100% protection against the virus, which Harper says is sometimes forgotten.

The HPV vaccine Gardasil 9 is only protective against seven — around half — of the cancer-causing types of HPV. These seven include the strains most likely to cause cancer, 16 and 18, as well as many of the strains that cause genital warts.

"[Patients] need to know that because HPV vaccination is a wonderful bridge to screening but we can't forget about screening because the vaccination isn't 100% coverage," she says, adding that if people think the vaccine they may think they don't need to screen, which is a problem.

With that said, Harper says that she always suggests that people get the vaccine if it's available to them.

I'm old. Should I get the vaccine?

Harper says that although mass vaccination of women over 25 will do little to eliminate cervical cancer at a population level, she still suggests it on a personal level if a woman wants to invest in it.

"The way the vaccine works is it grabs onto that little HPV particle and won't let it go into the cell," Harper says. "And so it makes it so it doesn't fit into the receptors and so that part of it becomes very clear that it works to prevent that [spread]."

How do I know if the HPV is gone?

By continuing screening, you can keep track of your HPV.

Does an STI test detect HPV?

Traditional STI tests don't catch HPV, and although pap smears may detect it, they aren't nearly as accurate as actual HPV tests themselves. These tests are the most sensitive and will detect HPV if you have it.

Will the HPV live in me forever?

In the vast majority of cases, the HPV is no longer detectable after a few years. This is when doctors say it has been "cleared". But there are rare situations in which the HPV reoccurs. Harper stresses these situations are seldom but do happen, which means it's impossible to say HPV goes away completely.

Edited by: Fred Schwaller

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