Individuals aged 27 through 45 years old can still get the HPV vaccine to prevent multiple cancers and genital warts. For some people, the vaccine may even have therapeutic effects, experts say.
The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, which most individuals will contract during their lifetime.
Usually, the immune system will clear the virus from the body without experiencing any symptoms, but persistent infection of high-risk HPV strains can lead to cancer.
While HPV is the most common cause of cervical cancer, the virus also carries significant health risks for men, including oncological diseases.
HPV vaccine and pre-cancer
The U.S. Food and Drug Administration has approved Gardasil 9, the vaccine against nine HPV strains, for all individuals aged nine to 45.
However, the vaccine is not recommended for everyone over the age of 26, as most people have already been exposed to HPV, according to the Centers for Disease Control and Prevention (CDC) guidelines.
Rebecca B. Perkins, M.D., MSc, an associate professor of obstetrics and gynecology at Boston University, says the vaccine is over 90% effective when given on time at ages nine to 12. Its effectiveness drops with age and has not been demonstrated over age 26.
Nevertheless, some people could still benefit from receiving it later in life. Most observational studies indicate that HPV vaccination reduces the risk of cervical pre-cancer coming back after treatment, she explains.
The vaccine is very safe, so the risks are low, and patients may benefit from reducing the risk of a pre-cancer coming back. The American College of Obstetricians and Gynecologists recommends considering HPV vaccination after treatment for pre-cancer for patients aged 27-45.Rebecca B. Perkins, M.D., MSc
A recent study on cervical cancer incidence found that cases of invasive cervical cancer dropped by 65% from 2012 to 2019 in women aged 20–24, the generation that was exposed to the HPV vaccine. The protective effect is carried forward into older age groups, with cervical cancer rates also dropping among women aged 25 to 29 years.
Because the vaccine is expensive — each dose costs around $260 — scientists say vaccinating people 27 and older may not be cost-effective because most of them have already been exposed to HPV.
A 2021 study by Harvard University researchers found that extending HPV vaccination to women and men up to age 45 years would provide "limited health benefit at the population level, at a substantial cost."
HPV has 150 strains, 12 of which are high-risk. Two of these strains, HPV 16 and HPV 18, are responsible for most HPV-related cancers. However, patients are unlikely to have been exposed to all strains, even if they are older than 26.
"While the vaccine won't help clear your current HPV infection, it can still help protect you from future infections," says Kate White, M.D., an associate professor of OB/GYN at the Boston University Chobanian & Avedisian School of Medicine.
HPV vaccine and men's health
The HPV vaccine benefits men's health by protecting against genital warts and reducing the risk of penile, throat, and anal cancers, says Justin Dubin, M.D., a urologist and men's health specialist in South Florida.
Moreover, HPV led to a five-fold increase in head and neck cancers in young men from 2001 to 2017, according to the data presented at the 2021 American Society for Clinical Oncology annual meeting.
"If you're sexually active and not in a monogamous relationship, consider getting the vaccine at 27 through 45 to reduce the risk of cancer in the future," Dubin tells Healthnews.
He says individuals in monogamous relationships should also consider getting the HPV vaccine. Because the virus may not always present as genital warts, a person may not now know they carry the virus and put their partner at risk.
It's never too late to get the HPV vaccine. You don't know your status.Justin Dubin, M.D.
Dubin says that the vaccine can also have therapeutic effects, such as preventing the recurrence of warts. Therefore, he recommends the vaccine even for those who already have genital warts.
HPV is also a cause of half of penile cancer cases globally. The condition is rare — the American Cancer Society estimates there will be about 2,100 new cases of penile cancer diagnosed in 2024. Although the chance of developing penile cancer is extremely low, it can have serious consequences.
Dubin explains, "Sometimes the result of penile cancer is a partial penectomy, which means cutting off half part of your penis, or a radical penectomy, which means the removal of the entire penis."
Where to get the HPV vaccine
The CDC recommends routine HPV vaccination at age 11 or 12 years, with two doses given six to 12 months apart. Teens and young adults who start the series at ages 15 through 26 years should receive three doses of the HPV vaccine.
The vaccine is free for most insured individuals through age 26, including those covered by their parent's insurance. Later, each dose of the HPV vaccine costs about $260.
In 2022, over 99% of commercially insured adults aged 27 to 45 were covered by Gardasil 9. For those on Medicaid, HPV vaccination is covered through age 45 years without the need for prior authorization in 43 states, according to a 2022 study on Medicaid coverage for the HPV vaccine.
Gardasil may be available at doctor's offices and pharmacies, including at retail chains such as Costco and Walgreens, school-based health centers, and health departments.
Families of eligible children who might not otherwise have access to the HPV vaccine can seek aid from the Vaccines for Children (VFC) program.
Should my child get the HPV vaccine?
The younger you get the vaccine, the better, says Bhishamjit Chera, M.D., an associate professor at the University of North Carolina- Chapel Hill.
He tells Healthnews, "The moment you become sexually active, you are at risk of getting an HPV infection, and the risk increases over time, especially if you have multiple sexual partners."
Seventy-six percent of children aged 13 to 17 have received at least one dose of the HPV vaccine, with similar rates among girls and boys. However, 2022 data from the CDC shows that for the first time since 2013, HPV vaccination initiation did not increase among teenagers in this age group, primarily among those covered by Medicaid.
While the HPV vaccine is most commonly discussed in the context of cervical cancer, Dubin encourages parents to vaccinate their sons, too.
Dubin says, "If you want your child to be at the lowest risk of preventable health issues, I would highly recommend getting the HPV vaccine."
The HPV vaccine protects against genital warts and multiple cancers in both women and men.
The vaccine is most effective when given to children between the ages of nine and 12, although people up to 45 years old can benefit from it.
The vaccine does not treat current HPV infections but can protect against HPV strains a person has not been exposed to yet.
The HPV vaccine reduces the risk of HPV-related cervical pre-cancer coming back after treatment.
- CDC. HPV Vaccine.
- National Cancer Institute. HPV and cancer.
- Kaiser Family Foundation. The HPV vaccine: access and use in the U.S.
- Harvard T.H. Chan School of Public Health. HPV vaccines for adults over age 26 may not be cost-effective.
- Gardasil9. Understanding insurance coverage for GARDASIL 9.
- American Cancer Society. Key statistics for penile cancer.
- JAMA Network. State Medicaid coverage of human papillomavirus vaccination in adults and implications for dermatologists.
- CDC. Vaccination coverage among adolescents aged 13–17 years — national immunization survey–teen, United States, 2022.
- American Society of Clinical Oncology. HPV-associated cancers in the United States over the last 15 years: Has screening or vaccination made any difference?