Why every woman should get the HPV vaccine

Would you rather go to a gynaecologist as an unmarried woman or attempt to hike to Everest base camp as a complete novice? The comparison may seem ridiculous and the choice very obvious. But for many, a visit to the gynaecologist without the intention of getting pregnant, or while pregnant, can be scary (as these women revealed by sharing their worst experiences). If the fear of judgement hadn’t kept us away from the doctor’s office for so long, many Indians — me included — would have probably been aware of and asked for the life-saving Human Papillomavirus (HPV) vaccine at the right time. 

Even though I knew about the HPV vaccine, I was under the assumption that I was ineligible for it. I was over the age of 26, which I had heard was the cut-off — I didn’t verify it with a doctor. It was as recently as last week that a workplace discussion sent me down the rabbit hole of cancer research (including these all-important medical tests every woman should take), leading me to discover three shots that could prevent one of the most common cancers in women. 

“But why do you need to get a vaccine for a sexually transmitted infection?” a confused friend asked me. I understood the quizzical expression and slight judgement in her voice. Like many others, I had my preconceived notions and embarrassment when it came to discussing STIs and STDs. Like getting vaccinated would somehow emblazon ‘promiscuous’ on my forehead in neon lights. But HPV is not just about safe sex. 

“Currently, we have no cure for cervical cancer and HPV is commonly associated with cervical cancer. It is worth taking the vaccine,” says Dr Asha Dalal, director of obstetric and gynaecology, Sir HN Reliance Foundation Hospital.

The numbers are pretty astounding. India accounts for 23% of global cervical cancer cases. Government statistics say that 1,22,844 women are diagnosed with cervical cancer every year. Out of 668 Tweak readers who answered a poll on the HPV vaccine, 67% said they’ve not taken the shot. Like me, most weren’t aware about the HPV vaccine and its potential benefits and risks. 

How does HPV affect women?

Not all HPV is the same. There are over 100 strains, some high-risk and some low-risk. Strains like HPV6 and HPV11 can cause genital warts, whereas high-risk strains like HPV16 and HPV18 are responsible for a majority of cervical cancer cases. 

The virus latches onto the point of contact, which can affect the mouth, throat, penis, anus, vagina and vulva. If you’re confused, take a quick deep-dive down south in our dummies’ guide to the vagina to find out that those last two aren’t the same thing.

Experts say that most sexually active people will come into contact with at least one strain of HPV in their lifetime. A large number of HPV strains are fought off by our body’s immune system before it does any damage. So for the most part, you won’t even realise that it’s happening. “A cause of concern is the potential of an asymptomatic person not knowing they have a high-risk strain of HPV and passing that on to someone else for whom the symptoms could be dire,” says Dr Nomita Das, a Delhi-based obstetric and gynaecology specialist. 

HPV doesn’t have a cure and symptoms present differently in different people. Some women might get genital warts once in their lifetime, while for others it can be a recurring problem. For those with high-risk strains, it’s not a given that it will develop into cancer, but experts advise precaution and regular screening.

“About 60% of genital warts are caused by HPV6 and HPV11 (low-risk strains). They are treated with topical creams. In some women, strains can lead to an infection that could cause dysplasia, a type of abnormality on the cervix. This can, over time, progress to cervical cancer, though it’s not a given. But it’s very important to get regular screenings if it does occur for treatment options,” adds Das. 

How do I know if I have HPV?

The idea of getting tested for HPV comes up for most people when they seek treatment for genital warts. Das says that after the age of 21, an HPV test should be done every three years, like a pap smear. In fact, the process is pretty much the same.

For the test, a speculum is inserted into the vagina to separate the walls so the doctor can see the cervix. A swab is taken to collect a sample which is then assessed. An HPV test can also be used to screen for cervical cancer. While the test can’t show whether you have cancer, it detects the presence of the virus which would potentially lead to it.

How does the vaccine work?

According to Dalal, the ideal age for vaccination is before puberty by the age of 11-12. With a low chance of coming into contact with the virus, only two doses are given within a gap of six months.

It used to be recommended until the age of 26 years, but now women up to 45 can receive the vaccination. However, over the age of 15, the vaccination consists of three doses spaced out at zero-, one/two-, and six-month intervals, depending on your doctor’s advice.

Like any other vaccine, the HPV vaccine triggers our immune system to produce antibodies. If in the future, these antibodies encounter the HPV strains, they will bind to the virus and stop it from infecting our cells.

“The vaccine can prevent cervical, vaginal, or vulval cancer in girls/women if the vaccine is given before they are exposed to the virus. It may also prevent genital warts, and anal and mouth cancers,” adds Dalal.

What if I already have HPV?

Busting a myth that I had believed, Dalal says that even if you have a particular strain of HPV, you can, and should, take the vaccine. Vaccines aren’t treatments or cures, and HPV itself does not have any cure, only treatment options to make symptoms manageable. But taking the vaccine can “protect you from other strains you have not been exposed to. It cannot treat an existing infection.”

Even if you have a low-risk asymptomatic or symptomatic strain of HPV, the vaccination can protect you if you’re exposed to a high-risk strain in the future. The vaccination has been well studied and found to have over 90% efficacy.

Are there any side effects of the HPV vaccine?

If you have received the COVID-19 vaccination, you may have felt tired, feverish and weak the next day. The HPV vaccine, like any other medication, can also have side effects which include the aforementioned, nausea and dizziness with some pain, swelling, and redness at the spot of the injection.

But as Das points out, the potential benefits far outweigh these side effects. You should, however, always consult your healthcare provider to discuss any co-morbidities you may have. The people whom Dalal says should avoid the vaccine are pregnant women and those who have an allergic reaction to any ingredient of the vaccine (details of which you should obtain from the doctor before taking the shot).

Is the vaccine only for women?

HPV is not a ‘lady problem’. One study found that it is three times more common in men than women. Das explains that women are more likely to experience symptoms of it. Though the common cause of mortality related to HPV is cervical cancer, studies have found that it can also cause 88% of cases of anal cancer in men and women, oral cancer, and 63% of penile cancer cases.

Vaccinations exist for women and men, and India rolled out its first gender-neutral HPV vaccine in 2021 to protect against nine strains. It can be administered to girls and women aged 9 to 26 years and boys aged 9 to 15 years. As I’ve learned, if you’re above the age range, you can still talk to your doctors and assess the benefits of the vaccine for you.

Should I talk to my partner about HPV?

This is one uncomfortable conversation you need to have. Talking to your partner about STDs is rarely on anyone’s to-do list (though it’s crucial to have these 8 uncomfortable conversations before getting into a new relationship.

The shame and stigma of STIs are strong, but sharing this information with a partner before you get intimate can be as easy as stating, “If we’re going to get more intimate, I want to let you know that I was screened for STDs/STIs and it came clear. How about you?”

“HPV is spread by skin-to-skin contact. It’s very unlikely to spread through saliva or even shared utensils. Some have suggested it can be transmitted through open-mouth kissing, but that is highly debated and not fully studied. As long as you practice safe sex with barrier protection like condoms, you and your partner can enjoy a healthy sex life,” says Das. That’s what we like to hear, even if it does mean a dreaded visit to the OBGYN.

A note of caution: This story is for educational purposes and contains inputs from experts and personal experiences. Please consult your healthcare provider if you’re in crisis for a treatment plan that works for you.