HPV - human papillomavirus

It is known that 15 types of HPV cause cancer: cervical, anal, vulvar, vaginal, penile, and throat cancer.

In most cases, infection causes no symptoms, so a person may not even know they are infected. The infection usually lasts 1–2 years and clears up on its own.

However, at least one in ten infections lasts longer and can cause precancerous changes. Nearly all cases of cervical cancer begin with an HPV infection—in Estonia, an average of 160 new cases are diagnosed each year, and approximately 65 women die from the disease.

In Estonia, both the prevalence of HPV and the incidence of cervical cancer are higher than in most other European countries.

HPV is one of the most common sexually transmitted infections. Most sexually active people become infected with it at some point in their lives. Prevalence is highest among 20–25-year-olds.

HPV spreads through skin-to-skin or mucous membrane contact—during sexual intercourse or intimate touching. Infection can occur as early as the first sexual encounter. Using a condom reduces the risk of infection but does not provide complete protection.

After infection, the virus can remain in the body for a long time without causing any symptoms. In most cases, the immune system is able to clear the virus within a few months or a year. However, some people’s bodies are unable to clear the virus, and long-term infection can lead to cancer. Cancer develops slowly, over a period of 15–20 years.

• Get vaccinated.
• Avoid casual sexual encounters.
• Use a condom.
• Avoid tobacco products.
• Get regular health checkups, including screening tests.

HPV vaccination helps prevent 90% of diseases caused by HPV infection.

The best solution is vaccination before becoming sexually active, combined with regular cervical cancer screenings.

HPV vaccination does not protect against all HPV types, but depending on the vaccine, it provides protection against the types that cause 90% of cervical cancer cases and up to 90% of genital warts.

Having a steady sexual partner and using condoms can also help prevent infection (though condoms do not provide complete protection).

In Estonia, young people aged 12–18 are vaccinated free of charge. The vaccination series consists of one dose of the vaccine, administered into the deltoid muscle of the upper arm.

Vaccination of children generally takes place at school. The school health care provider informs the parent of the child’s vaccination schedule and requests consent for the vaccination of a minor at least one week in advance. In exceptional cases (e.g., if there is no school health care provider at the school), children in the target group can be vaccinated against HPV by their family doctor or family nurse. 18-year-olds can also get vaccinated against HPV at pharmacies.

Gardasil 9 contains purified virus-like proteins from nine HPV types. The vaccine does not contain live virus and does not cause disease. When the vaccine is injected into the body, the immune system produces antibodies against these proteins, just as it would against the actual virus. If you are later exposed to the actual virus, your body will be ready to fight it off.

No separate medical checkup is required before HPV vaccination. However, before administering the injection, the vaccinator will assess whether the person has any contraindications and explain everything related to the vaccination.

Pregnant women should postpone vaccination—HPV vaccines have not been tested on pregnant women. Vaccination can be done after childbirth.

No separate health check-up is required after vaccination. However, it is important for both women and men to undergo regular health check-ups, including sexual health screenings.

Women should also undergo cervical cancer screening, as the vaccine protects against most, but not all, cancer-causing HPV types. If vaccination occurs after the onset of sexual activity, a person may already be infected with certain HPV strains and may not have developed full protection.

Severe side effects are very unlikely. However, to ensure a smooth vaccination process, there are a few things to keep in mind:

• If your child has allergies, inform the healthcare provider before vaccination; they can assess whether this might affect the vaccination.
• Stay with your child at the healthcare facility for 15 minutes after the injection. If during this time your child experiences itching, a rash, difficulty breathing, heart palpitations, or weakness, contact a healthcare professional immediately.
• Common side effects, such as pain, swelling, or redness at the injection site, fever, fatigue, headache, or muscle pain, are mild and resolve quickly without treatment.
• If you notice anything unexpected, inform the healthcare professional and the Medicines Agency. Such reports are taken very seriously.

The vaccine contains small amounts of adjuvants, which are substances that enhance the immune response and make the vaccine more effective. These may include mineral salts, water, and substances such as aluminum sulfate, which we are constantly exposed to through the air and food, as well as through the use of cosmetic products, such as deodorants.

A list of the vaccine’s active ingredients and excipients can be found in the Gardasil 9 Summary of Product Characteristics.

Yes, but the sooner you get vaccinated, the better. The vaccine protects against HPV types you haven’t been exposed to yet, and since infection often occurs shortly after becoming sexually active, it makes sense to get vaccinated before that.

At ages 12–14, the immune response to the vaccine is stronger than at a later age, making this the best time to get vaccinated.

HPV doesn’t only affect women—the virus causes cancer in men as well. Unlike women, however, there is no screening for men that would allow for the early detection of HPV-related cell changes. Therefore, vaccination is particularly important for boys.

Vaccinating boys protects their health and helps reduce the spread of the virus in the general population.

Cervical cancer is not hereditary—the fact that you don’t have it does not protect your daughter. Most people are infected with one or more strains of HPV during their lifetime, and some of them develop cancer as a result of the infection. Vaccination is the most effective way to prevent this.

The World Health Organization recommends that all young people get vaccinated against HPV. In addition, it is important to undergo regular screening.

Yes, in Estonia, parents have the option to refuse HPV vaccination.

However, you should understand that an unvaccinated child is unprotected against future HPV-related diseases, and these diseases, including cancer, can be prevented through vaccination.

80% of unvaccinated people will be infected with at least one strain of HPV during their lifetime. Since infection with the virus does not immediately cause symptoms, an unvaccinated person can become infected and infect others without even knowing it.

Most infections clear up on their own, but not always—a persistent infection can cause precancerous changes that develop into cancer over time:

• in women, cervical, vaginal, or vulvar cancer;
• in men, penile, anal, or throat cancer.

Some HPV strains cause genital warts.