HPV Questions and Answers for the General Public

What is Human Papillomavirus (HPV)?

• Human Papillomavirus (HPV) is a virus that can infect many parts of the body in both men and women. There are over 100 different types of HPV. Some are low-risk, some are high-risk based on their potential risk of cancer.
• There are approximately 15 known high-risk types of HPV that can cause pre-cancerous lesions and cervical cancer; they can also cause oral cancer and anal cancer.
• Most of these infections are cleared by the body’s immune system without the individual knowing that they had an infection.
• Persistent infection of a high-risk virus can lead to early changes in the cervical cells (dysplasia). If these changes are not detected by screening and treated, they may progress to cancer of the cervix (lower part of the woman’s uterus that leads into the vagina).
• Some low-risk types can cause genital warts and even some dysplasia. These dysplasias usually do not progress to cancer. Genital warts are single or multiple growths or bumps that look like small cauliflowers.
• Other low-risk types of HPV can develop into warts on hands and the soles of the feet that are generally not harmful. These skin warts do not cause changes on the genital tracts of women and men.

How does someone get genital HPV?

• Some types of HPV can be spread during sexual contact with a person who is already infected.
• Sexual contact includes (skin-to-skin contact) with the vagina, vulva (the outside parts of a woman’s genitals), penis, scrotum, anus and/or the mouth.
• HPV is estimated to be one of the most common sexually transmitted infections (STI) in Canada and around the world.
• Any person who has sexual contact can get the virus.

What are the signs and symptoms of an HPV infection?

• Most HPV infections occur without any symptoms.
• It is easy for people who are infected to pass it on to others without knowing it.
• It is possible to have more than one type of HPV infection at a time.
• While most HPV infections go away with no treatment, some do not and can go on to cause skin and genital warts, or more importantly, cancers of the cervix, or, more rarely, cancers of the vagina, vulva, rectum, penis and mouth.

How can someone prevent or reduce the risk of getting HPV?

• The only way to completely avoid HPV infection is to not have sexual contact (skin-to-skin contact) with the vagina, vulva, penis, scrotum or anus
• Delay onset of sexual activity.
• Limit your number of sexual partners.
• Condoms can offer protection from HPV and other sexually transmitted infections, but skin that is not covered by the condom can still be exposed and infected.
• Consider your partners' sexual history, as they may not know they are infected with HPV (ex: if they have had one previous partner).
• Practice good health habits which include: not smoking, eating a healthy diet, getting plenty of exercise and rest.
• Get immunized with the HPV vaccine to reduce the risk of infection, pre-cancerous lesions and cervical cancer. Current HPV vaccines only protect against some HPV types.
• Once your body matures and if you choose to become sexually active, it is recommended that you see your doctor for regular checks including Pap tests of the cervix.
• For more information on sexuality education, visit the Sexuality Education Resource Centre Manitoba.

What is the link between HPV infection and cervical cancer?

• HPV can cause changes in the cells on the cervix, called cervical dysplasia (abnormal cells). Over time, these changes can progress, stay the same or get worse. If these changes are severe and are not treated, cancer of the cervix can develop.
• HPV is considered to be a causal factor in virtually all cases of cervical cancer, and about 70% of cancers are associated with HPV types 16 and 18, two of the HPV types targeted by the HPV vaccine.
• Approximately 1,350 Canadian women are diagnosed with cervical cancer each year; about 400 women annually die from the disease.

In Manitoba (2006 stats from CancerCare Manitoba)  

• Approximately 45 women are diagnosed with cervical cancers annually.
• Approximately 15 deaths are reported annually.

What is the HPV vaccine and how effective is it?

• At this time, there are two HPV vaccines that have been approved for use by Health Canada. These vaccines are Gardasil^® and Cervarix^®.
• When the HPV vaccine is given before being exposed to HPV, it is highly efficacious in preventing infection from two of the HPV high-risk types.
• High-risk types of HPV (Type 16 and Type 18) account for about 70 per cent of cervical cancers. One of the two approved HPV vaccines (i.e. Gardasil^®) protects against these and two low-risk types (Type 6 and Type 11) of HPV, which cause about 90 per cent of all genital warts.
• The vaccine is given in three separate doses (needles/shots) in the upper arm over a six-month period.
• Clinical trials have shown that the vaccine is efficacious for at least five years.
• It is not known at this time whether a booster dose will be needed. Continued surveillance and research into how long the vaccine will be effective and whether or not booster shots will be needed is underway.
• The good immune response seen in vaccine recipients during clinical trials indicates that vaccine protection is likely to last for many years.
• When a new vaccine is approved for use, it is not unusual for there to be a number of unanswered questions about the duration of protection and the vaccination schedule.

Why is the HPV vaccine recommended for women?

• By preventing HPV infections that can cause pre-cancerous changes in the cervix, it is expected that the vaccine will reduce the rate of abnormal pap smears and the rate of cancer of the cervix.
• The National Advisory Committee on Immunization recommends the vaccine for females from the ages of nine to 26 years.
• Women who receive the vaccine should continue to be screened regularly with a Pap test.  This is because the vaccine does not protect against all types of HPV that can cause cancer and because the vaccine has not been studied long enough to show how many cancers will be prevented.
• For more information on screening, women should talk to their health care provider or contact the Manitoba Cervical Cancer Screening Program .

Who should receive the vaccine?

• Gardasil^® is the only HPV vaccine that is approved for use in both females and males from the ages of nine to 26 years. Cervarix^® is approved for use in females only from the ages of 10-25 years at the present time.
• The vaccines are thought to be most effective before the onset of sexual activity; however, you can still receive the vaccine even if you have already been sexually active.
• Individuals who are already sexually active may be infected with an HPV type contained in the vaccine, but they can still benefit from protection against the other HPV types the vaccine protects against.
• Females who have had previous Pap test abnormalities, including cervical cancer, or have had genital warts or known HPV infection, could still benefit from the vaccine. These women may not have had infection with the HPV types included in the vaccine and are very unlikely to have been infected with all four HPV types contained therein. It is therefore recommended by NACI that these women receive the vaccine. However, they should be advised that there is no data to suggest that the vaccine will have any therapeutic effect on existing cervical lesions.
• The vaccine does not treat existing HPV infections, genital warts or cervical abnormalities.

At the present time, all 10 provinces in Canada offer voluntary, publicly funded HPV immunization programs.

Who is offered the vaccine at no cost in Manitoba?

Manitoba Health introduced a voluntary, publicly-funded vaccine program for Grade Six girls starting in the school year 2008-2009. The program is delivered by public health nurses. Before any individual receives the immunization, information about HPV infections, the vaccine, and a consent form will be provided to parents and/or legal guardians.

Who should not receive the vaccine?

• Individuals under the age of nine or over the age of 26. The safety and efficacy of the vaccine has not been evaluated in children younger than nine years.
• Pregnant women.
• Anyone who is allergic to any of the ingredients listed in the vaccine package information (i.e. yeast allergies).
• Individuals who develop symptoms of hypersensitivity after receiving a dose of the vaccine should not receive further doses of the vaccine.

Is the HPV vaccine safe?

• Yes, the vaccine is considered safe, but as with all vaccines, adverse events may occur, including rare, life-threatening reactions.
• Health Canada has done a scientific review of the quality, safety and efficacy of the vaccine and has approved it for use. 
• You cannot get HPV from the vaccine as it does not contain a live virus.
• The vaccine does not contain a preservative (thimerosal) or antibiotics.
• Once a vaccine is in use, Health Canada and the Public Health Agency of Canada continues to monitor its use.

What are the possible common side effects?

The most commonly reported side effects of this vaccine are: pain, swelling, itching and redness at the injection site, fever, nausea, dizziness, headache and vomiting. Fainting has been reported. Fainting can occur after vaccination, most commonly among adolescents and young adults.

What are the rare side effects?

As with any vaccine or drug, severe, allergic, life-threatening (anaphylactic) reactions may occur with symptoms such as: difficulty breathing, wheezing (bronchospasm) and hives or rash.

It is a routine public health practice to observe individuals who have received a vaccine for at least 15 minutes following immunization. Public health care providers are trained to recognize and manage side effects, including severe allergic reactions.

As with other vaccines, side effects that have been observed after vaccination include: swollen glands (neck, armpit or groin). Guillain-Barré syndrome, a rare form of paralysis that is usually temporary has been reported, but a confirmed link to the vaccine has not been established.

For additional information on other rarely reported side effects, please consult your public health nurse or doctor.

Have there been reports of serious adverse events following HPV immunization?

For updated information see the Public Health Agency of Canada website.

For more information about adverse events following HPV immunization in the U.S. please visit the Vaccine Adverse Events Reporting System (VAERS) website.

If other individuals are not eligible for free vaccine, can they still get the vaccine?

• Yes, but only if a doctor prescribes it and it is purchased from a pharmacy.
• Contact your doctor to discuss your individual care.

Will Manitoba Health reimburse individuals who purchase the vaccine privately?

• No.
• If an individual has private health insurance coverage, they can contact the insurance provider about financial reimbursement.
• Manitoba Health’s Pharmacare program does not cover the cost of this vaccine.

Can cervical cancer be prevented by the HPV vaccine?

The HPV vaccine has been shown to decrease the incidence of early precancerous lesions. The vaccine is expected to reduce the risk of getting cervical cancer, but it has not yet been studied long enough to prove how much cancer will be prevented. For this reason and because the vaccine only protects against two types of cancer-causing HPV viruses, it will remain important for all women to practice safer sex and to continue to get screened with the “Pap test.” The Pap test can detect abnormal changes on the cervix before they develop into cancer. Cervical cancer and death from cervical cancer are found more often in women who have not had regular Pap tests.

The Manitoba Cervical Cancer Screening Program recommends regular Pap tests to women across the province. For more information on the program, you can view the following fact sheet from CancerCare Manitoba’s website .

For more information on HPV, visit:

(NOTE: There are many viewpoints and perspectives on the HPV vaccine and HPV-related matters. The following links provide additional information, covering a range of facts and opinions. These links are not exhaustive and the opinions expressed are not necessarily the opinions of Manitoba Health.)

Public Health Agency of Canada

• Human Papillomavirus (HPV)
• It's Your Health - HPV
• What Everyone should know about Human Papillomavirus (HPV) – Questions and Answers
• The FACTS on the Safety and Effectiveness of HPV Vaccine

Manitoba Cervical Cancer Screening Program

• PAP Test Pamphlets and Brochures

Sexuality Education Resource Centre Manitoba

• SERC Manitoba - Sexuality Education

Additional websites on HPV:

• Canadian Coalition for Immunization Awareness and Promotion – HPV
• Health Canada - Summary Basis of Decision (SBD) Gardasil^®
• Society of Obstetricians and Gynaecologists of Canada
• Society of Canadian Colposcopists
• Canadian Medical Association Journal (CMAJ-JAMC) August 28, 2007, Vol.177, No. 5
• Canadian Women’s Health Network
• Women’s Health Clinic
• Canadian Pediatric Society – Human papillomavirus vaccine for children and adolescents POSITION STATEMENT (ID 2007-01)

To reach staff and for general inquiries:

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