What is it?

Human papillomavirus (HPV) is a double stranded DNA virus that can infect both men and women. It can affect a person’s anogenital or respiratory tract. There are more than 100 known sub-types of HPV, with 40 of them affecting the anogenital region.

What to look for

Most people infected with HPV show no acute clinical symptoms at all however infection can progress to have significant health impacts or diseases such as cancer.

HPV subtypes 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81 and 89 are associated with the development of lesions such as genital warts, cutaneous warts and respiratory papillomatosis (wart-like lesions in the respiratory tract). Respiratory papillomatosis is characterised by warty growths within the respiratory tract which can lead to airway occlusion and can be fatal in severe cases.

Types 16, 18, 31, 33, 35, 45, 52 and 58 are oncogenic (cancer causing) strains of HPV and are associated with cancers of the cervix, vulva, vagina, penis, anus, oral cavity and oropharynx. Australian data from 2005-2015 has shown that 77% of all cervical cancers were associated with infections with either HPV-16 or HPV-18.

How is it transmitted?

HPV is a highly contagious virus that is transmitted through different forms of intimate contact. With infections often asymptomatic, people often do not know they are carriers and can unknowingly transmit the virus to others.

Genital HPVs are transmitted through sexual contact. Risks of exposure to HPV can be related to the number of sexual partners a person has had. Condoms can reduce the risk of transmission of genital HPVs, however, do not eliminate risk entirely.

Infected mothers can transmit the virus to their newborn during delivery resulting in oral HPV infections in the newborn. In some cases, this can lead to the development of respiratory papillomatosis.


Surveillance of HPV infections is complicated due to the majority of infections being asymptomatic. It is estimated that up to 90% of the population will be infected with at least one type of HPV at some point in their lives. Cervical cancer is the fourth most common cancer affecting women globally.

Immunocompromised individuals, in particular those with HIV, and men who have sex with men (MSM) are at higher risk of HPV infection and developing HPV-related cancers.


Vaccination can provide protection against HPV infection and the development of HPV-related lesions and cancers. It is ideally administered prior to a person becoming sexually active.

There are 2 vaccines available in Australia:

  • Cervarix®- 2vHPV recombinant vaccine protecting against types 16 and 18
  • Gardasil®9- 9vHPV recombinant vaccine protecting against types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

Gardasil®9 is funded on the National Immunisation Program (NIP) as a single dose for immune competent males and females in Year 7 (or age equivalent) primarily through the school-based program. A funded catch-up program is also available for individuals ≤ 26 years of age.

ATAGI further recommends that males ≥ 26 years of age who are at high risk of disease, as well as immunocompromised individuals of any age, are also vaccinated. Gardasil®9 is registered for use in both males and females up to the age of 45 years. Cervarix® is registered for use in females only up to 45 years of age.

Immunocompromised individuals of any age and immune competent individuals 26 years of age and over require a 3 dose schedule in order to be optimally protected. Doses should be administered at 0, 2 and 6 months.

Side effects

HPV vaccination is generally well tolerated with mild side effects such as fever, nausea, headache, dizziness and fatigue commonly occurring in the first 24-48 hours.

Syncope (fainting) is also commonly reported in the adolescent population however is likely associated with the process of vaccination rather than the vaccine itself. Anyone prone to syncopal episodes should lay down for 15 minutes before during and after the vaccination process to minimise the risk of injury due to falls.

Commonly asked questions

  • I thought the HPV schedule was 2 doses?

    A review of extensive evidence regarding vaccine efficacy, effectiveness and safety from around the world, has shown that a single dose of Gardasil®9 provides comparable protection to two doses of the vaccine in immune-competent individuals ≤ 25 years of age. As a result, from February 6, 2023, the National Immunisation Program (NIP) moved to offering a single dose only in Year 7.

    This advice also reflects the recommendations of the World Health Organization and advice from immunisation experts in the UK.

  • I received 1 dose in 2022 and am due for dose 2, do I still need this?

    With 1 dose of Gardasil® 9 considered a complete schedule from February 6 2023, anyone immune competent aged 25 years or less who has previously only received 1 dose is now considered up to date and there is no need for further doses. This up to date status should be reflected on the Australian Immunisation Register (AIR) from February 11, 2023.

  • What is the schedule for those with immune compromise?

    Immunocompromised individuals (except those with asplenia/hyposplenia) are still recommended to receive a 3 dose course of vaccination (at 0, 2 and 6 months) to ensure optimal protection.

  • Is the vaccine worth it for those who are already sexually active?

    Vaccination may still be beneficial for people who are already sexually active as it can provide protection against new vaccine-preventable HPV infections, infections caused by other vaccine-preventable strains of HPV, reinfection with vaccine-preventable HPV strains they have already been exposed to as well as protection against existing persistent HPV infections at other sites.

    Vaccination is a preventative measure, and will not treat a current infection or prevent disease that may be caused by a HPV-related infection.

  • Should people aged ≥ 26 years be vaccinated?

    Ideally vaccination should occur prior to exposure to infection (i.e., prior to sexual activity), however there may be some benefit in people aged 26 years and over being vaccinated. A case by case discussion with a healthcare provider to discuss if vaccination is recommended is encouraged.

    Individuals ≥ 26 years who are recommended to receive vaccination should receive a 3 dose course (0, 2 and 6 months) at cost to the patient.


Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute), Georgie Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)

Date: May 10, 2023

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.