What is the recommended Human Papillomavirus (HPV) vaccination series dosing for a 38-year-old male?

HPV Vaccination Series Dosing for a 38-Year-Old Man

For a 38-year-old man, HPV vaccination is not routinely recommended, but if he chooses to receive it after shared clinical decision-making, the standard 3-dose schedule should be administered: first dose at initial visit, second dose 1-2 months after the first dose, and third dose 6 months after the first dose. 1

Current Recommendations by Age Group

The Advisory Committee on Immunization Practices (ACIP) has established specific recommendations for HPV vaccination based on age:

• Ages 9-14 years: Routine vaccination with 2-dose schedule (doses separated by 6 months)
• Ages 15-26 years: Routine vaccination with 3-dose schedule (0,1-2,6 months)
• Ages 27-45 years: Not routinely recommended; shared clinical decision-making approach 1

Vaccine Type

The 9-valent HPV vaccine (9vHPV, Gardasil-9) is currently the only HPV vaccine available in the United States. This vaccine protects against HPV types 6,11,16,18,31,33,45,52, and 58, which are responsible for approximately:

• 90% of cervical cancers
• Most HPV-related anal cancers
• Most oropharyngeal cancers
• 90% of genital warts 2, 1

Dosing Schedule for Adults

For a 38-year-old man, if vaccination is pursued after shared clinical decision-making:

1. First dose: At initial visit
2. Second dose: 1-2 months after first dose
3. Third dose: 6 months after first dose 1

Considerations for Vaccination in Adults Over 26

Several factors should be considered when discussing HPV vaccination with adults aged 27-45:

• Prior exposure: Most sexually active adults have already been exposed to some HPV types, though not necessarily all vaccine-targeted types 1
• New risk factors: New sexual partners represent a risk factor for acquiring new HPV infections at any age 1
• Prophylactic nature: HPV vaccines cannot treat existing HPV infections or HPV-related disease but can still provide protection against HPV types to which the individual has not yet been exposed 1

Special Populations with Extended Recommendations

Certain populations have specific recommendations for HPV vaccination through age 26:

• Men who have sex with men (MSM): Routine vaccination recommended through age 26 2
• Immunocompromised individuals: Routine vaccination recommended through age 26 2, 1

Important Clinical Considerations

• Do not restart series: If the individual has previously started but not completed an HPV vaccination series, continue where they left off 1
• Avoid shortened intervals: Administering doses too close together may result in suboptimal immune response 1
• Complete all doses: All three doses are necessary for optimal protection in adults over 15 years of age 1

Efficacy Considerations

Recent research suggests that two doses of 9vHPV vaccine may elicit responses similar to three doses in individuals 15-26 years of age 3, but the current ACIP recommendation for individuals over 15 years remains a 3-dose schedule until further evidence supports a change in recommendations.

The efficacy of HPV vaccination decreases with age, primarily because the likelihood of prior exposure to HPV increases. Providers should inform individuals aged 22-26 years (and by extension, those older) that vaccination at older ages is less effective in lowering cancer risk 2.