What are the recommendations of Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), American Institute of Cancer Research (AICR), National Institute for Health and Care Excellence (NICE), and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) regarding Human Papillomavirus (HPV) prevention and management?

HPV Vaccination Recommendations from Major Obstetrics and Gynecology Organizations

Major obstetrics and gynecology organizations recommend routine HPV vaccination for girls aged 11-12 years, with catch-up vaccination through age 26 years to prevent HPV-related cancers and diseases. 1

Routine Vaccination Recommendations

• The Advisory Committee on Immunization Practices (ACIP), American College of Obstetricians and Gynecologists (ACOG), and American Academy of Pediatrics (AAP) recommend routine vaccination of females aged 11-12 years with HPV vaccine, though vaccination can start as young as 9 years of age 1
• Catch-up vaccination is recommended for females aged 13-26 years who have not been previously vaccinated or who have not completed the full vaccine series 1
• For males, routine vaccination is recommended at age 11-12 years, with catch-up vaccination through age 21 years, and through age 26 years for men who have sex with men (MSM) and immunocompromised persons 1

Vaccine Types and Dosing

• Three HPV vaccines have been licensed in various countries: bivalent (2vHPV), quadrivalent (4vHPV), and nonavalent (9vHPV) 1, 2
• The nonavalent vaccine (9vHPV) provides protection against HPV types 6,11,16,18,31,33,45,52, and 58, potentially preventing approximately 90% of cervical and other HPV-related cancers 1, 3
• For individuals aged 9-14 years, a two-dose schedule is recommended with doses given at 0 and 6-12 months 4
• For individuals aged 15 years and older, a three-dose schedule is recommended (0,2, and 6 months) 1
• The minimum interval between the first and second doses is 4 weeks, and between the second and third doses is 12 weeks 1

Special Considerations

• HPV vaccination is recommended regardless of sexual activity status; however, it is most effective when administered before potential exposure to HPV through sexual contact 1
• The vaccine can be administered in the following special circumstances:
  • When a patient has an abnormal or equivocal Papanicolaou test result 1
  • When a patient is breastfeeding 1
  • When a patient is immunocompromised due to disease or medication 1
• HPV vaccine is not recommended during pregnancy; subsequent doses should be postponed until completion of pregnancy 1

Cervical Cancer Screening Recommendations

• HPV vaccination does not replace the need for cervical cancer screening; vaccinated women should continue to follow age-appropriate screening guidelines 1
• The American Cancer Society (ACS), ACOG, and U.S. Preventive Services Task Force (USPSTF) recommend that all women should have a Pap test for cervical cancer screening within 3 years of beginning sexual activity or by age 21 years, whichever occurs first 1
• For women aged <30 years, ACOG recommends annual screening, while ACS recommends annual or biennial screening depending on the type of cytology used 1
• Women aged >30 years with three normal consecutive Pap tests should be screened every 2-3 years 1

Prevention Beyond Vaccination

• Condom use may reduce the risk for HPV and HPV-associated diseases; one study demonstrated a 70% reduction in HPV infection when partners used condoms consistently and correctly 1
• Abstaining from sexual activity is the surest way to prevent genital HPV infection 1
• For sexually active individuals, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections 1

Efficacy and Effectiveness

• HPV vaccines are highly effective in preventing HPV infection and related diseases when administered before exposure to the virus 2
• The efficacy of HPV vaccines against persistent infection, precancerous lesions, and genital warts caused by vaccine-targeted HPV types has been demonstrated in clinical trials 1, 2
• In males, quadrivalent HPV vaccine reduces the incidence of external genital lesions and anogenital warts compared to control 4
• The vaccine has been demonstrated to provide protection for at least 5 years without evidence of waning protection 1

Common Pitfalls and Caveats

• HPV vaccination does not appear to protect against persistent infection, cervical cancer precursor lesions, or genital warts caused by an HPV type that individuals are infected with at the time of vaccination 1
• Neither routine surveillance for HPV infection nor partner notification is useful for HPV prevention 1
• Females already infected with one or more vaccine HPV types before vaccination would still be protected against disease caused by the other vaccine HPV types 1
• Although the overall vaccine effectiveness would be lower when administered to sexually active individuals, the majority would still derive at least partial benefit from vaccination 1