HPV Vaccination for Adult Males Aged 18–45
Adult males aged 18–26 should receive catch-up HPV vaccination routinely without requiring shared decision-making, while males aged 27–45 should generally not be vaccinated unless they have new or anticipated sexual partners, are men who have sex with men, or are immunocompromised. 1
Age-Stratified Recommendations
Males Aged 18–26 Years: Universal Catch-Up Vaccination
ACIP universally recommends catch-up HPV vaccination for all males through age 26 who are not adequately vaccinated, regardless of sexual history, prior HPV exposure, or relationship status. 1
No shared clinical decision-making is required in this age group—vaccination should be offered routinely to all eligible males. 1, 2
This recommendation applies irrespective of gender identity, sexual orientation, behavioral risk factors, or history of genital warts. 1, 3
Males aged 22–26 who are men who have sex with men (MSM) are particularly prioritized, as they benefit from prevention of both genital warts and anal cancer. 3
Males Aged 27–45 Years: Selective Vaccination Only
ACIP does not recommend routine catch-up vaccination for males aged 27–45; instead, vaccination should be considered only through shared clinical decision-making for selected individuals. 1, 3
The American Cancer Society explicitly does not endorse vaccination in this age group, citing that extending vaccination to age 45 would prevent only an additional 0.5% of cancer cases compared to stopping at age 26. 1, 3
The number needed to vaccinate increases dramatically from approximately 202 in the routine program to about 6,500 when extending to age 45. 1, 3
Clinical Algorithm for Males Aged 27–45
Factors FAVORING vaccination: 1, 3
- New sexual partners or anticipation of new partners in the future
- Men who have sex with men (MSM)
- Immunocompromised status (HIV infection, solid-organ transplant, immunosuppressive therapy)
- Few lifetime sexual partners
Factors AGAINST vaccination: 1, 3
- Long-term mutually monogamous relationship with no anticipated new partners
- High number of lifetime sexual partners (likely already exposed to multiple HPV types)
- Most sexually active adults over 26 have already been exposed to multiple HPV types, reducing potential benefit
Dosing Schedule
Males who initiate vaccination at age 15 or older require a 3-dose schedule at months 0,1–2, and 6. 1, 2
Minimum intervals: at least 4 weeks between doses 1 and 2, and at least 12 weeks between doses 2 and 3. 1
Immunocompromised males require a 3-dose series regardless of age at initiation. 1, 2
If the series is interrupted, resume the remaining doses without restarting the series; there is no maximum allowable interval. 1, 2
Vaccine Product and Coverage
Gardasil 9 (9-valent HPV vaccine) has been the only HPV vaccine available in the United States since 2016. 1, 2
Gardasil 9 protects against HPV types 6,11,16,18,31,33,45,52, and 58. 1, 2
These nine HPV types account for approximately 92% of HPV-related cancers in the United States (≈32,100 of 34,800 annual cases). 1
Critical Caveats and Common Pitfalls
Prior HPV Exposure Is NOT a Contraindication
A history of genital warts, abnormal test results, or positive HPV DNA testing is explicitly NOT a contraindication to HPV vaccination. 3, 2
Most sexually active adults have been exposed to some HPV types, but not necessarily all vaccine-type HPV strains. 1, 3
The vaccine protects against multiple types; even males with prior genital warts (caused by HPV 6/11) can benefit from protection against oncogenic types 16,18,31,33,45,52, and 58. 3
HPV Vaccines Are Prophylactic Only
HPV vaccines prevent new HPV infections but do not treat existing infections, halt disease progression, or accelerate viral clearance. 1, 2
The vaccine will not clear existing genital warts or accelerate their resolution. 3
No Pre-Vaccination Testing Required
No pre-vaccination testing (Pap smear, HPV DNA, or antibody testing) is required to determine eligibility for HPV vaccination. 1, 2
No clinical antibody test can reliably establish whether an individual is immune or susceptible to specific HPV types. 1, 2
Why Effectiveness Declines with Age
HPV acquisition peaks shortly after sexual debut, with the highest infection rates in adolescents and young adults. 1, 2
By the late teens and early 20s, most sexually active individuals have already been exposed to at least one vaccine-type HPV strain. 1, 2
Vaccine effectiveness is substantially lower in adults aged 27–45 due to prior infections; some individuals may already possess natural immunity. 1
Despite reduced effectiveness with age, the vaccine remains highly effective against HPV types not yet encountered. 2
Contraindications and Precautions
Absolute contraindication: Immediate hypersensitivity to yeast or any vaccine component. 2
Pregnancy: Vaccination should be postponed until after pregnancy is completed; routine pregnancy testing before vaccination is not required. 1, 2
Lactating individuals may safely receive HPV vaccination. 1, 2
Cancer Prevention Impact
HPV vaccination prevents approximately 28,500–32,100 cancers each year in the United States, including virtually all cervical cancers, ~90% of anal cancers, ~70% of oropharyngeal cancers, and 60–70% of vaginal, vulvar, and penile cancers. 2
The vaccine also prevents about 90% of genital warts caused by HPV types 6 and 11. 2