Should I take a HPV vaccine?

I get this question a lot both from women and their mothers.

Before we get into answering the question proper, let’s look at some facts:

  1. Cervical cancer is the 7th most common cancer in Singapore and the 5th most common cancer in the world.
  2. Cervical cancer is caused by infection with the Human Papillomavirus (HPV)
  3. Certain strains of HPV, known as ‘high risk types’ are more likely to cause Cervical cancer.
  4. Cervical cancer is frequently asymptomatic until late stages.
  5. Cervical cancer can be cured if detected early.
  6. The best way to detect Cervical cancer early is by going for regular PAP smears.
  7. HPV can be transmitted by both penetrative and non-penetrative sexual contact.

As with any medical decision, it requires a weighing of the pros and cons to make an informed decision.

Pros Cons
1. You are protected against 90% of cancer causing HPV strains.2. With regular PAP smears your risk of getting Cervical Cancer just went down by 94%. 1. You are poorer by a few hundred dollars.2. Your arm hurts for 2 days.3. You have a bruise on your arm. No sleeveless tops for a few days.4. You still have to go for regular PAP Smears.

 

Sounds like a fairly straightforward decision to me.

The second decision to make is ‘Which Vaccine’?

 

Gardasil Cervarix
1. Needs 3 injections over 6 months 1. Needs 3 injections over 6 months
2. As of September 2010, there is still no need for any booster injections. 2. As of September 2010, there is still no need for any booster injections.
3. Protects against the 2 most common cancer causing HPV strains 16 and 18. 3. Protects against the 2 most common cancer causing HPV strains 16 and 18.
4. Offers some protection against the cancer causing HPV strain 31 and ‘9 others’. 4. Offers some protection against the cancer causing HPV strains 31 and 45.
5. Protects against the wart causing HPV strains 6 and 11. 5. No protection against warts.

 

This is more complex and requires a formal consultation with your doctor.

Questions that I get asked a lot:

But MOH (Ministry of Health) says the vaccine is only for women between the ages of 9 and 26?

My usual response: That is MOH’s policy. The fact is HPV vaccines protect against HPV, regardless of age. In fact, recent studies on both Cervarix and Gardasil indicate that HPV vaccination in women up to 45 years old is still effective in preventing Cervical cancer. The more important thing is to weigh the risk and benefits carefully.

Can I use my Medisave to pay for the vaccine?

Yes our clinic at Robertson Walk is accredited by MOH for you to use your Medisave to pay for HPV vaccination. You have to be female between the ages of 9 and 26. The withdrawal limit is $400 per year.

I have already been infected with HPV. Should I still get vaccinated?

My usual response: HPV infections are detected using the Digene DNA HPV test. It can tell if a woman is infected with a high risk HPV strain but is unable to tell the strains apart. It is unlikely that a woman is infected with all the high risk strains at once. It is therefore still good to get vaccinated to protect yourself against the other strains.

My husband and I have no other sexual partners. Do I still need to get vaccinated?

My usual response: There is no need for vaccination if you are in a mutually monogamous relationship. (stressing on the word ‘mutually’ which usually draws a chuckle).

Do I need to undergo a PAP smear and HPV test before having the vaccine?

My usual response: No. The results of these tests will not make a difference to your decision on whether or not to have the vaccine. It is always a good habit to have regular PAP smears anyway.

I always use condoms so I am protected against HPV right?

My usual response: Unfortunately that is not true. It has been shown that condoms do NOT prevent HPV infection. However, condoms do provide some protection against HPV related diseases like Cervical cancer and warts.

So after all of that this is the take home message ‘Go speak to your doctor about getting vaccinated against HPV for yourself and your daughter. It is very likely both of you will benefit from it. Remember to continue getting your regular PAP smears.’

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Related Topics:

Gardasil Vaccine

HPV Vaccine for Men

Genital Warts

Peri-Anal Warts

 


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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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24 Comments

  1. Hi, I just want to confirm regarding the HPV Vaccine. If I’m 26 as of now, am I still eligible to claim under my Medisave?

  2. Can I go down to consultation first before I decide shld I take up this jab?
    How much does it cost for this jab?

    Tks

    • Hi, of course you can come down for a consult and discuss this before taking the jab. The jab cost $150 per vaccine (before GST) and you will need a total of 3 vaccines spread out over 6 months.

  3. Hi, this jab is to prevent what cancer?
    I’m 24 years old. Do I need to take this jab?

    • drtan

      This jab primarily is to prevent Cervical Cancer. It can also protect against Vulvar, Vaginal and Anal Cancer. This jab is recommended for all women and men between the ages of 9 and 26 in Singapore. For women between the ages of 9 and 26, you can use your Medisave to pay for it. You can certainly benefit from this jab. Please come down to our clinic to speak with our doctors.

  4. i had the first shot of gardasil in august and forgot to go back to the same doctor in end of september. it’s now december, can i still go for the 2nd shot or i need to do the first round again? thanks.

  5. Hi Dr. Tan,

    Do you know approximately what percentage of women get vaccinated in Singapore?

    Thank you,
    Tanya

    • Very good question Tanya. Since HPV vaccination is not reported to the National Immunisation Registry, we really do not have any reliable data. From other sources, I have heard a figure of 10%. However, I stress that this figure is a very gross estimate with many presumptions.

      • Thanks Dr. Tan. From my research, the only source I was able to find said 1%, but that seems too low to me (http://medobserver.com/article.php?ArticleID=502). You don’t think there could be other papers and research out there that could give us additional insight?

        Tanya

        • Yes 1% sounds a bit low. But this depends heavily on the denominator. The number I gave you was derived from vaccine sales as the numerator and men and women between the ages of 9 and 45 in Singapore as the denominator. I am not aware of any other studies on this. I am sure pharmaceutical companies will know but it is unlikely they will share this info.

        • drtan

          Hi Tanya,

          Just came across some NIS data from the US that states females between the ages of 13 and 17 in the US, only about 35% have received 3 shots of HPV vaccine. About 50% received at least 1 shot.

  6. I’m 44 years old and have had a cervical conization 12 years ago due to a moderate dysplasia. I have been checked yearly with PAP smear which has always been normal. I have been married to the same man for 15 years, would you recommend the HPV vaccine?

    • I cannot recommend you anything. This forum is not for medical consultations. What I can say is generally speaking, the benefits of taking a HPV vaccine usually outweighs the risk. This is something you should discuss with your doctor.

  7. evelyn tan

    dear dr. Tan
    im 27 yo, monogamous sexually active. After discussed with my gynecologist, he said I should pap smear before vaccinated because the vaccine can over growing the virus if i already had hpv lesions… and i never pap smear before.is that right dr. Tan? my cousin in indonesia said same too while she do consultation with her gynecologist…thanks for your attention

    • I am not sure what you mean by ‘vaccine can over growing the virus if i already had hpv lesions’. I personally do not think getting a PAP smear is necessary prior to getting the HPV vaccine. Whether the PAP smear is normal or not, I would still recommend the vaccine. All sexually active women should get PAP smears. It is very important that you get yours done regularly regardless of whether or not you intend to take the HPV vaccine.

  8. Hi im 20to i enjoy learning all this information. Ive never had a hpv shot should i?? Ive had paps done though..

    • Hi lovely,

      That is a very good question. I am sure it comes as no surprise to you when I say ‘yes of course you should’. The fact is, more and more people are coming to realise the vast benefits of HPV vaccination. Gardasil has been proven to prevent not only cervical cancer but also genital warts, anal cancer, vulval cancer and vaginal cancer. Vaccinating men will not only protect them from genital warts and anal cancer, it will also provide a herd immunity and indirectly protect women from Cervical and Vulval cancers. Overall, the benefits to HPV vaccination far outweigh the risks. I will be writing a blog entry soon on which HPV vaccine to take. Be sure to look out for it!

      rgds

      Dr Tan

  9. Hi Doctor,

    I’ve taken one injection of Gardasil and been researching about the side effects. Most are minor while some are major and even deaths. Cases recorded are in US, Britain and Australia. I have yet to find records of major side effect in South East Asia region. Is there any record of those effect in Singapore? thanks

    • I know of the cases you are talking about. None of them have been definitely linked to the vaccine. I also know that there are a lot of conspiracy theories out there on these vaccines being dangerous and governments are pushing them only for a profit motive along with big pharma. You definitely come across as an intelligent person and I’m sure you can weight the information and come to a logical decision. As a more direct answer to your question: I have not heard of nor have received any updates from HSA with regards to any major side effects of HPV vaccines in Singapore.

  10. Lovebaby

    hello doctor, it’s me again. I really like the information from your website. Very useful. I’ve done Gardasil vaccine in 2009. I routinely do PAP smears (using the Thin Prep method) every once a year. What I want to know, approximately how many years the vaccine (Gardasil) protects against the HPV virus? When should I repeat injections of the vaccine Gardasil (supposing it to be repeated)? Thank you in advance for your answer.

    • Hi Lovebaby,

      You should have gotten 3 injections in 2009. If you have note, please see your doctor. If you completed the entire course, current studies show that there is no need for any booster injections.

      Rgds

      Dr Tan

      • lovebaby

        Yes i hv completed 3 injections in 2009. Thanks for your your answer….

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