Gardasil 9 protects against nine HPV types associated with genital warts and several HPV-related cancers.

Vaccination offers the greatest benefit before HPV exposure, but some adults who are already sexually active may still benefit.

The vaccine prevents new HPV infections but does not treat an existing infection.

Cervical cancer screening remains necessary even after completing the vaccination series.

Today, I would like to explain Gardasil 9, a vaccine that helps prevent infection with several types of human papillomavirus,

 commonly known as HPV.

What Is HPV?

Persistent infection with high-risk HPV is the main cause of cervical cancer.

Receiving a positive HPV test result can be frightening because HPV is transmitted mainly through sexual contact. 

However, HPV is extremely common, and most sexually active people are exposed to it at some point in their lives.

HPV can cause several health conditions, including:

• Cervical cancer
• Vaginal cancer
• Vulvar cancer
• Anal cancer
• Certain head and neck cancers
• Genital warts

Most HPV infections do not cause symptoms and are controlled naturally by the immune system within one or two years. 

Cancer is mainly associated with high-risk infections that persist over a long period. 

Risk Factors for HPV Infection and Persistence

Factors associated with HPV exposure or persistent infection may include:

• Beginning sexual activity at a young age
• Having multiple sexual partners over a lifetime
• Smoking
• A weakened immune system
• Having a new sexual partner

However, HPV can occur even in people with only one partner. 

A positive result does not prove infidelity or irresponsible sexual behavior.

High-Risk and Low-Risk HPV Types

HPV types are commonly divided into high-risk and low-risk groups.

High-risk HPV types can cause abnormal cell changes and cancer, while low-risk types are more commonly associated with genital warts.

HPV types 16 and 18 are especially important because they are responsible for approximately 70% of cervical cancers worldwide.

In Korea, HPV types 52 and 58 are also relatively common among women with cervical abnormalities. This is one reason why the broader coverage provided by Gardasil 9 can be particularly relevant.

Which HPV Types Does Gardasil 9 Cover?

Gardasil 9 protects against nine HPV types:

• HPV 6 and 11, which cause most genital warts
• HPV 16 and 18, which cause a large proportion of HPV-related cancers
• HPV 31, 33, 45, 52 and 58, which are also associated with a higher risk of cancer

Gardasil 9 is approved to help prevent cervical, vulvar, vaginal, anal, oropharyngeal and other HPV-related cancers, 

as well as genital warts caused by the HPV types included in the vaccine. 

Vaccination, Screening and Treatment

Preventing cervical cancer requires more than one step.

1. HPV Vaccination

Vaccination helps prevent new infections with the HPV types covered by the vaccine.

2. Regular Cervical Cancer Screening

Screening helps identify HPV infection and abnormal cervical cells before they progress to cancer.

3. Treatment and Follow-Up

If precancerous changes or cancer are detected, timely treatment and follow-up can help prevent disease progression and complications.

There is currently no medication that directly eliminates HPV itself. 

Therefore, vaccination, regular screening and appropriate treatment of HPV-related lesions are essential.

Is Screening Still Needed After Gardasil 9?

Yes.

Gardasil 9 does not protect against every HPV type that can cause cancer. 

It also cannot eliminate an infection that was already present before vaccination.

Therefore, regular cervical cancer screening remains necessary even after completing the HPV vaccination series.

Is It Too Late After Sexual Activity?

Many patients ask:

“I am already over 26 or have had sex. Does that mean Gardasil will no longer work?”

The vaccine provides the greatest benefit when given before the first exposure to HPV. 

However, previous sexual activity does not mean that someone has encountered all nine HPV types covered by Gardasil 9.

Vaccination is routinely recommended through age 26 for people who were not adequately vaccinated earlier.

For adults aged 27 to 45, vaccination is not routinely recommended for everyone, 

but some may benefit after discussing their risk of future HPV exposure with a physician. Gardasil 9 is approved for use through age 45. 

Women may also be vaccinated after childbirth. HPV vaccination is generally postponed during pregnancy, 

but it may be given postpartum, including while breastfeeding.

Should I Get Vaccinated If I Already Have HPV?

A current or previous HPV infection does not automatically mean that vaccination has no benefit.

Gardasil 9 will not treat, clear or shorten an existing HPV infection. However, it may still protect against other vaccine-covered HPV types that you have not yet acquired.

HPV testing before vaccination is not routinely required solely to determine whether someone can receive the vaccine.

Gardasil 9 Vaccination Schedule

The number of doses depends on the age at which the vaccination series begins.

If the First Dose Is Given Before Age 15

Most people receive two doses:

• First dose: initial visit
• Second dose: 6 to 12 months later

If the First Dose Is Given at Age 15 or Older

Three doses are generally recommended:

• First dose: initial visit
• Second dose: approximately two months later
• Third dose: approximately six months after the first dose

People with weakened immune systems may also require three doses regardless of the age at which vaccination begins.

If the schedule is delayed, the series usually does not need to be restarted. 

The remaining doses can be completed after consultation with a medical provider. 

A Positive HPV Test Does Not Mean Your Life Is Over

Some patients become extremely anxious after being told that HPV was detected.

They may fear developing cancer, blame their partner, consider ending their relationship or feel that they can no longer have a normal sex life.

However, HPV differs from infections such as HIV or syphilis. It is widespread among sexually active people, and most infections are naturally controlled by the immune system within one or two years.

A positive HPV test does not mean that cancer is inevitable.

The important issue is whether a high-risk infection persists and causes abnormal cellular changes. 

Regular screening allows these changes to be detected and treated before they progress.

HPV can occur even in people with a normal and healthy sex life.

Partners may also share the virus without knowing when or from whom it originated because HPV can remain undetected for a long time.

You do not need to view an HPV diagnosis with excessive fear or shame.

Vaccination can help prevent new infections with covered HPV types, while regular cervical screening can identify changes at an early stage.

With appropriate vaccination, screening and follow-up, you can continue to protect your health and maintain a healthy sexual life.