HPV vaccination helps reduce the chances of getting cervical cancer. It works by preventing infection with specific types of HPV targeted by the vaccines. However, HPV vaccination does not substitute for routine cervical cancer screening. Vaccinated women should still go for regular pap smear once every three years for early detection of cervical cancer.
About HPV and its link with Cervical Cancer
What is HPV?
- HPV stands for Human Papilloma Virus, a virus that can infect many parts of the body.
- There are more than 100 different sub-types of HPV, grouped into (i) high-risk types (may cause cancer) and (ii) low risk types (non-cancer causing).
- About 30 – 40 HPV sub-types can infect the genital area; and these can cause genital warts in both men and women, cervical cancer in women and less commonly, anal or penile cancer in men.
- Other HPV sub-types may infect the skin of the fingers, hands and face.
Who is at risk of HPV infection?
Risk factors for HPV infection include:
- Multiple sexual partners: The greater the number of sexual partners, the higher is your risk of HPV infection. Having sexual activity with a partner who has had multiple sex partners can also increase your risk. While using condoms can help reduce the risk of HPV infection, condoms however, do not cover all genital skin and does not guarantee 100% protection.
- Weakened immune system: People with weakened immune systems (e.g. may be due to Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) or on immune-system suppressing drugs) are at higher risk of HPV infection.
How is HPV transmitted?
- HPV infection is very common in men and women.
- It can be transmitted through genital skin-to-skin contact during sexual activity, by sharing contaminated sex toys and very rarely, during delivery from the infected mother to the baby.
- HPV cannot be passed by sitting on toilet seats or touching the door knobs.
What are the signs or symptoms of HPV infection?
- Most HPV infections occur without signs or symptoms. Sometimes, genital warts or warts in other parts of the body may appear and are a sign of HPV infection.
Can HPV be treated?
- The virus itself cannot be treated. Most HPV infection (90% cases) goes away on its own without any treatment.
- Although HPV virus cannot be treated, regular Pap smear can help to detect changes in the cervical cells caused by HPV infection.
- With appropriate treatment, the abnormal or pre-cancerous cells can be prevented from developing into cervical cancer.
How is HPV related to cervical cancer?
- Some types of HPV can infect the cervix (the lower part of the womb), causing the cells to change.
- In about 90% of the infection cases, the virus clears by itself and the cells return to normal.
- In some cases, the infection can persist and cause the cells to grow in an abnormal way.
- When this goes undetected by a Pap smear at an early stage, some of these abnormal cells may develop into cervical cancer.
- Specifically, HPV sub-types 16 & 18 cause about 70% cervical cancer cases, while HPV sub- types 6 & 11 cause about 90% genital warts cases.
How can I best protect myself against cervical cancer?
- Go for regular Pap smear as it is the most effective way to detect cervical cancer.
- All women aged 25 and above who have ever had sex or are sexually active should have a Pap smear once every three years
- Speak to your doctor about HPV vaccination to determine if you are suitable.
- Women should still for go for Pap smear despite being vaccinated.
Where can I go for a Pap smear?
- At your family doctor s clinic or at any polyclinic.
- You can also call 1800 223 1313 for more information on Pap smear and cervical cancer.
About HPV vaccination
1. What is HPV vaccination?
- HPV vaccination can help prevent specific types of HPV infection that may lead to cervical cancer. The maximum benefits of HPV vaccination occur when the vaccines are given before the start of sexual activity where HPV exposure occurs.
2. What are the different HPV vaccines currently available in Singapore?
- Two vaccines, Gardasil and Cervarix , are currently approved for use in Singapore.
- The characteristics of the two vaccines are shown in the table below.
3. Who is the vaccine for?
- The vaccines are approved for use in females aged 9 to 26 years old (depending on the specific vaccine being administered).
- The vaccines are most effective if given before first sexual exposure, in girls and women who have yet been exposed to the HPV types covered by the vaccine (HPV sub-types 6, 11, 16, 18).
- Girls and women who are sexually active may still benefit from the vaccine, as they may not be exposed to the HPV sub- types covered by the vaccine. They should speak to their doctor to determine if they are suitable for the vaccination.
4. Who should NOT be vaccinated?
- You should not be vaccinated if :
- you are sensitive to yeast or to any of the vaccine components.
- you are having a moderate or severe acute infectious illness (please wait till you have recovered from the illness).
- you have a bleeding disorder that causes you to bruise or bleed easily or if you are on medication that thins your blood (anticoagulant therapy), unless otherwise advised by your doctor.
- Talk to your doctor to find out if the vaccine is suitable for you.
5. Why is the HPV vaccines recommended for females aged 9 to 26 years old?
- This is the age range as recommended by the manufacturers, and which the vaccines are approved for use in Singapore by the Health Sciences Authority.
- If you are above 26 and wish to go for HPV vaccination, it is best that you speak to your doctor to find out if you are suitable for the vaccination.
6. Are HPV vaccines compulsory?
- No, HPV vaccines are not compulsory but recommended as prevention against cervical cancer.
7. How long does the protection last?
- Studies have demonstrated that protection for both vaccines lasts for at least five years.
- It is yet not known if additional doses or boosters shots are necessary.
8. Are the vaccines safe and effective?
- The two vaccines have been approved as safe and effective.
- Long-term safety and efficacy are still being evaluated.
- The vaccines are not made up of the virus or any infectious material; you cannot get HPV infection from the vaccine.
9. What are the common side effects of HPV vaccines?
- Pain, swelling, itching and redness at the site of injection and generalised reactions including fever are some of the common side effects.
- Isolated reports of fainting immediately after HPV vaccination have also been noted in some countries.
- If you encounter any of these side effects, please inform your doctor.
10. Are HPV vaccines 100% effective in preventing cervical cancer?
- No. As with any vaccination, HPV vaccinations may not result in 100% protection.
- HPV vaccination does not substitute for routine cervical cancer screening, and women who receive vaccination are encouraged to continue to go for Pap smear once every three years.
11. I’ve been vaccinated. Must I still go for a Pap smear?
- Yes! You should go for a Pap smear once every three years even if you have been vaccinated.
- About 30% cervical cancer cases are caused by HPV sub-types which the vaccine does not protect against. In other words, the vaccines do not protect against ALL cancer-causing HPV sub-types.
- Regular Pap smear is still your best protection against cervical cancer.
12. I m pregnant / breastfeeding. Should I be vaccinated?
- HPV vaccines are not recommended for use in pregnant females.
- If you discover that you are pregnant after receiving 1 or 2 doses of the vaccine, it is recommended that you postpone the remaining dose(s) till after you deliver.
- If discovered you are pregnant after completing 3 doses of the vaccine, it is not necessary to terminate your pregnancy.
- Gardasil may be given to lactating females because available data do not indicate any safety concerns. However, Cervarix s safety data for lactating females are not available yet.
13. I have a young daughter. Should she be vaccinated? When should she receive the vaccination?
- The vaccine is approved for females aged 9 years to 26 years (depending on the specific vaccine being administered).
- The vaccines are most effective in protecting against the selected HPV sub-types if given before your daughter is exposed to them (usually through sexual activity)\
- We advise you to speak to your doctor to find out more about HPV vaccination.
- Once you have understood the benefits, risks and limitations of the vaccines, the decision whether to proceed with vaccination is a personal one.
- People may arrive also at different decisions based on different religious or moral beliefs.
14. I was diagnosed with a cervical abnormality that my doctor said may lead to cervical cancer (e.g. ‘cervical intraepithelial neoplasia’ or CIN). Should I get the HPV vaccination?
- It is best to talk to your doctor who will be able to advise you if the vaccine is suitable for you and also how often you should be going for your Pap smears.
About Medisave use for HPV vaccination
15. Can Medisave be used to pay for the HPV Vaccination?
- With effect from 1 November 2010, patients can use up to $300 per Medisave account per year under the Medisave300 scheme to pay for HPV vaccination.
- Patients can use their own Medisave or that of their immediate family members (e.g. parents or spouse) to help pay for the vaccination.
- The deductible and co-payment rules will not apply for HPV vaccinations.
16. What happens if one do not have sufficient money in their medisave accounts to pay for the vaccines, is there help available?
- Needy parents and women with insufficient Medisave balances can seek special financial assistance at the polyclinics.