HPV vaccination: who gets it on the NHS, doses and how long protection lasts

Human papillomavirus is a group of related viruses. The NHS describes it as a common virus spread through skin contact, usually when having sex, and says that most types are harmless. A minority of types, however, are linked to an increased risk of certain cancers, and a separate set of types causes genital warts.

The cancers the NHS links to HPV are cervical, mouth, anal, penile, vulval and vaginal cancer. Because the virus is so widespread, the aim of a vaccination programme is not to treat anyone who already has an infection but to give the immune system a head start before a person is exposed.

This is why the routine offer is made in early adolescence. UKHSA guidance for practitioners explains that the national programme began in September 2008 for girls in year 8, and was later widened so that boys are also offered the vaccine, with the stated aims of direct protection for vaccinated boys, protection for gay, bisexual and other men who have sex with men before they become sexually active, and indirect protection for people who are not vaccinated.

UKHSA guidance for healthcare practitioners says current studies suggest that protection is maintained for at least 10 years, although it is expected to last longer and may be lifelong. The vaccine has not been used for long enough to say for certain how long protection lasts, so the honest answer is "at least 10 years so far, probably longer".

UKHSA also reports that in 2018, 10 years after the programme began, no HPV 16 or 18 infections were detected in 16 to 18 year olds. It describes this as showing the programme has delivered both direct protection to people who were vaccinated and indirect protection to others.

Separately, the vaccination course itself is short. Under 25 it is usually a single injection into the upper arm. Older people who are eligible usually need 2 doses, and people with a weakened immune system need 3, as set out in the doses section below.

Eligibility depends on age, sex assigned or birth date, and sometimes on risk. The NHS sets out several groups, summarised in the table below. If you are unsure whether you fall inside a group, the NHS suggests that school nurses, school vaccination teams and GP surgeries deal with catch-up for young people, while sexual health and HIV clinics deal with older at-risk groups.

The vaccine is an injection into the upper arm. The number of doses has fallen over the years as evidence built up. According to the UKHSA guidance, the original programme used three doses, which moved to two doses in 2014 for girls under 15, and from 1 September 2023 the routine adolescent programme moved to a single dose for those under 25.

Today the NHS says people under 25 usually have 1 dose, people aged 25 to 45 usually have 2 doses given between 6 months and 2 years apart, and people with a weakened immune system have 3 doses over a 12-month period. UKHSA guidance gives the same three-dose pattern for people who are immunosuppressed or known to be living with HIV, including those taking antiretroviral therapy.

The vaccine has changed too. The programme started with a vaccine covering two cancer-causing types, moved to one that also covered the two types responsible for genital warts, and from summer 2022 switched to Gardasil 9, which adds five more cancer-causing types.

The NHS says the vaccine works very well at reducing the chance of getting HPV and that, since it has been in use, there has been a big drop in young people developing conditions linked to HPV such as cervical cancer and genital warts. It also states that research suggests the vaccine will save thousands of lives in the UK over time.

It is not a treatment. It lowers the likelihood of new infection with the types it covers, so it cannot clear an infection you already have and does not cover every HPV type. For that reason the NHS stresses that vaccinated people should still attend cervical screening, since there is still a small chance of cervical cancer.

• Cervical screening looks for high-risk HPV and cell changes, which is a different job from prevention.

• The vaccine does not prevent other sexually transmitted infections, so it does not replace condoms or sexual health checks.

• Genital warts, if they appear, are managed separately in a sexual health clinic.

The NHS describes the common side effects as mild and short-lived: swelling or pain where the injection was given, headache, a high temperature, dizziness, feeling sick and tiredness. More serious effects such as a severe allergic reaction are very rare, and the person giving the vaccine is trained to recognise and treat one straight away.

Most eligible people can have the vaccine. The only firm exclusion on the NHS page is a previous serious allergic reaction (anaphylaxis) to an earlier dose or to an ingredient. If you have a high temperature or feel too unwell to do your normal activities, the advice is to wait until you feel better.

In pregnancy, the NHS says there is no evidence that the vaccine is harmful, although you may sometimes be advised to wait until the pregnancy is over. It can be given during breastfeeding.

People who were not vaccinated at school can usually still have the free NHS vaccine until their 25th birthday. The NHS says to contact your school nurse, school vaccination team or GP surgery if you or your child were eligible but did not get vaccinated.

After that, the NHS describes targeted groups only: men aged 45 and under who have sex with men and attend a sexual health or HIV clinic, and some other people at higher risk, such as sex workers, people with HIV and some transgender people. UKHSA notes that boys born before 1 September 2006 have not been offered the vaccine, because they are already benefitting from the indirect protection provided by the programme so far.

Whether an adult outside these groups could benefit is an individual question. The vaccine does not affect infections already present, but it can protect against covered types a person has not yet met. It is a conversation for a GP, practice nurse or sexual health clinician rather than something a general guide can settle.

Three separate tools sit around HPV: the vaccine to prevent infection, cervical screening to find early changes, and clinic treatment for warts. The NHS genital warts page notes that warts are usually small, rough lumps around the genitals or anus, that treatment is not always needed because they sometimes disappear on their own within 6 months, and that treatments such as creams, freezing or minor surgery can take weeks or months and the warts may come back.

Because Gardasil 9 includes types 6 and 11, it is designed to reduce the chance of the common wart-causing infections as well as the cancer-causing ones. Screening remains the safety net for cervical cancer regardless of vaccination status.

Most people have no problems after the vaccine. The NHS says more serious side effects such as a severe allergic reaction are very rare, and that the person who vaccinates you is trained to deal with allergic reactions and treat them immediately. If you feel very unwell after a vaccination at any point, use NHS 111, and call 999 for a life-threatening emergency.

Outside of vaccination, the NHS genital warts page says to go to a sexual health clinic if you notice one or more painless lumps or growths around your vagina, penis or anus, itching or bleeding from your genitals or anus, a change to your normal flow of pee that does not go away, or if a sexual partner has genital warts. A GP will probably refer you to a sexual health clinic if they think you might have them.

If you have a high temperature or feel too unwell to do your normal activities on the day of a booked vaccination, the NHS advice is to wait until you are feeling better before having it.

On the NHS the vaccine is free to eligible people. Children are offered it at secondary school (or at community clinics for those not in school), and people who missed it can usually be vaccinated through their school vaccination team or GP surgery. Eligible adults in the higher-risk groups are vaccinated at sexual health or HIV clinics.

The NHS page describes NHS routes only. If you do not fall into an NHS group, the sensible first step is to ask your GP or a sexual health clinic whether you are eligible or whether there are other options for you, rather than assuming either way.