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​About HPV and Its Link to Cervical Cancer

1. 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; some can cause genital warts in both men and women, but only 14 are associated with cervical cancer in women and less commonly, anal or penile cancer in men. These fourteen strains are known as the high-risk HPV.​
  • Other HPV sub-types may infect the skin of the fingers, hands and face.

2. Who is at risk of HPV infection?

HPV is a common skin infection. Most people infected by genital HPV have no clear history of contact. However, the risk of infection is seen to be higher for:​

  • ​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, it does not cover all genital skin nor guarantees 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.

3. 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.

4. What are the signs or symptoms of HPV infection?

  • Some HPV infection may cause genital warts.
  • High-risk HPV infection of the cervix does not cause any signs and symptoms. The abnormality on the cervix is detectable by cervical screening (Pap test) and by specific HPV test.

5. Can HPV be treated?

  • The virus itself cannot be treated. Most HPV infection (90% of the 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.

6. 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 account for about 70% of cervical cancer cases, while HPV sub-types 6 & 11 are responsible for about 90% of genital warts cases.

7. 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.

8. 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

9. 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.

10. 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.

 

Gardasil

Cervarix

Protect against the following HPV sub-types

6, 11, 16, 18

16, 18

Vaccination schedule

2 dose schedule
Interval at 0 and 6 months for females from age 9 to13 years inclusive

3 dose schedule  
Interval at 0, 2 and 6 months for females from age 14 to 26 years inclusive
2 dose schedule
Interval at 0 and 6 months for females from age 9 to13 years inclusive

3 dose schedule  
Interval at 0, 1 and 6 months for females from age 14 to 25 years inclusive

Approved indications

Prevention of cervical cancer, vulvar cancer, vaginal cancer and genital warts

Prevention of cervical cancer

Approved age for use

Girls and women aged 9 to 26 years, or as advised by your doctor.

Girls and women aged 9 to 25 years, or as advised by your doctor.

11. Who are the vaccines 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.

12. 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 a vaccination is suitable for you.

13. Why are 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 it.

14. I have a young daughter. Should she be vaccinated?
  • 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).
  • It is advisable 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 to proceed with vaccination is a personal one.

15. Are HPV vaccines compulsory?

No, HPV vaccines are not compulsory but recommended as prevention against cervical cancer.

16. How long does the protection last?

  • Currently available evidence demonstrates a sustained protection against vaccine-targeted HPV-related diseases in long term follow up studies for both vaccines.
  • There is currently no recommendation for additional doses or boosters shots.​

17. Are the vaccines safe and effective?

  • The two vaccines have been approved as safe and effective.​​
  • Long-term safety and efficacy are still under evaluation.
  • The vaccines consist neither the viruses or any infectious material. This means you cannot get HPV infection from the vaccines.

18. What are the common side effects of HPV vaccines?

  • Pain, swelling, itching redness at the site of injection and fever are some of the common side effects.
  • Isolated reports of fainting immediately after HPV vaccination have been noted in some countries.
  • If you encounter any of these side effects, please inform your doctor.

19. Are HPV vaccines 100% effective in preventing cervical cancer?

  • No. As with any vaccination, HPV vaccinations do not guarantee 100% protection.
  • HPV vaccinations are not substitutes for routine cervical cancer screening. Women who received vaccination are still encouraged to continue going for Pap smear once every three years.

20. 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 vaccines do 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.

21. I'm pregnant / breastfeeding. Should I be vaccinated?

  • HPV vaccines are not recommended for 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.

22. Where can I receive HPV vaccination?
  • You can receive HPV vaccination at a polyclinic or GP clinic.
  • It is advisable to speak to your doctor to find out more about HPV vaccination.

23. 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.
24. Is HPV vaccination for boys included in the National Childhood Immunisation Schedule (NCIS)?
  • HPV vaccination for boys is not included in the NCIS. Based on the recommendations by the Expert Committee on Immunisation, HPV vaccination is recommended only for females aged 9 to 26 years old under the NCIS.
  • It is advisable to speak to your doctor to find out more about the benefits and limitations of vaccinating your son against HPV.
25. Should my son go for HPV vaccination?
  • Currently the National Childhood Immunisation Schedule (NCIS) only includes HPV vaccination for females aged 9 to 26 years old.
  • The decision to proceed with vaccination is a personal choice.
  • We advise you to speak to your doctor to find out more about the benefits and limitations of vaccinating your son against HPV.

​About Medisave use for HPV vaccination

26. Can Medisave be used to pay for the HPV Vaccination?

  • ​Yes. With effect from 1 November 2010, patients can use up to $400 per Medisave account per year under the Medisave400 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.