June 26, 2023 – The human papillomavirus (HPV) vaccine may now be as critical as ever, though young people are taking the shot in fewer and fewer numbers. An epidemic of sexually transmitted HPV is now swirling around the U.S. and the U.K., with some serious cases leading to oropharyngeal cancer, which can affect the back of the throat, tonsils, and tongue.
HPV is the leading cause (70%) of this oropharyngeal cancer, according to the CDC. It is the most common sexually transmitted disease (STD) in the nation, and around 3.6% of women and 10% of men report oral HPV specifically. But over the past decade, oropharyngeal cases have been steadily falling a little under 4% and 2%, respectively, according to the National Cancer Institute.
HPV is often undetectable and can clear up within a few months. But unfortunately for some, serious disease, such as throat cancer, can develop if HPV isn't treated.
Studies show the HPV vaccine to be extremely effective in lowering sexually transmitted HPV cases. Yet, only 54.5% of young people ages 13-15 have taken the recommended two to three doses, according to the National Cancer Institute.
Why Aren’t More Young People Taking the Vaccine?
Low public awareness of the dangers of HPV may be behind young people’s poor vaccination rates, according to Teresa Lee, MD, an assistant professor at the Fox Chase Cancer Center in Philadelphia. “For example, while the link with head and neck cancers have been well-studied, the FDA labeling was not changed to reflect this as an indication until 2020,” she said.
Other reasons can include one’s socioeconomic background, poor health literacy, cultural or religious stigmas around vaccines, and lack of quality, low-cost health care, says Emmanuel Aguh, MD, a board-certified family medicine doctor. “Some individuals and families are still resistant to vaccines and the noted lack of uptake.”
Doctors and other health care professionals should also be sure to tell patients of all ages about the risks of HPV infection and how well the vaccine works, Lee said. “Not everyone who is now eligible may have been offered the vaccine as a child, and the first time young adults may receive counseling on this subject may not be until they are entering a very busy period of their lives with many responsibilities – when it may be hard to fit in things like health maintenance.”
How Safe Is the HPV Vaccine?
The FDA and CDC have studied the HPV vaccine for years to find out how safe it is and how well it works, Aguh said. No major side effects have been reported, and the most common side effect is soreness where you get the shot (which is normal after most vaccines). Some dizziness and fainting in adolescents can also occur, so young people are usually asked to sit or lie down during the shot and for 15 minutes afterward, he said.
“Serious adverse events have not been reported at higher rates than expected following HPV vaccination, meaning there is no clear evidence they are related to the vaccine,” Lee said. “The vaccine is highly effective in decreasing rates of detectable infection with the high-risk HPV strains responsible for HPV-associated cancers.”
The HPV vaccine is largely recommended for people ages 9 to 26, and sometimes up to age 45, depending on the individual, Aguh said. If you are over 26, talk to your doctor about whether you should consider getting the vaccine.
“It is usually given in two doses for complete protection if taken before the 15th birthday,” Aguh said. “If taken afterward, or in those with a weak immune system, they might require three doses to be fully protected.”
The vaccine produces antibodies that can stop HPV from infecting cells and lowers your chances of catching an HPV-related cancer, such as throat cancer or cancer of the cervix, he said.
While the vaccine is not guaranteed to protect you from the more than 100 strains of HPV, it can protect you from HPV 16 and HPV 18 – two high-risk strains that cause around 70% of cervical cancers.
What Is Fueling the Rise of HPV Cases?
A misconception that oral sex is somehow a “safe and risk-free” alternative to anal or vaginal sex could be one reason, Aguh said.
“It is important to know that with oral sex, you are exposed to many of the risks associated with vaginal intercourse, especially if you do not take any measures to protect yourself and/or your partner,” Aguh said. “[With oral sex] it is possible to end up contracting an infection like chlamydia, gonorrhea, and even HPV, leading to an increased risk of HPV-associated oropharyngeal cancers.”
A lack of public awareness of what can cause throat cancer could also explain this phenomenon. The number of people you have oral sex with, along with the age you begin sexual activity, can greatly determine your risk of the disease, according to Lee. She echoes a report by Hisham Mehanna, PhD, in The Conversation.
“For oropharyngeal cancer, the main risk factor is the number of lifetime sexual partners, especially oral sex,” wrote Mehanna, a professor at the Institute of Cancer and Genomic Sciences at the University of Birmingham in England. “Those with six or more lifetime oral-sex partners are 8.5 times more likely to develop oropharyngeal cancer than those who do not practice oral sex.”
What Are Symptoms of Oropharyngeal Cancer?
Labored breathing or swallowing, a cough that won’t go away, and crackling or hoarseness of your voice could all be signs of throat cancer. Other symptoms include earaches, swelling of the head or neck, and enlarged lymph nodes, among others, Aguh said.
“The signs and symptoms of HPV-related throat cancers can be difficult to identify and recognize, as they can be vague and are also associated with other medical conditions. Sometimes, there are no signs at all, or they are not easily noticeable due to the location,” he said.
You should go see your doctor if you have any of these ailments for an extended period.
How to Reduce Your Risk
In addition to having six or more oral-sex partners, smoking and drinking heavily could also raise your risk of throat cancer, said Lee. Proper dental health – like seeing your dentist regularly and practicing proper oral hygiene – can also shave your risk.
“[Good dental health] can help not just with head and neck cancer risk, but with many other inflammation-related diseases,” Lee said.
Using dental dams and condoms can also be a good method of protection, Aguh said. A dental dam is a stretchy sheet of latex, or polyurethane plastic, in the shape of a square that is made for blocking body fluid to lower your risk of contracting an STD via oral sex.
Keep in mind: Even with these protections, make sure you and your partner discuss each other’s sexual history, any prior or current STDs, and their preferred protection from STDs, said Aguh.
If you or your partner is being treated for an STD, consider opting out of oral sex and consulting a doctor.
The HPV vaccine is another common method of protection. The shot is “approved for prevention of nine of the most high-risk strains of HPV," or those that are most commonly linked to cancer, according to Lee. The vaccine “reduces the frequency of infection” with these viruses, which can ultimately lower the risk of cancers linked to HPV, including cervical, anal, and vulvar and vaginal cancers, she said.
“The best time to receive treatment for prevention of disease is prior to onset of sexual intercourse,” said Lee.
To get your HPV vaccine, head to your family doctor, school- or community-based health center, or state health department, suggests the CDC.
Click here learn more about the HPV vaccine and here for more information about oral HPV and cancer.