Santé et Services sociaux Québec

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Human Papillomavirus Viruses (HPV)

Questions and Answers

HPVs

The Vaccine

The Program

How are HPVs transmitted?

HPVs are transmitted during sexual activity through skin-to-skin contact with the penis, scrotum, vagina, vulva or anus of an infected person.

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Who can be infected by HPVs?

Anyone who engages in sexual activity, even without penetration, can get an HPV infection. It is the most common sexually transmitted infection (STI). Between 70% and 80% of men and women will be infected by an HPV at least once in their lifetime.

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What are the symptoms of HPV infection?

In most cases, people do not realize they have been infected by an HPV because there are no signs or symptoms. This means that they can pass on the virus without knowing it.

Often people have condylomas without knowing it because they are not always visible to the naked eye. Every year 14,000 men and women in Québec are diagnosed with condylomas. These ano-genital warts can require several visits to the doctor and painful treatments.

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How can HPVs and their complications be avoided?

There are four ways to protect against HPVs. However, using only one at a time is not effective you need to do them all to have the best protection:

  • Vaccination: to prevent infection with the main HPVs associated with cervical cancer and ano-genital warts.
  • Cervical cancer screening: to detect abnormal cells in the cervix as early as possible.
  • Restricting the number of partners: the higher the number of sexual partners, the higher the risk of catching an HPV.
  • Using condoms: Condoms remains the best way of preventing all STIs. However, since condoms do not cover the skin around the genitals, transmission of HPVs remains possible.

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Can vaccination cause HPV infection?

The vaccine does not contain HPVs and cannot cause infection. It stimulates the immune system to build defenses (antibodies) against these four HPVs. They offer no protection, however, against other STIs.

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Is HPV vaccination a replacement for screening for cervical cancer?

No. The vaccine is a method of prevention that protects against the HPVs that cause 70% of cervical cancers and against the HPVs that cause 90% of ano-genital warts. Cervical cancer screening is the only way of detecting abnormal cells in the cervix that could later turn cancerous. Screening tests are unnecessary before the onset of sexual activity and rarely before the age of 21.

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Who is eligible for the free HPV vaccination program?

Québec’s HPV vaccination program is offered to girls in Grade 4. Girls who did not receive the vaccine in Grade 4 can receive it free of charge in Secondary 3. Other girls under the age of 18 can be vaccinated free of charge by making an appointment at a CLSC or with their doctor and will need to receive three doses over a period of six months.

The vaccine is free for younger girls if they are at high risk of HPV infection and for women between the ages of 18 and 26 who are immunosuppressed or HIV positive.

Women age 18 years or older who have not initiated vaccination must pay the cost of the vaccine if they wish to receive it.

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Why aren't there free vaccination programs for boys?

At the start of the program, the vaccine was solely intended to prevent cervical cancer, and so was given to girls only. Since that time, many scientific studies show that the vaccine protects boys against condylomas and against a form of cancer of the anus associated with HPVs. We don’t yet know if vaccinating males prevents cervical cancer in their female partners, but vaccinating a large portion of the female population results in fewer cases of condylomas for males. Canadian experts do recommend vaccinating boys against HPVs, but this is not free of charge.

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What is the objective of the HPV vaccination program?

The objective of the vaccination program is to prevent cervical cancer and other illnesses associated with HPV.

Every year in Québec, an average of 281 women discover they have cervical cancer and 69 die of the disease. In reality many more women are affected. Around 53,000 women a year have to see a specialist for follow-up exams after a Pap test indicating abnormalities related to HPV. These clinical examinations can be unpleasant and stressful, and may require several visits. In some cases, they can even be painful (biopsy, colposcopy, removal of part of the uterus, etc.) and impact the woman’s fertility.

The vaccine used in the vaccination program (Gardasil®) can also prevent most ano-genital warts (condylomata)—90% of which are caused by HPV 6 and 11, which are covered by the vaccine. Approximately 14,000 people are affected by HPV every year in Québec. As well as being embarrassing and unpleasant, ano-genital warts can require treatment spread over numerous doctor’s appointments. For most people, the infection disappears on its own.

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Why was an HPV vaccination program for fourth graders?

Québec’s HPV vaccination program is offered to girls in elementary school Grade 4 for the following reasons:

  • The immune system responds best to the vaccine between the ages of 9 and 11;
  • The vaccine is most effective when the person is not already infected. Since infection usually occurs during the first years of sexual activity, it is preferable that girls be vaccinated before their first sexual relations;
  • There is already a vaccination program in Grade 4 against, hepatitis B, thus avoiding undue hassle for parents.
  • In Grade 4, two doses of vaccine are sufficient, whereas a teenager or young woman requires three doses.

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Is the HPV vaccination program being assessed?

Yes, as is the case with all vaccination programs, the HPV program is being systematically assessed. Assessment deals mainly with the program's effectiveness in achieving the objectives of reducing the spread of the disease, monitoring vaccine side effects, and determining the effectiveness of the extended schedule.

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Is the HPV vaccination program integrated into a broader approach?

This program is not an isolated activity. It stands alongside other measures already in place to prevent sexually transmitted infections (STIs) and to encourage safe, responsible sex practices. Indeed, various prevention and promotion actions, particularly in schools, very specifically target youth issues and situations related to sexuality they may encounter.

Moreover, efforts continue to go into screening for cervical cancer, since women who have had HPV vaccination still need to have a Pap test.

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Why should HPV vaccination be authorized or supported?

Vaccination has proven itself by reducing, even eradicating, certain serious diseases. The case of the HPV vaccine is no exception. To the contrary, it prevents, in particular, precancerous cervical lesions as well as genital warts (condylomata). Beyond the studies conducted on the vaccines, this protection has been confirmed in countries where vaccination has been implemented for several years, such as in Australia. Concerned with the health of the general public, Québec public-health authorities are encouraging young girls to receive the HPV vaccine—a recognized effective, safe means of protection—and encouraging their parents to support them.

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