I have been on Tysabri for 16 years with no discussion of HPV. Too old to get Gardisil in the USA. Tested positive for 8 strains a few years ago and had treatment to remove a layer of my cervix. Not fun. Asked both the Neuro and OB/Gyn about relationship to DMT and got a head shake. Same issues with staying on birth control, menopause and HRT. Crazy
States also. No HRT due to previous cancer here ages ago. It’s miserable. A family members had cervical freeze treatment I attended, and it was no walk in the park. Fingers crossed you are in remission and stay there, friend.
Natalizumab is considered safe. But it does reduce trafficking of lymphocytes and hence immunosurveillance of the gastrointestinal tract so may increase your risk of some HPV associated cancers.
I have had issues with hpv and CIN3 in the past and two lots of treatment around 15-20 years ago.
Hpv returned more recently since starting DMTS and I tested positive Aug 2020, positive August 21 and positive July 22 and had lletz treatment again August 22. I tested positive again Mar 2023 and Mar 2024. It concerns me deeply that nobody in my health care has spoken to me about any risks with being immunosuppressed and chronic HPV and because I had LLETZ treatment in 2022 they’re happily awaiting a 3rd positive result again (even tho it will actually be 6 years from original positive test in 2020 and could’ve been more years than that because I hadn’t had a smear for 5 years previous to that). I am on ocrevus so not sure if vaccination would work at my grand age of 48. I’m post menopausal and on HRT.
Never had any discussion before embarking on natalizumab 10 years ago and I have been positive for HPV. My last cervical smear came back negative for HPV and due to my age I will no longer be offered any more smears
Thank you. It looks like at age 59, I’m not eligible for the vaccine. I’ve asked my gynecologist as well as my neurologist (in the US), and no one seems to be aware of this matter.
No neurologist ever spoke to me about HPV or anything else from this article. Thanks prof G, it seems it is up to us patients to do regular check ups, and hope for the best
Hi, the NHS doesn’t offer a HPV vaccine to those over 25 years of age. You mention in your article adults getting one - two, three doses etc. Should we therefore be exploring this on the private health system - is that what you mean? Many thanks
I was already vaccinated with the original Gardasil, so I don't remember if my doctor mentioned it or not.
I was older than the guidelines and had to pay out of pocket, but I still think that was a great decision. I remain older than the guidelines, so I probably wouldn't pay out of pocket for the updated version, even after IRT.
No there is no age restriction on the vaccine. There is a lobby to extend the vaccine to all ages. Clearly this depends on your risks of exposure to the virus. If you have very little chance of being exposed then arguably the vaccine is not needed.
Have I picked this up correctly that a group of men up to the age of 45 can get the HPV vaccine but woman can only get the vaccination on the NHS up to the age of 25?
No the NHS covers the vaccine under the age of 25 if you missed out at school. If you are over 25 you have to pay for it yourself regardless of your sex. Those between 25 and 45 can have two doses and those over 45 or the immunosuppressed are advised to have 3 doses. The latter is based on the fact as you get older and your immune system ages your immune system is not working well due to immunosuppression, you need more boosters to have an adequate immune response.
If you haven't had the vaccine in the past you should consider the vaccine. You will need 3 doses under the NHS guidelines. If you had the bivalent or qudravalent vaccine you may want to consider upgrading your immunity with the polyvalent vaccine, which covers additional oncogenic strains.
As someone pointed out, we in states do not have smears after a certain age if all has been well, and no one discussed any vaccinations other than pneumonia and later, shingles, if I recall when I was on a DMT. I’m aware of the bump of STDs in my older cohort. (Get with it! It ain’t the 60s anymore people! But I know plenty of younger folks who think everyone is faithful and things are hunky dory and…oops..) But I digress. This seems really risky for men, so this was news to me. Thanks for more to ponder, Prof G..
The reason why boys are now being vaccinated is to primarily increase herd immunity and secondly to prevent penile and anal cancer. As this virus is spread sexually it makes no sense to protect on one half of the population and not the other half. The good news is that herd immunity is working; the incidence of CIN and cervical cancer is falling in unvaccinated women as well. This means less circulation of oncogenic HPV strains. This doesn't mean people who don't want to get vaccinated can free-load on those getting vaccinated. The incidence of HPV infection, CIN and cervical cancer is still substantial in unvaccinated women.
I never understood why both boys and girls were not included at the start of the HPV vaccination programme in Britain. Why it was years before boys were given the option of the HPV vaccination. As the virus will be passed between individuals regardless of gender. I also wish that we as a society were more open about the involvement of the HPV in oral and throat cancers. Personally I would start by removing the tag of STI, remove the old stigma of infections being related to intimate practises. Its infection, just as colds are infections, get over it and stop being shy about these things
Excellent to hear that boys are being vaccinated! It certainly makes sense. I am wondering if they are doing this in the states; I have a bunch of grandsons. We shall see..As always, thank you for educating us!
At age 58, whilst on Ocrevus am I eligible in the UK for an HPV vaccine? This was never discussed with me before I started on Ocrevus about three years ago.
Anyone can have the vaccine, but you would have to cover the costs privately. You don't have to have the vaccine if you feel you are low risk of being exposed to the virus.
I just received a letter yesterday to say I'm finally HPV negative after a persistent infection.
Before starting DMF over 6 years ago I was asked if I'd had all my vaccinations, I said yes because that's what I believed (not knowing I should have had an MMR booster!). But I'm 42 and there was no HPV vaccine.
Are you saying I'm eligible for it now? But can I have it if I'm on DMF?
(Apparently it doesn't matter that I haven't had the MMR booster because I was vaccinated against measles as a baby and also infected with all three as a child)
Should HPV-positive patients with a history of HPV infection receive the vaccine? My gynecologist says no. But if someone is positive for certain hp viruses, shouldn't they protect themselves from others?
ACIP recommends that people who have an HPV infection and/or an abnormal cervical smear test result that may indicate an HPV infection should still receive the HPV vaccine if they are in the appropriate age group because the vaccine may protect them against high-risk HPV types that they have not yet acquired. It may also boost their immunity to the strain they are infected with and help clear the virus.
I have been on Tysabri for 16 years with no discussion of HPV. Too old to get Gardisil in the USA. Tested positive for 8 strains a few years ago and had treatment to remove a layer of my cervix. Not fun. Asked both the Neuro and OB/Gyn about relationship to DMT and got a head shake. Same issues with staying on birth control, menopause and HRT. Crazy
States also. No HRT due to previous cancer here ages ago. It’s miserable. A family members had cervical freeze treatment I attended, and it was no walk in the park. Fingers crossed you are in remission and stay there, friend.
Where does Tysabri fall regarding increased incidence of HPV infection? It is not depleting like the CD20 DMT
Natalizumab is considered safe. But it does reduce trafficking of lymphocytes and hence immunosurveillance of the gastrointestinal tract so may increase your risk of some HPV associated cancers.
thank you. A fine balance between keeping the MS in check and everything else
I have had issues with hpv and CIN3 in the past and two lots of treatment around 15-20 years ago.
Hpv returned more recently since starting DMTS and I tested positive Aug 2020, positive August 21 and positive July 22 and had lletz treatment again August 22. I tested positive again Mar 2023 and Mar 2024. It concerns me deeply that nobody in my health care has spoken to me about any risks with being immunosuppressed and chronic HPV and because I had LLETZ treatment in 2022 they’re happily awaiting a 3rd positive result again (even tho it will actually be 6 years from original positive test in 2020 and could’ve been more years than that because I hadn’t had a smear for 5 years previous to that). I am on ocrevus so not sure if vaccination would work at my grand age of 48. I’m post menopausal and on HRT.
Never had any discussion before embarking on natalizumab 10 years ago and I have been positive for HPV. My last cervical smear came back negative for HPV and due to my age I will no longer be offered any more smears
Thank you. It looks like at age 59, I’m not eligible for the vaccine. I’ve asked my gynecologist as well as my neurologist (in the US), and no one seems to be aware of this matter.
No neurologist ever spoke to me about HPV or anything else from this article. Thanks prof G, it seems it is up to us patients to do regular check ups, and hope for the best
Hi Belma, I think it’s up to us to check and follow up on all manner of things. I wish I had more energy. Sending good thoughts to your bladder… ;)
Hehehe this really made my day, thank you, no one ever sent me good wishes specifically to my bladder :-) Take care Italien
Was not discussed but I have a feeling HPV vaccination is not generally considered for males anyhow...
Was it ever (considered for males)?
Hi, the NHS doesn’t offer a HPV vaccine to those over 25 years of age. You mention in your article adults getting one - two, three doses etc. Should we therefore be exploring this on the private health system - is that what you mean? Many thanks
Yes, if you are at risk of acquiring HPV it would make sense having the vaccine.
I was already vaccinated with the original Gardasil, so I don't remember if my doctor mentioned it or not.
I was older than the guidelines and had to pay out of pocket, but I still think that was a great decision. I remain older than the guidelines, so I probably wouldn't pay out of pocket for the updated version, even after IRT.
Gavin - as a paid subscriber-
can you please let us know whether the trauma caused by a high speed MVA also uses up the same reserve that we are said to have neurologically for ms?
Ie- reducing the reserve that could speed up the time from RR to SPms?
Could you advise where someone over 45 could have this vaccine. When I looked before you had to be under 45, even if paying privately.
No there is no age restriction on the vaccine. There is a lobby to extend the vaccine to all ages. Clearly this depends on your risks of exposure to the virus. If you have very little chance of being exposed then arguably the vaccine is not needed.
Have I picked this up correctly that a group of men up to the age of 45 can get the HPV vaccine but woman can only get the vaccination on the NHS up to the age of 25?
No the NHS covers the vaccine under the age of 25 if you missed out at school. If you are over 25 you have to pay for it yourself regardless of your sex. Those between 25 and 45 can have two doses and those over 45 or the immunosuppressed are advised to have 3 doses. The latter is based on the fact as you get older and your immune system ages your immune system is not working well due to immunosuppression, you need more boosters to have an adequate immune response.
I’m a 33 year old female, HPV positive with over 12 months and on Gilenya since my MS diagnosis four years ago- what would you advise ?
If you haven't had the vaccine in the past you should consider the vaccine. You will need 3 doses under the NHS guidelines. If you had the bivalent or qudravalent vaccine you may want to consider upgrading your immunity with the polyvalent vaccine, which covers additional oncogenic strains.
As someone pointed out, we in states do not have smears after a certain age if all has been well, and no one discussed any vaccinations other than pneumonia and later, shingles, if I recall when I was on a DMT. I’m aware of the bump of STDs in my older cohort. (Get with it! It ain’t the 60s anymore people! But I know plenty of younger folks who think everyone is faithful and things are hunky dory and…oops..) But I digress. This seems really risky for men, so this was news to me. Thanks for more to ponder, Prof G..
The reason why boys are now being vaccinated is to primarily increase herd immunity and secondly to prevent penile and anal cancer. As this virus is spread sexually it makes no sense to protect on one half of the population and not the other half. The good news is that herd immunity is working; the incidence of CIN and cervical cancer is falling in unvaccinated women as well. This means less circulation of oncogenic HPV strains. This doesn't mean people who don't want to get vaccinated can free-load on those getting vaccinated. The incidence of HPV infection, CIN and cervical cancer is still substantial in unvaccinated women.
I never understood why both boys and girls were not included at the start of the HPV vaccination programme in Britain. Why it was years before boys were given the option of the HPV vaccination. As the virus will be passed between individuals regardless of gender. I also wish that we as a society were more open about the involvement of the HPV in oral and throat cancers. Personally I would start by removing the tag of STI, remove the old stigma of infections being related to intimate practises. Its infection, just as colds are infections, get over it and stop being shy about these things
Excellent to hear that boys are being vaccinated! It certainly makes sense. I am wondering if they are doing this in the states; I have a bunch of grandsons. We shall see..As always, thank you for educating us!
At age 58, whilst on Ocrevus am I eligible in the UK for an HPV vaccine? This was never discussed with me before I started on Ocrevus about three years ago.
Anyone can have the vaccine, but you would have to cover the costs privately. You don't have to have the vaccine if you feel you are low risk of being exposed to the virus.
Good to know. Thank you for the reply.
I just received a letter yesterday to say I'm finally HPV negative after a persistent infection.
Before starting DMF over 6 years ago I was asked if I'd had all my vaccinations, I said yes because that's what I believed (not knowing I should have had an MMR booster!). But I'm 42 and there was no HPV vaccine.
Are you saying I'm eligible for it now? But can I have it if I'm on DMF?
(Apparently it doesn't matter that I haven't had the MMR booster because I was vaccinated against measles as a baby and also infected with all three as a child)
Re: Are you saying I'm eligible for it now? But can I have it if I'm on DMF?
Anyone can have the vaccine, but you would have to cover the costs privately. As it is a component vaccine it is safe to have it on DMF.
£555 for a three dose course from Boots! I'll start saving...
Should HPV-positive patients with a history of HPV infection receive the vaccine? My gynecologist says no. But if someone is positive for certain hp viruses, shouldn't they protect themselves from others?
ACIP recommends that people who have an HPV infection and/or an abnormal cervical smear test result that may indicate an HPV infection should still receive the HPV vaccine if they are in the appropriate age group because the vaccine may protect them against high-risk HPV types that they have not yet acquired. It may also boost their immunity to the strain they are infected with and help clear the virus.
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
Prof Gavin, thank you for the reply.