Several patients who have been HPV positive have asked whether or not they should get vaccinated to protect themselves from other strains of the virus.
I'm 62, had MS for 20 years. Since being on fingolimod (6 years), I've tested positive for HPV. I've been seeing my gynaecology dept at my local hospital for the same time. I test positive for HPV after every annual smear test, despite there being no evidence of abnormal cells. I have raised the issue of being on fingolimod and there being evidence that it may heighten my chances of being HPV positive (I have presented the gynaecology dept with several papers covering the issue). I took matters into my own hands and managed to get the latest HPV vaccination done last year (my neurologist on my clinical trial (Sizomus) organised it for me, and I was questioned every step of the way by medical professionals who queried why I wanted the HPV vaccine). Didn't work. I've just undergone my third colposcopy procedure because I am still testing positive for HPV, under general anaesthetic (not pleasant). That doesn't seem to be solving the HPV problem either. Not sure what else I can do.
If you are 62 and have an active viral infection, you may want to derisk your immune system and get onto a DMT that is not immunosuppressive. Unfortunately, fingolimod blunts vaccine responses, which may explain why you didn't respond to the vaccine.
I contacted my MS team at Kings College Hospital about moving onto another DMT, having explained the situation regarding the recurring HPV. They told me that as I was doing well on fingolimod that they didn't really see a need to move me onto something else. I'm due to see my neurologist in July so I'll ask again. I had a relapse late last year, first one in 10 years, so I might use that as well in my argument to change DMTs. If I don't ask, I won't get. Thank you for your response.
I had 2 HPV vaccines in 2024 - I have not had the 3rd one yet. The full "package" is having all 3 I believe. How do I know if I received the Gardasil-9 one? Or since it was as recent as 2024 is this what I would have received?
Thank you for this great update . HPV positive and cytology normal so awaiting 1 year repeat test if not cleared will be getting gardasil 9 privately cost £ 500 . By the way some were even more unlucky to have Cervarix vaccine which only covered 2 strains ! If aged 27-30 ish now this is what the nhs used intially ! Cheaper vaccine at time !
Not that I am aware of. At a population level genital HPV is largely a STD and the risk is linked to number of sexual partners, i.e. the higher the number the greater the chance of exposure. The only way anti-CD20 can affect this is by bunting vaccine responses and increasing your chances that an exposure results in an infection
Good discussion, Prof G. I believe at one point, the boomer generation had a high rate of HIV as well, from lack of protection and plain cluelessness (imo). If I were on an immune suppressing DMT, or considering one, I would not hesitate to get as much protection from HPV as possible. I don’t know if I can get this now at my age either. No one talks about it. As always, many thanks for this information. :)
I had the 4 strain when I was 24 years old. And then I had the 9 strain when I was 38, but rather concurrently to getting the 9 strain I also got HPV. I did to alemtuzumab 2 years later, no issues though took acyclovir longer than the NHS recommended post alemtuzumab, and I am still HPV positive, grade 1 changes which have been stable and unchanging. All I know is I don't have strain 16 or 18 which are the most dangerous ones, but the pap couldn't distinguish what strain I do have.
As there are no licensed antivirals for HPV, you can only remain under active surveillance. If your MS becomes active, I recommend considering teriflunomide or possibly cladribine. You don't want to be on a chronic immunosuppressive therapy for your MS. Teriflunomide may have antiviral effects, which makes it appealing.
Hi Gavin - so I met with my OBGYN who is treating my HPV. She said to not worry about something even as immunosuppressive as alemtuzumab, you'd just need to do more monitoring.
I'll say I've noticed a tendency for doctors to be most worried about the conditions they don't treat. So MS specialists are more worried about OBGYN issues than MS issues and vice versa.
Also it is an interesting data point that my HPV was completely unchanged and did not advance at all during 2 rounds of alemtuzumab.
If one is concerned about HPV, not all strains are equal. Strain 16 and 18 are the most likely to spread quickly.
I did 2 rounds of alemtuzumab all while having HPV, nothing got worse on the paps. I was assuming that if I had new activity I would first do a 3rd round of alemtuzumab and just strictly monitor. Is that not wise?
Interestingly I was also on a HPV vaccine trial (at the John Radcliff in Oxford) for clearing persistent HPV infections. I did have a clean pap the first year after the vaccine but it came back after another year. Not sure if that's because my husband is reinfecting me or if that was a false positive clean pap. I've not been unblinded yet for the trial, so I am not sure what arm I was on, but a foot verruca also decreased in size after the vaccine notably so I think I at least had something but maybe not the strongest dose.
I tested positive for 8 strains of HPV and asked the OB?GYN exactly this question. HIs answer: NO IDEA. In addition insurance will not pay in anyone over 40. so I waited and we retested. The viruses all cleared thankfully. This is just another instance of the lopsided medical treatment for women. I am glad all three of my kids (2 girls and 1 boy) have been vaccinated. Totally not necessary to get HPV these day.
what about those of us too old to have had the vaccinations?
way back i think i had maybe it was hpv with a CIN3?
regular smears since then mostly and definitely recently all ok
smear checked as part of derisking before i started DMT for the first time a few years ago - but no questions about hpv.
incidentally i was very unimpressed by being told, despite specifically asking, that i couldnt have shingles vaccine - and then a few months after starting dmt (now it wont work so wellll) being told i should get shingles vaccine
There is a strong argument for older women to be offered the HPV vaccine, given the recent emergence of a late peak in HPV infections and cervical cancer. The latter is due to a change in sexual behaviour amongst older people driven by social media and dating apps, i.e. single older people are more likely to engage in promiscuous and unsafe sexual practices. I suppose the decision to have the HPV vaccine when you are older is an individual call based on your potential exposure to HPV. Please note that HPV is not only sexually transmitted, but it can also be transmitted via skin contact.
This year I’ve started Ozanimod, before starting the Spanish, well at least in Catalunya, health system has made compulsory an update of the vaccines. Gardasil was not included in the list, and when I asked about it they told me that it was not free, and with the fast pace vaccination I was one it was not possible to add it then.
I could pay for it now but I’ve already started the dmt, and I’m not sure about the decrease of the vaccine effectiveness
I'm 62, had MS for 20 years. Since being on fingolimod (6 years), I've tested positive for HPV. I've been seeing my gynaecology dept at my local hospital for the same time. I test positive for HPV after every annual smear test, despite there being no evidence of abnormal cells. I have raised the issue of being on fingolimod and there being evidence that it may heighten my chances of being HPV positive (I have presented the gynaecology dept with several papers covering the issue). I took matters into my own hands and managed to get the latest HPV vaccination done last year (my neurologist on my clinical trial (Sizomus) organised it for me, and I was questioned every step of the way by medical professionals who queried why I wanted the HPV vaccine). Didn't work. I've just undergone my third colposcopy procedure because I am still testing positive for HPV, under general anaesthetic (not pleasant). That doesn't seem to be solving the HPV problem either. Not sure what else I can do.
If you are 62 and have an active viral infection, you may want to derisk your immune system and get onto a DMT that is not immunosuppressive. Unfortunately, fingolimod blunts vaccine responses, which may explain why you didn't respond to the vaccine.
I contacted my MS team at Kings College Hospital about moving onto another DMT, having explained the situation regarding the recurring HPV. They told me that as I was doing well on fingolimod that they didn't really see a need to move me onto something else. I'm due to see my neurologist in July so I'll ask again. I had a relapse late last year, first one in 10 years, so I might use that as well in my argument to change DMTs. If I don't ask, I won't get. Thank you for your response.
I looked into vaccination after clearing an HPV infection. It's too expensive sadly 😥
This is why we need the NHS to reconsider the current guidelines.
I had 2 HPV vaccines in 2024 - I have not had the 3rd one yet. The full "package" is having all 3 I believe. How do I know if I received the Gardasil-9 one? Or since it was as recent as 2024 is this what I would have received?
Yes, for adults, it is a triple-dose vaccine. In the NHS, Gardasil-9 has been the vaccine used since 2022.
Thank you for this great update . HPV positive and cytology normal so awaiting 1 year repeat test if not cleared will be getting gardasil 9 privately cost £ 500 . By the way some were even more unlucky to have Cervarix vaccine which only covered 2 strains ! If aged 27-30 ish now this is what the nhs used intially ! Cheaper vaccine at time !
Are there concerns about anti-CD20 immune suppression making it easier to contract HPV or clear it?
Please be aware that T cell responses should remain intact in people on anti-CD20 who decide to get vaccinated whilst B cell depleted.
Not that I am aware of. At a population level genital HPV is largely a STD and the risk is linked to number of sexual partners, i.e. the higher the number the greater the chance of exposure. The only way anti-CD20 can affect this is by bunting vaccine responses and increasing your chances that an exposure results in an infection
Good discussion, Prof G. I believe at one point, the boomer generation had a high rate of HIV as well, from lack of protection and plain cluelessness (imo). If I were on an immune suppressing DMT, or considering one, I would not hesitate to get as much protection from HPV as possible. I don’t know if I can get this now at my age either. No one talks about it. As always, many thanks for this information. :)
I had the 4 strain when I was 24 years old. And then I had the 9 strain when I was 38, but rather concurrently to getting the 9 strain I also got HPV. I did to alemtuzumab 2 years later, no issues though took acyclovir longer than the NHS recommended post alemtuzumab, and I am still HPV positive, grade 1 changes which have been stable and unchanging. All I know is I don't have strain 16 or 18 which are the most dangerous ones, but the pap couldn't distinguish what strain I do have.
As there are no licensed antivirals for HPV, you can only remain under active surveillance. If your MS becomes active, I recommend considering teriflunomide or possibly cladribine. You don't want to be on a chronic immunosuppressive therapy for your MS. Teriflunomide may have antiviral effects, which makes it appealing.
Hi Gavin - so I met with my OBGYN who is treating my HPV. She said to not worry about something even as immunosuppressive as alemtuzumab, you'd just need to do more monitoring.
I'll say I've noticed a tendency for doctors to be most worried about the conditions they don't treat. So MS specialists are more worried about OBGYN issues than MS issues and vice versa.
Also it is an interesting data point that my HPV was completely unchanged and did not advance at all during 2 rounds of alemtuzumab.
If one is concerned about HPV, not all strains are equal. Strain 16 and 18 are the most likely to spread quickly.
I did 2 rounds of alemtuzumab all while having HPV, nothing got worse on the paps. I was assuming that if I had new activity I would first do a 3rd round of alemtuzumab and just strictly monitor. Is that not wise?
Interestingly I was also on a HPV vaccine trial (at the John Radcliff in Oxford) for clearing persistent HPV infections. I did have a clean pap the first year after the vaccine but it came back after another year. Not sure if that's because my husband is reinfecting me or if that was a false positive clean pap. I've not been unblinded yet for the trial, so I am not sure what arm I was on, but a foot verruca also decreased in size after the vaccine notably so I think I at least had something but maybe not the strongest dose.
I tested positive for 8 strains of HPV and asked the OB?GYN exactly this question. HIs answer: NO IDEA. In addition insurance will not pay in anyone over 40. so I waited and we retested. The viruses all cleared thankfully. This is just another instance of the lopsided medical treatment for women. I am glad all three of my kids (2 girls and 1 boy) have been vaccinated. Totally not necessary to get HPV these day.
Nice work PG
Thanks for sharing
Grande cena
How many courses of the vaccine would you recommend adults to have if previously had those in 2008 in school?
Also how often do you recommend these to be repeated?
The adult course is meant to be three-doses, but many infectious disease consultants say two doses are enough. It is a one-off; no need to repeat.
what about those of us too old to have had the vaccinations?
way back i think i had maybe it was hpv with a CIN3?
regular smears since then mostly and definitely recently all ok
smear checked as part of derisking before i started DMT for the first time a few years ago - but no questions about hpv.
incidentally i was very unimpressed by being told, despite specifically asking, that i couldnt have shingles vaccine - and then a few months after starting dmt (now it wont work so wellll) being told i should get shingles vaccine
There is a strong argument for older women to be offered the HPV vaccine, given the recent emergence of a late peak in HPV infections and cervical cancer. The latter is due to a change in sexual behaviour amongst older people driven by social media and dating apps, i.e. single older people are more likely to engage in promiscuous and unsafe sexual practices. I suppose the decision to have the HPV vaccine when you are older is an individual call based on your potential exposure to HPV. Please note that HPV is not only sexually transmitted, but it can also be transmitted via skin contact.
This is a slightly unrelated question:
What happens and what to do if the course of Gardasil wasn't completed and over a year has passed?
Same with Shingrix: What if the second shot is pending and over a year has passed?
You should still have it as it acts as a booster.
This year I’ve started Ozanimod, before starting the Spanish, well at least in Catalunya, health system has made compulsory an update of the vaccines. Gardasil was not included in the list, and when I asked about it they told me that it was not free, and with the fast pace vaccination I was one it was not possible to add it then.
I could pay for it now but I’ve already started the dmt, and I’m not sure about the decrease of the vaccine effectiveness