Human Papilloma Virus (HPV)

The following page outlines commonly asked questions about HPV and the role for HPV vaccination.

Gardasil 9 Vaccine

The Gardasil 9 vaccine protects against the 9 most cancer causing strains of HPV. After a brief conversation with a doctor to determine if the vaccine is appropriate for you, we will fax a prescription to your local pharmacy for the complete series. Your local pharmacist, walk-in clinic, or primary care provider (nurse practitioner or family physician) can give you the injection.
The Gardasil 9 vaccine costs approximately $200 per vaccine (three are needed). Many insurance plans cover the cost of vaccination, so please check in with your insurance provider. You will need 3 vaccinations given initially, 2 months later, then 4 months later (0, 2, and 6 months).
In Ontario, the vaccine is covered (free) for students in grades 7 to 12, as well as males up to 26 years of age who self identify as having sex with men (self-identify as gay, bisexual, or trans).

About Human Papillomavirus (HPV)

Human papillomavirus (HPV) infections are the most common sexually transmitted infections. Most infections occur without symptoms and resolve without treatment. Most Canadians will have an asymptomatic HPV infection at some time. There are more than 200 strains of the HPV virus. Most HPV infections, including those that cause cancer, typically resolve within 12 months. HPV can cause anogenital warts. HPV infection is related to 80-90% of anal cancers, 40% of vaginal and vulvar cancer, 40-50% of penile cancers, and 25-35% of mouth and throat cancers. Most of these cancers are related to high-Risk HPV types 16 and 18.


HPV infections occur through sexual contact (skin to skin, or mucosa to skin). Exposure can also occur to offspring through maternal genital contact at the time of a vaginal delivery.

Risk Factors for HPV

Risk factors for HPV include
  • Previous sexually transmitted infection
  • History of sexual abuse
  • Early age of first sexual intercourse
  • Number of lifetime sex partners
  • Tobacco and marijuana use
  • Immune Suppression
  • HIV infection

Common Questions

I've had an abnormal PAP in the past, can I still get Gardasil 9?

Although women who have had an abnormal pap, or have had cervical cancer or genital warts may have had a prior infection with one or more HPV types, they will still benefit from receiving HPV vaccine for the types to which they haven't been exposed. Vaccination doesn't have a beneficial effect on pre-existing cervical disease, but we strongly encourage HPV vaccination if you will have new sexual partners as you have the potential to be exposed to the virus.

I'm a male sexually active with other men. Do I need to get the HPV vaccine?

Men who have sex with men have a disproportionately high burden of HPV infection, particularly high-risk HPV types 16 and 18. High-risk types are associated with anal cancer, particularly among men who are HIV-positive. HPV vaccines should be strongly considered in men less than 27, and older men as well because of their increased risk of contracting HPV diseases. Getting HPV vaccination prior to the onset of sexual activity and exposure to HPV is recommended to maximize the benefit of the vaccine.

Can I get HPV from oral sex?

Unprotected oral sex is a risk factor for acquiring HPV. Many people will be exposed to oral HPV, with 10% of men and 3.6% of women having oral HPV. Most people clear HPV within a couple of years, but others can have a persistent infection. HPV can affect the oropharynx (back of throat including tongue and tonsils). Approximately 70% of oropharyngeal cancers are caused by HPV.

What are ways to lower my risk of getting HPV?

Condom usage and dental dams can lower the chance that HPV is passed from one person to another.

Who cannot get the HPV vaccine?

The HPV vaccine is not given to patients who have had an anaphylactic reaction to a prior dose, or who are currently pregnant because data is limited about its safety in pregnancy. HPV vaccines may be administered to breastfeeding women.

What are common vaccine side effects?

The most common adverse effects were mild or moderate injection site reactions (pain, redness, and swelling). Since its introduction, hundreds of millions of doses of HPV vaccine have been administered, with the most common reported adverse events being vaccination site reactions and muscle pain.

I started my HPV vaccine, but I missed the booster shots. Can I still get re-vaccinated?

Our current recommendations are that vaccination can be restarted where you left off, and the entire series does not need to be restarted.

Can I get tested for HPV?

Public health laboratories do not check for the HPV virus at present time. This test can specifically be requested for women at the time of completing your pap test but is presently an uninsured test with an approximate cost of $80. It is NOT RECOMMENDED to get tested for HPV, because there is little we can currently do about HPV once you have acquired it. Because most infections spontaneously resolve, there is little value added from doing HPV at the time of your pap test. The most important testing related to HPV is routine pap testing for women.