In late 2014, the U.S. Food and Drug Administration approved Gardasil 9, a vaccine that protects against nine types of the human papillomavirus (HPV).

Gardasil 9 covers a broader range of the HPV virus as compared to Gardasil, which protects against only four types of HPV. For those who’ve already received the Gardasil vaccine, questions arose about re-vaccination and the potential effectiveness of Gardasil 9 in addressing a more complex group of HPV. And a broader debate continued as to why both vaccines continue to be underused.

“HPV is an extremely common sexually transmitted disease which, if left untreated, can lead to cervical cancer,” said Orlando Suris, M.D., an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. “Fortunately, the Gardasil and Gardasil 9 vaccines have proven to be very effective in reducing the risk of contracting HPV.”

The seven types of HPV which are implicated in 90 percent of cervical cancers are covered with Gardasil 9, in addition to two types associated with genital warts.

HPV is typically detected through a Pap test, which is conducted at an annual well woman gynecologist appointment. Pap tests screen for cervical cancer and other vaginal abnormalities. Since the introduction of these tests in the 1950s, cervical cancer incidence and mortality have decreased sharply. “Still,” Dr. Suris cautioned, “It’s necessary to continue to receive a Pap test in order to detect HPV.”

“The seven types of HPV which are implicated in 90 percent of cervical cancers are covered with Gardasil 9, in addition to two types associated with genital warts”

The Gardasil and Gardasil 9 vaccines prevent cancer from forming by immunizing the patient to HPV. HPV is the root cause of the majority of cervical cancers, which are traditionally extremely slow to form. “Patients whose Pap test results indicate the presence of HPV don’t necessarily have cervical cancer,” Dr. Suris said. “Further testing is necessary to determine a treatment plan.” A treatment plan for HPV or cervical cancers is most effective if HPV is detected early enough.

InstituteForWomensHealth_GardasilVaccination against HPV is recommended for girls ages 9 – 26 and boys ages 9 – 15, ideally before they become sexually active. The vaccine is administered in three doses over a six-month period.

Since their introduction to the market, the vaccinations have been underused. Many physicians believe that the stigma surrounding the vaccination of a child for an STD while they are very young is the cause of this underutilization. To address this issue, the Centers for Disease Control launched a campaign called “You are the key to cancer prevention” in 2014. The campaign aims to educate physicians and parents about the benefits of recommending their children be vaccinated. After all, they pointed out, it’s about cancer, not sex.

When it comes to re-vaccinations, however, the message is simpler.

“If you’ve already received the Gardasil vaccine, there’s no need to be re-vaccinated with Gardasil 9,” Dr. Suris said. “If you’re 21 or older, just continue to schedule your annual well woman exams, and have your gynecologist order your Pap tests on the schedule specific to you.”


Orlando Suris, M.D., is an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. To schedule an appointment with Dr. Suris, please call 210.494.2000.

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