not to have known that HPV vaccine could be beneficial at my age (45)?

[hpvandme]

I’m 45 and have just had an abnormal smear result, showing high risk HPV and low grade dyskyasosis/ CIN 1. I’ve never had an abnormal smear before. I didn’t know that there is a peri/menopause ‘spike’ in HPV, and that this can come from either reactivation of an old infection or a new infection/reinfection.

In my case, it feels very likely that it’s the latter (married for 20 years, now divorced, one new sexual partner post-divorce). One study I read said that while it is very difficult to establish whether HPV is a new infection or reactivation, when it appears in older women there is a strong link with new partners. pmc.ncbi.nlm.nih.gov/articles/PMC4068337/#S9

The HPV vaccine protects against 9 of the most serious strains of HPV. It can’t protect against a reactivation of a strain but it can protect against reinfection and against infection from strains that you have not encountered previously.

If I’d known all of this a year ago I would 100% have got the HPV vaccine privately before having sex with new partners again. I expect some replies will say that HPV is very common and nothing to worry about – but in a minority of cases it can be very serious indeed and if I’d been making an informed choice, I would have chosen to take the vaccine for the added protection it provides. I just didn’t know how it worked or that I could benefit from it!

I'm posting this in the hope that it might help someone else. (Also, very happy for any experts to correct my explanation above and provide more accurate knowledge)

AIBU not to have known that the HPV vaccine could be beneficial at my age (45)?
Yes you are unreasonable not to have known. Everyone knows this.
No you are not unreasonable. It's news to me too.

I never knew this.

I didn't know this either.

I didn’t know this.

No, me neither.

I didn’t know either
will look into this
thank you

Annoyingly when I tried to get a HPV vaccine I was refused, as I was over 46 and it's only licenced up to that age.

I didn't know this. Thank you OP.

Thank you for posting this OP. I'm 46 and assumed I'd be too old to benefit. I've found a clinic in London which says there is no upper age limit.

I’m newly seperated and in my late 30s and I’m having it privately. I wasn’t aware but then I got a lump on my vagina and had a panic it was a wart (it wasn’t) so I decided to get the vaccine at that point. If that hadn’t happened, I wouldn’t have been aware.

I didn’t know this, but of course, here’s women’s health, another example of the lack of information in women’s healthcare as usual.

I also think the shingles vaccine should be available to younger people. Maybe delayed until 60’s due to cost?

If it can protect against ‘reactivation’ of any previous strain why isn’t it available to all sexually active women regardless? Especially given it’s so common.

I currently have HPV and have been tempted to get the vaccine after reading that ‘it might’ kick your body into fighting it off but I don’t think there is any real proof that it does or that it protects against existing dormant infections . And it’s not cheap. I’d pay any money if it was guaranteed.
i think gay men get it for free .

@User14March the vaccine does not / can not protect against reactivation of a dormant HPV strain. But it CAN protect against reinfection from that strain (eg a new partner). and against infection from one of the 9 strains that is not already in your system. That’s my understanding from my reading, anyway, and those still seem to be very significant advantages from taking the vaccine.

I've had the HPV vaccine. Until I read up on it I thought it was too late.

It's unfortunate it's only given to teens but I guess the cut off has to be somewhere and cost has to be taken into account. Like everything it's best given before any contact.

Gay & bisexual men can get the vaccine on the NHS up to the age of 45. Why not women? Personally I think women should be given the choice to have it, if that's why they want, too.

@3678194b can I ask how you found out that the vaccine would be worth getting? I’m not even suggesting it should be available on the NHS, I understand that public health requires choices around costs and benefits. I’m annoyed that I didn’t have the basic information that would have allowed me to make a choice to have the vaccine before I had sex with a new partner. There is no way of knowing whether the HPV that showed up on my smear is new or if it’s been dormant from my 20s. But if I’d had the vaccine I would know I’d done everything I could to prevent it at least. There IS an infection rise in women at 45+. Why not try to prevent the new infection risk within that age group instead of apparently just assuming that it is all reactivation of dormant infections? Not to mention preventing genital warts among anyone that hasn’t had them (some of the HPV strains that are protected against by the vaccine cause cervical cancer, others cause warts. Who wouldn’t want to avoid getting those if possible?)

Thanks this is so helpful to hear. I’ve been debating getting it for a few years but every nurse I’ve spoken to didn’t explain it would be beneficial. I will now get it.

@user1497535565 i also had the impression that is was too late / not worth getting it after early 20s but i just can’t see how that is true if you have new sexual partners when older.

I got it at 30. I can’t remember what made me decide to do I but at nearly £500 I assume the govt don’t want women to realise they could benefit as then they’ll want it paid for! Women’s healthcare is a joke sometimes

Didn’t know we could have it in our 40s

I obviously didnt have it at school because it didnt exist

I asked about having it in my mid 20s and was told by the nurse I’m not sure if it would have any benefit. It’s actually really difficult to get a straight answer.

Thank you for this, OP, I didn't know.

I am mid-thirties and newly divorced. We were each other's first and only. And I was too old for the HPV vaccine on the NHS, when it was first introduced.
So it sounds like the vaccine could be a very good move for me as and when I start to date new people. I will definitely start saving up (from a quick Google it's around £180 per dose and I'd need two).

Amazing thank you for sharing this!

My DD got the vaccine after several LETZ procedures and irregular smears in her 30s. She paid £500 and luckily, it kick started her immune system. Now clear of HPV but resultant treatment caused a shortened cervix and problems in pregnancy leading to careful monitoring and then emergency c section.

@hpvandme this is an interesting article and useful to read. Unfortunately data and scientific papers can be difficult to decipher and the “headlines” are not always as clear as what they say.

Whilst you’re right the study suggests that HPV in older aged women is more linked with a reinfection it is important to note that there is no actual way to say whether or not a “reinfection” is actually a reinfection or the same infection that you previously couldn’t detect. The study actually states themselves. They have “estimated” what a reinfection is by calling anyone who has previously had HPV previously, that they didn’t detect for an average of 1.5 years and then later did find HPV- even if it was the same type they previously had they call this a reinfection. We know that this not how it works as they themselves have written:

“Even with today's highly sensitive PCR protocols to detect HPV DNA the possibility remains that the apparent clearance of HPV infections may simply reflect that viral load dipped below the threshold of detectability.”

“We called initial or first infections as any episode with a type the woman had not harbored before. We also used the term re-infections loosely, to denote infections that we qualified as “with the same type” or “with a different type” occurring in women with an initial infection at the early visits in the cohort. Proper characterization of a truly incident HPV infection event would have required that we observed the cohort from the onset of sexual exposure, an impractical proposition in most settings.”

Also the average age of women at recruitment into the study was 32 so what they consider a “initial infection” may actually be a reactivation or reinfection as those women may well have had HPV infection prior to enrollment in the study.

Moreover This study does not even give women the HPV vaccine so we have no idea what effect if any actually being given the vaccine would have on people who have already been exposed to the virus. That’s the reason why it’s not given as routine to people over the age of 12 because the vaccine is known to prevent you being infected with the virus but there is not strong evidence yet that it will help your immune system clear it quicker if you have already been exposed.

It makes it very difficult to make clear cut conclusions. As a rule when reading scientific papers if you read the limitations section which they all should have it gives you an idea of what confounders there are in their study design and how it may not actually be applicable to real life.

i agree it’s an area that requires more research and also agree that as a HPV vaccine is relatively safe there is no harm in self sourcing one to keep yourself as protected as you can be but don’t think think this one paper shows that reinfection is higher in people who are older - it shows that they found more HPV - after periods of not finding it in women who were older - that to me doesn’t equate to reinfection - and we cannot extrapolate that the vaccine will be of benefit. Whilst there’s no harm in an individual trying it out, you can see why the nhs wouldn’t undergo an expensive vaccination programme when there is no evidence it would work when there is already a robust screening programme in place and a vaccination programme in place for groups where it is clear it will be helpful. Everything needs to be costed and proven to be cost effective when the model is it’s 100% paid for by the taxpayer and free at point of care.

Gosh this is expensive. But I think I will look into it!