Human papillomavirus (HPV)

Background

Human papillomavirus (HPV) is a DNA virus that infects the deepest layer of the skin or genital surfaces, also known as epithelium. HPV infections are very common and over 225 types of HPV have been identified, 40 of these infect the genital tract.

The majority of infections disappear within 12 to 18 months with no apparent disease. HPV types can be further characterised into high and low risk types based on their ability to cause cancer. Persistent infection with high risk HPV types is responsible for 5% of all cancers worldwide. Infection with low risk types leads to warts on skin and genital areas. Transmission of HPV is mainly through sexual contact with the exception of some low risk types.

The most common HPV induced cancer is cervical cancer, with HPV 16 and 18 responsible for 70% of cervical cancers worldwide, and 80% of cervical cancers within Scotland. The remaining 20 to 30% of cervical cancers are caused by the other 16 high risk HPV types.

High risk HPV infection is also responsible for a subset of anogenital and oropharyngeal cancers. Low risk HPV types 6 and 11 cause 90 to 95% of genital warts.

Public information on HPV is available on theĀ NHS inform website.

Guidance

For more information on HPV immunisation, including updates, please refer to the Public Health England (PHE) Green Book, Chapter 18a.

Training and educational materials for healthcare professionals is on the NHS Education for Scotland (NES) website for the following programmes:

  • girls
  • men who have sex with men (MSM)

Information about the girls programme can be found on the NES website.

Find out about the MSM programme on the NES website.

Publications

View the 'Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study' scientific paper on the National Center for Biotechnology Information (NCBI) website.

View the 'Impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap' scientific paper on the NCBI website.

Data and surveillance

National HPV surveillance system

The national HPV surveillance system in Scotland was set up alongside the immunisation programme to assess the impact of the HPV vaccines on HPV prevalence and HPV related disease. The surveillance system is possible through the link up of national datasets and collaboration with the Scottish Human Papillomavirus Reference Laboratory (SHPVRL). The HPV surveillance system is described in detail in the surveillance protocol.

Until June 2016, women in Scotland were invited for cervical screening at age 20. Women from the catch up groups have been screened since 2010, and from routinely immunised groups since 2015. Scotland has comprehensive immunisation and cervical screening data and we've been able to demonstrate the effectiveness of immunisation on various outcomes, including:

  • HPV prevalence
  • herd immunity
  • cervical disease
  • colposcopy outcomes
  • uptake of cervical screening

This is a comprehensive programme of immunisation surveillance. In more deprived women, we've demonstrated a 71% reduction in high grade disease.

For the MSM programme, it's too early to assess the impact of the HPV vaccine programme. The aim is to assess the impact of the vaccine programme on genital wart prescription data and rectal HPV prevalence, with long term evaluation on HPV driven cancers.

Vaccination

Scottish HPV immunisation programme

The Scottish HPV immunisation programme started in September 2008 and vaccination is now routinely offered to all secondary school girls, from age 11 to 12 years. At the start of the programme, all 13 to 17 year old girls in Scotland were also offered HPV vaccine through a catch up campaign for a limited time. This catch up programme finished on 31 August 2011.

In September 2012, the vaccine was changed from Cervarix to Gardasil. Gardasil also protects against HPV 16 and 18 but also HPV 6 and 11.

In July 2017, a HPV vaccination programme was introduced for MSM, up to age 45 years. The vaccine is offered at sexual health clinics and administered as a three dose schedule.


Vaccine uptake statistics