And what to do if you have it already.
There are a few perks to getting older: You might get to retire. You don’t have to deal with your period anymore. And you don’t have to worry about those illnesses that only plague young people — but HPV isn’t one of them.
While the HPV vaccine is targeted at young folks, and your pool of sexual partners might shrink as you age, you can get the STI at any age. And though you might’ve gotten it when you were younger, the virus could remain dormant until later in life. “HPV infection is very common and it’s estimated that over 80 percent of sexually active adults, ages 18-65, have been infected with at least one strain, even if they never knew it,” says Karyn A. Goodman, MD, MS, professor and vice-chair of clinical research in the department of radiation oncology at the Icahn School of Medicine at Mount Sinai.
We’re breaking down what older people should know about HPV:
What is HPV?
Human papillomavirus (HPV) is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex, according to Cancer.gov. Sexually transmitted HPV types fall into two groups: low-risk and high-risk. Both men and women can become infected with HPV and develop HPV-caused cancers, though “most HPV infections don’t cause cancer.”
Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (part of the throat that includes a portion of the tongue, the soft palate, the side and back walls of the throat, and the tonsils), anus, penis, vagina, and vulva.
“The downstream effects of HPV infection, such as HPV-related cancers, tend to affect older adults since it takes many years for these cancers to manifest themselves,” says Dr. Goodman. “Most of these patients had HPV infections in their teens or 20s and the infection had ‘cleared,’ but the long-term impact of the infection on the cells lining the cervix, anus, or oropharynx may have initiated the multi-step process that eventually lead to the development of cancer until later in life.”
Can older people get HPV?
HPV doesn’t discriminate based on age: Yes, HPV infection peaks in women ages 20-24, “but the rates increase again later in life,” says Dr. Goodman.
“Many people think that HPV is transmitted only in young people who are more sexually active, but even older adults who have new or multiple partners can be infected with HPV,” she tells us. “While we don’t see a lot of people over 40 with HPV, it’s not uncommon, and it’s possible that these individuals were infected in the past,” she explains. “This also underscores the importance of continued screening with Pap smears for women over 40.”
Why older adults are getting HPV
Well, it’s a sexually transmitted infection…
“One way for an older person to acquire a new HPV type is to have new sexual exposures, and/or their partner may be having new sexual exposures,” says Joel Palefsky, MD, infectious disease specialist and professor of medicine and laboratory medicine at UCSF.
While you can contract HPV at any age, Dr. Goodman, who’s also the associate director of clinical research at The Tisch Cancer Institute and an advisor to the board at The HPV Cancers Alliance, tells us that if people develop HPV later in life, “it’s likely that they were exposed to it when they were younger, before the vaccine was available.” She knows this because “we’re seeing a decrease in HPV infection rates in young adults who’ve been vaccinated, so the vaccine is clearly effective.” So if vaccination rates in young people continue to increase, “this will likely lead to fewer older adults testing positive for HPV in the future.”
Yes, diagnosis of HPV infection in older women can be a result of a recent infection from a sexual partner, but more often than not, it’s a reactivation of an infection that was acquired earlier in life and has been dormant for many years, says Dr. Goodman.
Dr. Palefsky, who’s also the director of the Anal Neoplasia Clinic, Research and Education Center, agrees, and thinks it has something to do with aging. “The reasons for the reactivation are not well understood but might at least in part be due to some reduction in the immune response that occurs as part of the normal aging process,” he tells us. “This may result in reduced control of that HPV acquired so many years earlier.”
Can people over 26 get the HPV vaccine?
The HPV vaccine is marketed to younger people, because of how prevalent the virus is as soon as you become sexually active. “HPV infection is very common and it’s estimated that over 80 percent of sexually active adults, ages 18-65, have been infected with at least one strain, even if they never knew it,” says Dr. Goodman. “The HPV vaccine is most effective if given prophylactically, i.e. before someone is exposed to the virus.” And since so many sexually active people have been infected, that would be the vaccine is more effective pre-sexual debut. “It also seems to be more effective if given earlier,” says Dr. Goodman.
“The CDC recommends vaccination for everyone through age 26, if not adequately vaccinated when younger.” The HPV vaccination is given as a series of either two or three doses, depending on the person’s age at the initial vaccination.
However, people above the age of 26 can get the vaccine. “In adults older than 26, vaccination may be considered based on various risk factors and each individual can discuss the pros and cons with their doctor. Generally, since the vaccine does not treat HPV, it just prevents it, there is less benefit after people become sexually active and have likely been exposed to HPV already. The cost-benefit ratio for vaccinating older adults weighs more to the side of just adding cost, so the CDC does not recommend it,” says Dr. Goodman.
The risks of developing cervical cancer change with age
While HPV is detected most commonly among women around the age of sexual debut, the detectable cases decline as women get older. “But a small proportion of older women may continue to have HPV, and it’s the women who continue to have HPV detected who are at the highest risk of being diagnosed with cervical cancer or pre-cancer,” says Dr. Palefsky.
Dr. Goodman adds, “The risk of HPV-related cancers increases with age. HPV infection can induce changes in the cells lining the cervix, anus, and/or oropharynx that can be the first step in the progression toward becoming a cancerous cell. This process occurs over many years and therefore, the cancer risk increases with time. However, not all people who are infected with HPV will develop cancer later.”
She says, “Most patients that I see with HPV-related anal cancer are in their 60s but were exposed to the virus 30-40 years ago. The virus itself may have been cleared by the immune system, but there are characteristic changes that occur in the cells. Patients may have been completely asymptomatic from the HPV infection or just have had anogenital warts from the non-cancer causing strains of HPV when they were younger.” This is why it’s important for people with HPV to continue getting screened. “There are different strains of HPV: those that have a higher risk of causing cancer, and those that are less likely. They can travel together, so if patients have anogenital warts, it’s important to have a physician treat those and also follow up afterward with screenings for the development of cancer.”
Is HPV as common in older men as it is in older women?
Comparing the rate of HPV between the sexes is complicated because it’s more easily detectable in women. “HPV infection rates in older men may be similar to rates in older women, but it’s more difficult to test for it — HPV infection is often picked up on a routine Pap smear in women, whereas there is no real routine screening for men,” says Dr. Goodman. And it gets worse as you get older. “The prevalence of HPV infection is much harder to determine for older men, but they’re just as likely to be infected if they’re sexually active and can serve as carriers, passing it on to their sexual partners without knowing it.”
What should older people with HPV be doing to be safe?
“Older people with HPV should be followed by their physicians and undergo routine screening such as pap smears, gynecologic exams, and visits with their doctors,” urges Dr. Goodman. “Older patients with HPV should also practice safe sex with new partners since they do have the potential to spread the virus.”
