HPV Vaccination Guidance for Adults Beyond Routine Age Range

Age‑Based Recommendations

The CDC (ACIP) recommends routine HPV vaccination for males aged 9–21 years, with catch‑up vaccination permitted through age 26 years. 1
For males aged 22–26 years, ACIP issues a permissive (optional) recommendation that vaccination be offered based on shared clinical decision‑making. 2
The U.S. FDA approved Gardasil 9 for use in males aged 27–45 years (October 2018); vaccination in this group also requires shared decision‑making because effectiveness may be reduced by prior HPV exposure. 3
Adults older than 45 years (e.g., a 52‑year‑old man) are outside the approved age range for routine or catch‑up HPV vaccination according to CDC and FDA guidelines. 1

The presence of genital warts does not contraindicate HPV vaccination and should not delay vaccine administration. 4
Individuals with genital warts can still benefit from vaccination because they remain susceptible to HPV types they have not yet acquired, especially oncogenic types 16 and 18, which cause roughly 70 % of HPV‑related cancers. 4
Genital warts are caused by HPV types 6 and 11 in about 90 % of cases; the quadrivalent and nonavalent vaccines also protect against HPV 16, 18 and additional oncogenic types. 4
HPV vaccination provides no therapeutic benefit for existing genital warts and will not accelerate resolution or prevent recurrence of the current infection. 4
The vaccine only protects against future infections with vaccine‑type HPV strains that the individual has not yet acquired. 4
Men with warts due to HPV 6/11 remain susceptible to oncogenic HPV 16/18, which are responsible for anal cancer (≈ 89 % HPV‑associated), penile cancer (≈ 63 %), and oropharyngeal cancer in males (≈ 72 %). 3

Offering HPV vaccination to an adult older than 45 years is off‑label and should be accompanied by a thorough shared decision‑making discussion about the limited expected benefit given likely prior HPV exposure. 3
When vaccination is pursued in adults ≥ 15 years, a 3‑dose schedule (doses at 0, 1–2, and 6 months) is required. 3
HPV testing is not required before vaccination and is not clinically useful in men because no FDA‑cleared test exists for male specimens; testing does not affect eligibility. 2

Do not postpone vaccination while awaiting treatment or clearance of genital warts if the decision to vaccinate has been made. 2
Do not tell patients that the vaccine will treat existing warts; it is purely preventive. 4
Do not order HPV testing in male patients, as it lacks clinical utility and FDA‑cleared assays are approved only for cervical samples. 2
Do not assume condoms provide complete protection against HPV; transmission can occur from uncovered genital skin even when condoms are used. 2

Men who have sex with men (MSM) should be considered for HPV vaccination because this population has a higher risk of HPV‑associated anal, penile, and oropharyngeal cancers, and vaccination can provide preventive protection against oncogenic HPV types. 5
Epidemiologic evidence from a 2019 Eurosurveillance study shows an increased incidence of HPV‑related cancers among MSM, supporting the recommendation to offer vaccination as part of individualized decision‑making. 6