Recommendations are summarized below. It is important that OB/GYNs and other health care providers educate parents and patients about the benefits and safety of human papillomavirus (HPV) vaccination. The CDC and ACOG recommend routine vaccination for girls and boys. Despite these recommendations, only about 50% of girls aged 13-17 years in the United States receive at least one vaccination, and only 33% complete all three vaccinations. The target age for vaccination for girls and boys is 11-12 years. The nine-valent HPV vaccine has been added to the U.S. Advisory Committee on Immunization recommendations, targeting girls and boys aged 11-12 years. Males and females who did not receive the vaccine at the target age can complete the vaccination with a supplement until age 26. HPV DNA testing is not recommended prior to vaccination in any population, and if a patient tests positive for HPV DNA, vaccination is still recommended. Additional content is summarized below: In the United States, HPV 16 and 18 cause 66% of cervical cancer cases, while HPV 31, 33, 45, 52 and 58 cause an additional 15% of cervical cancer cases. For CIN 2+, 50-60% of cases are caused by HPV 16 and 18 and 25% by HPV 31, 33, 45, 52, and 58. Approximately 90% of genital warts are caused by HPV 6 and 11. All three vaccines currently available require three doses (0, 1-2 and 6 months). The duration of the immune response is still being monitored, but there is currently no indication for consolidation vaccination. There is no need to restart vaccination if the second and third doses are delayed. The recommended age of vaccination for all three vaccines is 9-26 years, with higher antibody levels obtained with early vaccination (9-14 years) and before the start of sexual intercourse. Although the WHO recommends two doses for children and adolescents aged 9-13 years, these recommendations are not yet available in the United States. Vaccination is not related to whether or not one is sexually active or exposed to HPV. More than 60 million HPV vaccinations have been administered without any serious adverse outcomes or reactions related to vaccination. The nine-valent vaccine has a similar safety profile, but injection site swelling and erythema are somewhat higher than with the quadrivalent vaccine. Although not recommended during pregnancy, HPV vaccination during pregnancy is safe. If pregnancy is discovered after the series has been started, follow-up vaccination can be postponed until the pregnancy is over. Breastfeeding women can receive any type of HPV vaccine. Patients with HIV infection or organ transplants are not a contraindication to HPV vaccination. However, their immune response may be weaker. Table 1. Use and effectiveness of bivalent, quadrivalent, and nine-valent HPV vaccines. Vaccine HPV type Disease reduction Effectiveness Bivalent 16 and 18 HPV 16 and 18 associated cervical cancer, CIN 1, CIN 2/3 and cervical adenocarcinoma in situ HPV 16 and 18 associated lesions, 98.1% Quadrivalent 6, 11, 16 and 18 HPV 6, 11, 16 and 18 associated cervical, vulvar and vaginal cancers; CIN 1; CIN 2/3; adenocarcinoma in situ VIN 2/3; vaginal intraepithelial neoplasia grade 2/3 penile intraepithelial neoplasia grade 1/2/3 and penile cancer in men and women Warts, anal intraepithelial neoplasia and anal cancer HPV 6, 11, 16 and 18 associated lesions up to 100% Male external genital tract disease, 90.4% IX 6, 11, 16, 18, 31, 33, 45, 52 and 58 HPV 6, 11 16, 18, 31, 33, 45, 52 and 58 associated cervical, vulvar and vaginal cancers; CIN 2/3; adenocarcinoma in situ; VIN 2/3; vaginal intraepithelial neoplasia grade 2/3 penile intraepithelial neoplasia grade 1/2/3 and penile cancer in men and women Warts, anal intraepithelial neoplasia and anal cancer HPV 6, 11, 16 and 18 associated lesions, over 99% HPV 31, 33, 45, 52 and 58 associated lesions, 96.7%.