Adult HPV vaccination (27-45 years): who benefits, when to offer, and how to counsel.

OBJECTIVES

The aim of the study was to translate major international recommendations and the current evidence base into a practical approach for counselling adults aged 27-45 years about human papillomavirus (HPV) vaccination.

METHODS

We conducted a targeted narrative review of guidance from the World Health Organization, the European Centre for Disease Prevention and Control and US public health sources that frame HPV vaccination in mid-adults as shared clinical decision-making. We prioritised systematic reviews, randomised trials and recent evidence syntheses relevant to mid-adult vaccination and vaccination after cervical excisional treatment.

RESULTS

Global and European guidance emphasises that the greatest population impact is achieved by high vaccination coverage before sexual debut and therefore does not support routine population-wide vaccination programmes for mid-adults. In contrast, US guidance supports shared clinical decision-making for adults aged 27-45 years because some individuals may still derive meaningful personal benefit, particularly those not adequately vaccinated who anticipate new sexual partners or belong to higher-exposure networks (e.g., men who have sex with men) or who are immunocompromised. Vaccine effectiveness is highest in individuals not previously exposed to vaccine HPV types; vaccination prevents new infections but does not treat established infection or existing HPV-related disease. Evidence on vaccination after cervical conisation is mixed: observational studies often suggest reduced recurrence, whereas randomised-trial-only syntheses do not show a consistent overall reduction in recurrence of high-grade lesions (high-grade squamous intraepithelial lesion) or cervical intraepithelial neoplasia.

CONCLUSIONS

Adult HPV vaccination should be considered selectively and framed as prevention of future infections. A brief shared decision-making conversation focusing on anticipated future exposure, realistic benefits, dosing, and ongoing screening can support consistent practice. We provide a decision algorithm and practice scenarios to facilitate implementation.