Hello, here is the backstory: I am a 28 year old male, and my female partner of 1 month contracted HPV in June 2023 (she not vaccinated). We have had protected vag sex 6 times but the most recent time the condom broke and we did not notice until after, so unprotected sex took place for around 2-3 minutes. I have also noticed a bump right next to her anus. Not cauliflower shaped and she said she thinks it might be a hemerrhoid. 

Your questions come down to a straighforward answer. Research the last few years has shown that two doses of the HPV vaccine provide equal protection as the full course of three doses. You are very well protected against the 9 HPV types covered by the vaccine -- and those 9 types account for the large majority (~90%) of all important clinical consequences of HPV, i.e. warts and cancers. The only uncertainty is how long the protection lasts, but there is no question that it lasts at least 10 years. Somewhere along the line, you might consider having the third dose. Think of it not as completing your 3-dose series, but as a booster dose that will prolong your protection, probably for life.

Nevertheless, your closing question ("What are the odds I am now infected with HPV?") requires a bit more discussion. There are more than 100 genital/sexually transmitted types of HPV. The vaccine prevents infection with nine of them. So assuming you've had a reasonably normal sex life -- with at least a handful of sex partners over the years -- it's pretty certain you have yinhad HPV and could still be carrying the virus. But not any of the most harmful types. Acquiring and carrying HPV are normal, expected, unavoidable consequences of a normal sex life. However, if you are (or have been) infected, there is little chance you will have any important health problems as a result -- or that you'll ever know for sure.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

1) To confirm, even though my first dose was received at 16.5 years old instead of before 15, and the second dose was received two years later, I am still afforded the same protection as if I got the first dose before 15 and the second dose a couple months after that? (Also might be worth noting that I did not have sex for the first time until about 7-8 months after my second dose with my girlfriend who was also a virgin. I then did not have sex with another partner until about a year and a half after that.)

2)  Your information about the likelihood that I have had HPV in the past is very helpful. I am most concerned about the chances of acquiring HPV from my current partner who has had HPV since a pap smear in June 2023 (she has a bump next to her anus that may or may not be a wart, I am really not sure and when I described it to her she said she gets hemerrhoids. She hasn't had any recognized warts to date).

3) If she does have a type of HPV that causes warts, and it is in the small percentile of HPV strands that my vaccine doses do not protect against, what are the odds that if I contracted it I would also get warts?

2) It is highly probable that you are immune to the HPV type your partner has, because of vaccination. Even in the statistically unlikely scenario that she has a non-vaccine-covered HPV type, and you were infected, likely it will never cause symptoms, you'll never know it, and will not infect future partners. You can completely disregard any risk to yourself (or future partners) on account of your present situation.

3) The high risk types of HPV, as she apparently has, rarely cause warts. Having been vaccinated, it is very unlikely you will ever experience genital warts. And if you do, you should look at this as an unpleasant inconvenience, not an important health problem.

Mellow out about your own HPV risks. They are trivial if any at all!

1) Since I received my first dose in July 2012 and my second in January 2014 that would have been the vaccine that only protects against four strains of HPV instead of 9 strains right? I thought Gardasil 9 was released in December 2014.

2) If the above is true I still would be protected from the vaccine-protected strains that cause 90% of genital warts (6 and 11), correct?

3) If that vaccine I got was only designed to protect against 4 strains instead of 9 should I do the whole regimen over again or, as you previously recommended, just get that third dose as a booster?

4) What makes you say my partner's strain is high risk?

2) Yes, you still are 100% protected against HPV 6 and 11, which cause 90% of genital warts; and HPV 16 and 18, which cause 60-70% of HPV cancers.

3) I would say it's optional whether you should be revaccinated with the current vaccine. As just implied, you are well protected against both warts and cancers. If you've had an average dating life, with a few sex partners since your second dose, you likely have already experienced some of the additional 5 types covered by the vaccine -- so it won't enhance your protection against those strains. And if you're over age 26, you're beyond the usual age for HPV vaccine. Therefore the benefit of the 9-type vaccine isn't likely to be great. OTOH, being revaccinated is harmless (except maybe to your wallet, depending on your medical insurance). Personally if I were in your situation I probably wouldn't do it.

4) I didn't mean to imply your partner has a high risk strain. That's such a common question/concern among HPV related forum that I sort of assumed it without carefully reading your question. My apology! In fact, it seems you don't even know she has HPV at all, right?  That you noticed a "bump" near her anus is far from confirmation she has genital warts or even HPV, and genital warts usually are multiple; only one "bump" argues against a wart.  If she is concerned about the bump, she can consider seeing her doctor about it. 

1) I agree that doing the whole round of vaccine shots again seems unnecessary but could I still do my third shot as a “booster” as you mentioned previously? Could this still be beneficial even if my first two shots were Gardasil 4?

2) Even with my first two shots being Gardasil 4, does what you said about two shots being just as effective still apply? Also, does what you said about my age at the time of the shots, and the interval of time between the two shots not the hurting the vaccine efficacy still apply? 

3) My understanding is that the two hpv wart strains that are addressed with the vaccine (whether Gardasil4 or Gardasil9) are just 6 and 11 so doing the full gardasil 9 regimen wouldn’t afford me more protection against genital warts, but would afford me protection against any of the other 5 hpv strains I may have not caught already? 

4) My partner has confirmed hpv via a Pap smear in June 2023. She is not vaccinated. She said she has not noticed any warts. I was just a little worried about the bump I noticed. 

2) ...which should be at least a month apart.

3) I agree -- warts prevention will not be improved by receiving Gardasil 9.

4) Given your vaccination history, you should not be at all concerned about genital warts, even if it turns out your partner has them. As for her abnormal pap several months ago, having had regular sex with her, you can assume you have been repeatedly exposed and infected -- or exposed but not infected, depending on the type of HPV she has been found to have. Either way, you'll probably never know and never have any adverse outcome from it.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.