Before You Get the HPV Vaccine: Is Gardasil or Cervarix the HPV Vaccine for Me?

Joe Raedle /Getty Images News/Getty Image

Now that there is more than one HPV jab on the market, how do you choose the HPV vaccine that is right for you? Here are some facts to consider when you're choosing between Gardasil, Gardasil 9, and Cervarix. All the vaccines are good HPV protection options, but they each have certain advantages.

Does Gardasil or Cervarix Have A Better Dosing Schedule?

One of the first questions people often ask about HPV vaccination is how many times they need to get the HPV jab and when they need to get them.

All three currently available vaccines require a series of three shots. Gardasil is given at 0, 2, and 6 months, while Cervarix is given at 0, 1 and 6 months. In either case, you'll be done within half a year. However, it is very important to get all three shots for the HPV vaccines to have maximum efficacy.

What HPV Strains Do the HPV Vaccines Protect Against?

Gardasil is designed to protect against new infections with HPV 6, 11, 16, and 18.

Gardasil 9 is designed to protect against new infections with HPV 6, 11, 16, 19, 31, 33, 45, 52 and 58,

Cervarix is designed to protect against new infections with HPV 16 and 18.

There is data suggesting that both Gardasil and Cervarix may offer cross-protection against other HPV strains; however, they do not protect against strains with which you have already been infected. Because of it's increased coverage, it's thought that Gardasil 9 may be slightly more cost-effective than Gardasil.

Are the HPV Vaccines FDA-Approved?

Cervarix is approved for girls and women aged 9 to 25 for the prevention of cervical cancer and cervical interepithelial neoplasia.

Gardasil is approved for both men and women from the ages of 9 to 26 for the prevention of genital warts, anal cancers, and anal interepithelial neoplasias.

It is also approved for the prevention of cervical cancer and cervical and vulvar interepithelial neoplasia in young women.

Gardasil 9 is approved for women and girls aged 9 to 26 and men and boys aged 9 to 15.

None of the three vaccines have yet been shown to protect against diseases caused by pre-existing HPV infections. All of them can be used for routine vaccination

Safety Issues and/or Side Effects

One of the issues that often comes up in discussions of the HPV vaccines is whether or not they're safe. All three vaccines do cause mild to moderate side effects -- such as pain and redness at the injection site, as well as headaches, stomach aches, and other full-body symptoms -- in a reasonable fraction of recipients. However, they are generally considered to be quite safe.

The more serious side effects that have been reported to the vaccine adverse event reporting system have, by and large, not been shown to be vaccine-related, and the reports of vaccine-linked fatalities appear to be unfounded.

Accessing the HPV Vaccine

Although the vaccine will not be covered by your insurance, it is possible to find doctors willing to give you the vaccine even if you are outside the currently approved age range.

However, since most sexually active people will have been exposed to numerous strains of HPV by the time they are in their late 20s, there are debates over whether vaccination is actually worthwhile for these adults. If you are over 26 and considering vaccination, you should discuss your interest and your risk factors with your doctor to see if vaccination is a good choice for you.

What Antigens Do the HPV Vaccines Use?

Gardasil and Cervarix each target the HPV L1 capsid protein to attempt to induce immunity against the virus. In both cases, the antigen in the vaccine is actually a virus-like particle (VLP) made up of these proteins -- or more accurately multiple VLPs, one for each strain of the virus the vaccine targets.

The L1 capsid protein is a protein found on the surface of the human papillomavirus, and it varies slightly from strain to strain.

The main difference between the two vaccines is that Gardasil has 4 types of VLP and Gardasil 9  has 9 types instead of Cervarix's 2. None of the vaccines contain viral DNA, and there is no way for them to cause HPV.

What Adjuvants Do Cervarix and Gardasil Contain?

The adjuvant is the carrier used to stimulate the body to produce an immune reaction against the antigen found in the vaccine. Cervarix uses the AS04 adjuvant, which is is composed of 3-O-desacyl-4’-monophosphoryl lipid A (MPL) adsorbed onto aluminum (as hydroxide salt). Gardasil uses amorphous aluminum hydroxyphosphate sulfate as an adjuvant.​


Cervarix Prescribing Information. 

Gardasil prescribing Information. 

Jenkins(2008) A review of cross-protection against oncogenic HPV by an HPV-16/18 AS04-adjuvanted cervical cancer vaccine[...] Gynecol Oncol.110(3 Suppl 1):S18-25.

McCormack & Joura (2010) Quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine (Gardasil®): a review of its use [...]. Drugs. 70(18):2449-74.

Petrosky E, Bocchini JA Jr, Hariri S, Chesson H, Curtis CR, Saraiya M, Unger ER, Markowitz LE; Centers for Disease Control and Prevention (CDC). Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015 Mar 27;64(11):300-4. PubMed PMID: 25811679.