HPV: A Male Tale

As we start to settle down from the Christmas season and ease into our New Year’s routines, our brains are probably ready to start taking in new information and applying it. The subject is the ACIP’s recommendation to vaccinate all 11- and 12-year old boys against HPV. The HPV vaccine recommendation for boys had its time in the spotlight back in October, but you’ve probably filed it for a while. I hope to give you some new or expanded information on the subject.

What is the ACIP?

Let’s start with a few definitions. ACIP stands for the “Advisory Committee on Immunization Practices.” The ACIP’s job is to provide advice and guidance to federal agencies, including the CDC, on the best way to control vaccine-preventable diseases for the U.S. non-military population. Essentially, they examine all of the past, current and upcoming research regarding vaccines and make recommendations to help keep us and our children from getting diseases which could be prevented by vaccines.

What is HPV?

The next definition is HPV, which stands for “Human Papilloma Virus.”

About 20 million Americans are currently infected with HPV. HPV is the most common sexually transmitted infection. We most often hear about the diseases that affect females and their cervixes. But HPV also causes cancers other than cervical cancer, including cancer of the vulva, vagina, penis, and anus as well as cancers of the head and neck (most often referred to as “oropharyngeal” in nature). These include cancers of the tonsils AND the base of the tongue. In the U.S. each year, about 18,000 HPV-associated cancers affect women, with the most common being cervical cancer. But what you may not realize is that about 7,000 HPV-associated cancers affect MEN each year in the U.S. with the most common being head and neck cancers. As cervical cancers caused by HPV seem to be developing now at even earlier ages in women, male cancers may take decades to develop.

Eighty percent of anal cancers in men and women are caused by the HPV strains that can be prevented through immunizations received with HPV vaccines. HPV is also the cause of those lovely (not!) genital warts in both men and women. Once venereal warts are acquired, they are difficult if not impossible to eliminate and are painful to treat. They can be given to future partners, too. Talk about the “gift that keeps on giving!” Over the past few decades, there has been an increase in head and neck cancers caused by HPV that are NOT related to smoking and tobacco products. Cancers of the anus have been increasing, also.

The HPV Vaccine

A little background on HPV vaccine, and then I will discuss the rationalization for recommending the vaccine for boys. In 2006, the ACIP recommended routine vaccination of girls ages 11-12 years old and women through age 26 with girls as young as 9 able to receive it. (FYI: girls/young women currently have two vaccines available to them-“Gardasil” and “Cervarix”). In 2009, the FDA approved the use of one of the vaccines (“Gardasil”) for boys and young men. Both are covered by “Vaccines for Children” (VFC) guidelines — those meeting certain financial requirements. Both vaccines are a series of three shots. The vaccine is recommended for 11- to 12-year-olds because it has been found they have a better immune response compared to older individuals. The vaccines are MOST effective when given BEFORE there is exposure to any of the covered HPV strains.

HPV vaccination of males gives an opportunity to decrease the numbers of HPV-related disease in both males AND females. There is the direct benefit of preventing genital warts and anal cancer. There is also the potential that it will indirectly decrease the spread of HPV from males to females and reduce the HPV disease that women suffer from. HPV is found two to four times more often in men than in women. The risk of HPV disease does not appear to decline with age in men as is seen in women.

In Summary

To summarize, as of October 25, 2011, the ACIP recommended the routine vaccination of males ages 11-21 (females ages 9-26) with “Gardasil.” This recommendation should be approved by the CDC by the time of this publication. Remember, it is a 3-dose series! Full protection is only achieved with completion of the series. The most common side effects that might occur are redness at the injection site, headache and fever. These effects tend to be mild or moderate in intensity. At this time, the HPV recommendation is not a mandate for either boys or girls. This means it does not force anyone to be immunized.

I do hope this information provides a basis for a good conversation between you and your child’s or your own physician or healthcare provider about the risks and benefits to your child or-yourself. I also hope this conversation extends into other ways to improve your child’s health and prevention of disease in the future.

For more information on the HPV vaccine or other vaccines, check out tulsa-health.org or cdc.gov.

Dr. Kline is a Medical Director with the Tulsa City-County Health Department and a medical advisor to the Tulsa Area Immunization Coalition.