HPV Vaccine - Not Just for Women
For men, the potential consequences of infection by the human
papillomavirus are nasty, like genital warts, and even life-threatening, as
penile and anal cancers. But these complications are quite rare. For the
average guy, the virus lies silent, doesn't cause problems, and clears in a
year or two.
Still, HPV is the most common
sexually transmitted disease
in the United States, and the federal Advisory Committee on Immunization
Practices is deliberating whether to issue a public recommendation that
boys and men be vaccinated with Gardasil, the only HPV vaccine approved for
that group, just as it's recommended for women. There is no easy answer.
Experts must weigh the cost of immunizing against the benefits, which could
include fewer cases of HPV-related
in female partners but most of the time is just about staving off a few
relatively harmless warts. They also want to wait and see whether the U.S.
Food and Drug Administration will allow Gardasil maker Merck to market the
vaccine for the prevention of anal cancer; currently it is approved for
preventing cervical cancer in females between the ages of 9 and 26 and
genital warts in males and females in that same age group. The FDA is
expected to make a decision by the end of the year. ACIP officials will
consider the FDA's action in making their recommendation, which could come
as soon as February, says Lauri Markowitz, leader of ACIP's HPV working
group. For now, though, men and parents of boys are on their own. They can
request the three-shot series, and doctors are free to provide it.
So far, however, demand has been underwhelming. "Let's just say they're not
knocking down the doors asking for it," says Michael Rich, an associate
professor of pediatrics at
Children's Hospital Boston
. And from a professional perspective, he says, "It's not a standard
protocol for your average 11-year-old boy, you know, troopin' in for his
physical." But it's still something some parents will ponder.
The decision may be easier for men and parents who believe that males and
females have a shared responsibility in preventing STDs.
Johns Hopkins Bloomberg School of Public Health
Professor Neal Halsey falls into that group. Widespread vaccination, he
says, is the best way to control HPV and avoid its potentially serious
effects-and it's also the most ethical. Men infected with one of a few
strains of HPV who pass it on to female sexual partners put them at risk
for cervical cancer if they haven't been vaccinated themselves, which the
government advises to prevent that form of cancer. And
men who have sex with men are at greater risk for HPV-related anal cancer,
which affects 1,100 men a year.
Vaccinating boys when they are 11 or 12 would be the most effective timing,
catching the vast majority of them before their "sexual debut," says James
Turner, the American College Health Association's liaison to ACIP and
director of the University of Virginia's Student Health Center.
Besides cancer, the thought of genital warts alone may convince a man to
get vaccinated, says Turner. The warts, which affect about 1 percent of
sexually active men at any given time, typically aren't painful, respond
readily to freezing with a little liquid nitrogen at the doctor's office or
even an at-home gel, and are considered a fairly "trivial medical
condition," he says. But he still regards them as destructive. The warts
can pop up months or years after the initial infection. In the interim, a
man wouldn't know if he was infected. If he develops a close relationship,
his significant other would need to take his word at the start that he was
free of HPV. And if he develops genital warts later, his other half would
also have to take on faith that he really did contract the virus
before they got together. "Believe me, a genital wart can be a devastating
occurrence in an otherwise monogamous intimate relationship," says Turner,
basing his view on the college students he has worked with. At the
University of Virginia
, roughly 10 percent of the current male population have been vaccinated.
That's pretty high, he says, most likely because of an active gay and
bisexual community and a student health plan that covers the three-shot
vaccine's $400 price tag
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