HPV Vaccine: Who needs it?

By Dr. Irving Salit

Irv PortraitDid you know that men can get HPV cancers? HPV (the human papillomavirus) causes warts, pre-cancers and cancers. HPV is most famous for causing cervical cancer so it has mainly been linked in people’s minds to cancer in women. Because of that, HPV cancer prevention programs have only focused on women (for example, governments spend many millions on cervical cancer screening and immunizing girls against HPV). However, HPV is readily passed between partners and the other half of the world (men!) get HPV as much as women do. So let us get the facts straight about HPV in men and women and what to do about it.

HPV is the commonest sexually transmitted infection (STI) in the world; there are many HPV strains but only a few of them cause cancers. HPV can cause cancers in all genital tissues in men and women – such as cancers of the cervix, vulva, vagina, penis and anus. HPV increasingly is also causing cancers in the mouth and throat, most commonly in men. Mouth and throat cancers are actually more common than cervical cancer. Just as with genital cancers, the HPV causing these oral cancers came from their partners.

What are the risk factors for getting HPV cancers?

  1. Having lots of partners increases your chance of getting any HPV and possibly a bad HPV type that causes cancer.
  2. Smoking is a big risk factor for HPV cancers.
  3. Unprotected sex: condoms protect somewhat against HPV.
  4. HIV is a big factor no matter what your transmission risk group – but HIV-positive men who have sex with men (MSM) have the highest rates of anal cancer.
  5. Age over 50

So, how do we prevent HPV infections and cancers?

Cervical cancer screening does help and maybe screening for anal and oral cancers might help too (but they are not funded so are not routinely done). These are called secondary prevention strategies. Primary prevention is always better and in this case it means preventing HPV infection because…no HPV, no HPV cancers! Gardasil is the only available HPV vaccine and it almost totally prevents HPV infection when given before you ever get HPV, so it should be given just before sexual activity starts. Gardasil-4 includes the four main HPV types that cause cancer or warts; the newer Gardasil-9 includes additional types that could cause cancer. These vaccines prevent HPV infections, warts, pre-cancers and cancers. Initial programs in Canada made Gardasil-4 available free to schoolgirls and this has been finally expanded in some provinces to include boys. (This makes a lot of sense because: boys could pick up HPV from non-immunized girls or from their own male partners. And it just sends the right message that this is a disease of males and females.)

What if you are an older adult who is sexually active? Gardasil is now indicated to prevent HPV infections and cancers in men ages 9-26 (but can still be given to those over age 26) and women ages 9-45 but it is only publicly funded for schoolchildren ages 9-13 (grades 4-8). Two shots are acceptable for children but three may be more reliable for adults. The benefits are not proven in those with HIV infection but I still do recommend it in the higher-risk situations. However, the vaccine is expensive and may only be covered if you have private insurance.

Dr. Irving Salit is Professor of Medicine at the University of Toronto. He is a Fellow of the Royal College of Physicians and Surgeons of Canada and a specialist in Internal Medicine and Infectious Diseases. He is the Director of the Immunodeficiency (HIV) Clinic at the Toronto General Hospital.

 His research interests include the Human Papillomavirus (HPV) and screening tests for HPV-associated anal cancer. He has completed a large research screening study for the detection of anal dysplasia and an assessment of transmission between partners. Current studies include community-based screening for anal cancer and the role of HPV vaccine in high-risk men.

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4 comments on “HPV Vaccine: Who needs it?

  1. Steve Hinks on

    The European Medicines Agency recently did a safety review on HPV vaccines and ‘reports of adverse reactions did not show a consistent pattern regarding time-to-onset following vaccination, they appear to have totally ignored the evidence provided by the UK Association of HPV Injured Daughters (AHVID) which reported that a questionnaire completed by 94 member families indicated that:
    • 27 girls (31% ) had adverse reactions on the same day as the vaccination, many of them suffrering immediately, within minutes.
    • 12 girls (14%) had adverse reactions after just 1 dose
    • 19 girls (22%) had adverse reactions after just 2 doses (some of these had reactions also to the 1st dose
    • 14 girls had adverse reactions after the 3rd dose (and some of these had earlier reactions)
    • At least 4 girls (4%) had adverse reactions after each of 3 doses. Health professionals had indicated that the vaccine is safe and the adverse reactions suffered were not recognised as side effects of the vaccine. Initial symptoms were often ‘generally unwell, flu-like, tired, aches and pains’. With each dose the severity increased and day-by-day the severity increased. With some it was eventually several weeks before these symptoms developed into collapse with total fatigue and sleeping up to 23 hours each day.

    Reply
    • Irving Salit on

      Reactions to the HPV vaccine and other vaccines are very common. For example, a sore arm is the commonest side effect.

      I agree with your statement that other “adverse reactions suffered were not recognised as side effects of the vaccine”. When millions of people receive a vaccine, there are many other events occurring in those people’s lives. It is important to rigorously prove that these events were caused by the vaccine.

      Reply
  2. Steve Hinks on

    This vaccine has never been proven to prevent a single case of cancer and it will be decades before we find out. Cases of cervical cancer in developed countries using Pap screening are 9/100,000. Deaths have come down from 8 to just 2/100,000 over the last 40 years with no vaccine and current uptake of screening of just 80%. Screening is still necessary even after vaccination. There are over 100 strains of HPV and some scientists expect other strains to replace those that are targeted by the vaccine.

    In the meantime thousands of girls are being seriously disabled and their lives ruined by the adverse reactions. In the UK 20,503 adverse reactions have been reported by Yellow Card, including 5 with fatal outcome (data obtained by FOIA request to MHRA). Even the manufacturers admit huge numbers of serious adverse reactions during the clinical trials.

    Reply
    • Irving Salit on

      HPV vaccine has 100% efficacy against HPV-16 and HPV-18 precancerous lesions in those not already infected with HPV.

      The WHO Global Advisory Committee for Vaccine
      Safety (GACVS) has regularly reviewed the evidence on
      the safety of HPV vaccines. The Committee reviewed
      post-licensure surveillance data from the United States,
      Australia, Japan and the manufacturers. Data from all
      sources continue to be positive regarding the safety of
      both vaccines. GACVS concluded in March 2014 that
      both HPV vaccines continue to have an excellent safety
      profile.
      “Adverse events following HPV vaccination are generally non-serious and of short duration.”

      Reply

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