HPV Vaccine: Who needs it?
Did 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?
- Having lots of partners increases your chance of getting any HPV and possibly a bad HPV type that causes cancer.
- Smoking is a big risk factor for HPV cancers.
- Unprotected sex: condoms protect somewhat against HPV.
- 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.
- 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.