Many of us who provide scientific information about HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), tend to focus on its effects on preventing cancers in women, so articles are inclined to pay attention to vaccinating teenage girls rather than boys. But, if you carefully analyze the disease, human papillomavirus, a sexually transmitted disease, its subtypes 16 and 18 not only cause approximately 70% of cervical cancers, but they cause most HPV-induced anal (95% linked to HPV), vulvar (50% linked), vaginal (65% linked), oropharyngeal (60% linked) and penile (35% linked) cancers. The viruses are generally passed through genital contact, almost always as a result of vaginal, oral and anal sex.
These HPV-related cancers can be prevented as long as you can prevent the HPV infection itself, either through never having genital contact with an infected person (and since about 79 million adult Americans are infected with the virus, that’s going to be difficult) or the HPV vaccine. The vaccine is a vitally important part of the war against HPV, it prevents the transmission of certain types (pdf) of human papillomavirus (HPV), specifically types 6, 11, 16 and 18. These subtypes of HPV are most often implicated in these cancers.
A recent article in The Journal of Infectious Diseases reported that the overall prevalence of HPV infection in young gay men in the USA was around 70%, while the prevalence of HPV 16 and 18, the two HPV subtypes that are associated with anal cancer (and many other male cancers including oropharyngeal and penile) was around 37%. These are startling results, since we have continued to focus on women with the HPV quadrivalent vaccine. With this research, we clearly see a link between HPV and anal cancer with regards to gay men.
The study followed 94 gay men in Seattle, between the ages of 16 and 30 years old, for one year. To check for HPV infection, the study participants were given three anal swabs: one at baseline, six months and 12 months. For men who had no infection at baseline, the incidence rate of any new HPV infection was 38.5 per 1000 person-month. Additionally, HPV infection rates increased dramatically from 6% with individuals who had one sexual partner to 31% to individuals who had >2 partners. These results were similar to general data that has been published with a general population of young men and women in the USA.
Our findings highlight the need to immunize YMSM [young men who have sex with men] prior to their sexual debut, something that will likely require universal male immunization. At the same time, the fact that most YMSM appeared to remain susceptible to at least some HPV types included in the vaccine, catch-up immunization programs do offer YMSM some benefit.
Given the very high prevalence of HPV infection among YMSM, many (if not most) have been exposed to infection from one of their first few partners, a finding that highlights the desirability of immunizing YMSM before they become sexually active. (Note: the authors also advocate that sexually active gay males should also get the vaccine.)
In the U.S., Gardasil is recommended for all males between 11 and 21 years of age, and for gay men up to 26 years old. Given these study results and other research showing higher rates of anal cancer among gay men, the bottom line remains that immunization to HPV before sexual experience is best.
And because it’s always mentioned, the HPV quadrivalent vaccination is safe. In a large study, which included nearly 200,000 young females who had received over 350,000 doses of the vaccine, found that the vaccine was only associated with same-day syncope (fainting) and skin infections in the two weeks after vaccination. These findings support other large studies that also found the vaccine safe and an appropriate strategy to prevent cervical cancers. The authors stated that, “this study did not detect evidence of new safety concerns among females 9 to 26 years of age secondary to vaccination with HPV4.”
The HPV vaccine saves the lives of gay men by preventing the infection of human papilloma virus that cause devastating cancers like anal and penile. And in massive epidemiological studies, we have shown that the HPV vaccine is extremely safe. If you’re a young gay man (or of course any young man or woman), get the vaccine. You’ll thank me in 20 years when you don’t get cancer.
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- Camenga DR, Dunne EF, Desai MM, Gee J, Markowitz LE, Desiliva A, Klein NP. Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations. Sex Transm Dis. 2013 Jul;40(7):534-8. doi: 10.1097/OLQ.0b013e3182953ce0. PubMed PMID: 23965766. Impact factor: 2.594.
- Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males–Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60(50):1705-8. PubMed PMID: 22189893.
- Glick SN, Feng Q, Popov V, Koutsky LA, Golden MR. High Rates of Incident and Prevalent Anal Human Papillomavirus Infection Among Young Men Who Have Sex With Men. J Infect Dis. 2013 Sep 1. [Epub ahead of print] PubMed PMID: 23956439. Impact factor: 5.848.
- Klein NP, Hansen J, Chao C, Velicer C, Emery M, Slezak J, Lewis N, Deosaransingh K, Sy L, Ackerson B, Cheetham TC, Liaw KL, Takhar H, Jacobsen SJ. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Arch Pediatr Adolesc Med. 2012 Dec;166(12):1140-8. doi: 10.1001/archpediatrics.2012.1451. PubMed PMID: 23027469. Impact factor=4.140