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A close-up of the human papillomavirus.

HPV vaccine: Not just for women

by Lauren Gold and Zack Aldrich
Oct 13, 2011

When a vaccine that could protect women from cervical cancer first came out, the marketing campaign caught fire. It wasn’t long before young American women went straight to their doctors to get the three rounds of the vaccine over six months.

But what about boys? Gardasil, the HPV vaccine made by Merck & Co., protects men and women from the four most common types of human papillomavirus, two that cause cancers and two that cause genital warts, or condyloma, according to the Centers for Disease Control and Prevention in Atlanta.

In studies of HPV, the vaccine was highly effective in preventing the four most virulent kinds of HPV in men, said Dr. Lauri Markowitz, an epidemiologist at the CDC. And yet most people think the vaccine is only for women.

The vaccine protects men from anal, penile and oral cancers, but also prevents them from sexually transmitting HPV to their partners, according to the CDC.

Through June, more than 35 million doses of the HPV vaccine had been distributed in the United States. Gardasil distributed almost all of these, according to the CDC. The U.S. Food and Drug Administration approved the vaccine for women in 2006 and for men in 2009. Cervarix, the other HPV vaccine made by GlaxoSmithKline PLC, is approved only for women.

“The one thing about HPV that people don’t understand and really need to know is that there are millions of types of HPV,” said Barbara Hartnett, a nurse practitioner at the Women’s Group of Northwestern. “You can still be positive for HPV even if you’ve had Gardasil. It’s the types that are the most virulent that are the ones we really try to protect with the Gardasil vaccine.”

The CDC recommends vaccination for young women ages 13 to 26 and young men ages 9 to 26.

As for side effects, there are some reports of fever, fainting, dizziness and nausea associated with the vaccine, but these effects are rare.

“If we can eradicate a kind of cancer, it’s kind of a no-brainer,” Hartnett said. “We do strongly support it, and we feel that the benefits far, far, far outweigh the risks.”

There is no test for men to determine if they are carriers of HPV, according to the CDC. Both partners could be vaccinated and still contract or spread a certain strain of HPV. The solution? Use condoms, practice safe sex or abstain from sexual activity completely.

In light of Sept. 12 comments from Cong. Michele Bachmann (R-Minn.) at the Republican presidential debate about the HPV vaccine causing mental retardation, there is concern that vaccination rates may go down.

Bachmann’s spokesperson could not be reached for comment.

Joe Serio, manager of child and adolescent services at Kenneth Young Center in Elk Grove Village, said that public figures such as Bachmann ought to research their claims before they communicate any sort of expertise.

“It wasn’t like, ‘Oh I read in a journal,’ or ‘The American Medical Association says …’ It was basically ‘some woman told me.’ There’s absolutely no empirical evidence to back up the fact that HPV can cause mental retardation. Zero. In fact, no vaccine has ever caused mental retardation,” he said.

Recalling the scare of vaccines causing autism, Serio said the importance of the HPV vaccine can be overshadowed.

“Most kids are not responsible for their own health care — it’s their parents,” he said. “I think there’s already a stigma attached to HPV, because in some parents’ minds, it’s condoning sexual activity. To add another pseudo-risk factor goes against prevention.”

Serio doesn’t think the vaccine has been marketed to men. He said gay men in particular need to know about the vaccine. Gay males are at a higher risk of anal cancer associated with HPV.

“All our energies are currently being directed toward HIV prevention, which is far more of an imminent risk,” he said. “But, in particular with young people, no one wants to talk to teenagers about reproductive health. In most of the schools I work, they teach an abstinence program or very much gloss over reproductive health issues.”

As a mother of three boys and nurse practitioner in Glenview, Doris Spicer wonders why a person wouldn’t choose to vaccinate a child.

“If one of my kids contracted condyloma and had to go through the surgical eradication of it, as a parent, I would look back and say, ‘Why didn’t I vaccinate?’ … God forbid if you got throat cancer.”

She said it’s her impression that the push for vaccinating men hasn’t surfaced until recently because health professionals haven’t observed the same levels of prevalent disease as in young women. The possibility of treating genital warts and penile and oral cancers in the U.S. might not have been enough on its own to warrant a push for a men’s vaccine at the time Gardasil became available, but Spicer said both genders benefit from vaccination.

“You want to target your population prior to their becoming sexually active,” she said. “Over 50 percent of high schoolers are sexually active.”

She noted that some parents tend to hold off on vaccinating their children right away because of its potential implications.

“A lot of parents do not like getting their children vaccinated because they think they are promoting sexual activity in their children,” she said. “When you look at the statistics, it doesn’t make sense.”

Dr. Julie Morita, deputy commissioner for the Chicago Department of Public Health, said a CDC advisory committee recommended the vaccine for men about a year and a half ago. She said this is only a permissive recommendation, meaning the vaccine is offered for men, but the health community isn’t necessarily saying ‘you should’ get the vaccine. More time is needed to observe the benefits in men before an evidence-based recommendation is made.

Morita said the state does not mandate that HPV cases be reported to health departments, but the Chicago Department of Public Health will be tracking HPV vaccine coverage levels in its upcoming public health agenda.

She said there is no correlation between vaccination and promiscuity.

“Because we make condoms available, will children have more sex? That’s not necessarily true. That’s a misconception,” Morita said.

She noted that, after proposing the benefits of HPV vaccination to her teenage daughter, her daughter responded, “Well, what’s the question?”