Should men get the HPV vaccine?

Source: Web exclusive, November 2011

By now you’ve probably heard of Gardasil, the Human Papillomavirus (HPV) vaccine that was approved by Health Canada in 2006 for women and girls aged nine to 26. Gardasil has since been approved for use in boys and men between the same ages. (Cervarix, a vaccine that targets the most common cervical-cancer causing strains of HPV, has not yet been approved for males). While more and more females are being vaccinated, the same can’t be said for boys and men. But doesn’t it make sense for them to also be inoculated?

While the effects of HPV disproportionately affect women, it’s common in both sexes. HPV is the most widespread sexually transmitted infection in adults worldwide, and an estimated 75 percent of sexually active Canadians will have at least one HPV infection in their lifetime. There are more than 100 strains of the virus, more than 40 of which can cause genital warts, and in rare case, throat warts. Other types of HPV can cause cervical cancer, as well as other less common cancers, such as anal and vulva.

In its March 2007 budget, the federal government allocated $300 million to support HPV vaccination efforts across all 13 provinces and territories. But, in 2011, the bulk of Gardasil marketing and prescribing continues to target girls and women. More importantly, boys have limited access to the vaccine. In Ontario, Grade 8 girls can receive it for free, but boys can only get the vaccine if their parents obtain a prescription and pay for it. At more than $400 for the necessary three doses, the cost of Gardasil can be another significant barrier, even if parents are willing to vaccinate their sons.

Early critics of HPV vaccination argued that because 90 percent of HPV infections are cleared by the body’s immune system within two years, expensive vaccinations aren’t necessary. Others, however, argue that the importance of prevention outweighs any costs. But it’s impossible to predict who will experience effects of the virus and who will not. Additionally, HPV is so pervasive because many people never know they’re infected and unknowingly pass the virus onto subsequent partners.

Dr. Erika Feuerstein, who works at Women’s College Hospital’s Bay Centre for Birth Control in Toronto, says that men are at risk for many things, including "penile, anal, throat and mouth cancer." Receiving the vaccine would also help prevent gential warts. Given the potentially uncomfortable, painful or fatal health problems caused by HPV, Dr. Feuerstein says, "boys and men should absolutely get the HPV vaccine."

So why aren’t men getting vaccinated?

As with boys, the cost of Gardasil remains a significant factor in why men don’t get the vaccine. Another is that many men simply don’t know that it’s available to them. Alan* didn’t even consider getting the vaccine until he contracted genital warts. He says: “I first considered the vaccine out of fear. The genital warts were a nuisance and having them frozen off over a period of months was physically uncomfortable. It was a condition and treatment that I’d never want to experience again.”

Even though Gardasil does not protect against HPV strains already contracted, it does against others, so Alan went through with his vaccination. He recently received his third and final dose and says that to him, prevention is paramount. "I see myself as equally responsible for the safety and well-being of my partners," he says. "The peace of mind alone is worth the cost and hassle."

Despite being 30-years-old’over the recommended maximum age of 26 for men’Alan experienced no problems in getting his prescription. According to Dr. Feuerstein, since the Gardasil vaccine has now been approved for use in women up to age 45, it makes sense to do the same for men.

When it comes to possible side effects, she says: "I don’t have any specific concerns about the vaccine other than the possible serious side effects that can occur with any vaccine. "

Gardasil is most effective when given at a young age, before people become sexually active. So while availability is certainly a positive step, we should consider ways to expand access and education about HPV and Gardasil to boys and men. "Men are a source of infection for women," says Dr. Feuerstein. "So to more rapidly reduce the spread of HPV, vaccinating men would be beneficial."

* Name has been changed.

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