Myths about the HPV vaccine for boys

A vaccination policy statement released by the American Academy of Pediatrics has already drawn fire from a number of anti-vaccine groups, specifically for its endorsement of vaccination against HPV infection in boys.

First, let’s examine exactly what the AAP added to its guidelines regarding the HPV4 and HPV2 vaccines: “HPV4 may be administered in a 3-dose series to males 9 through 18 years of age to reduce their likelihood of acquiring genital warts.”

That’s it.  The AAP simply endorses the use of the HPV4 vaccine in young males to reduce their likelihood of acquiring those strains of HPV, which may present as genital warts in males (although are often asymptomatic).  However, females contract HPV of all strains from males, and reducing the number of males infected will indirectly protect females from developing cervical cancer.

I’d like to share with you a comment from a prominent news organization’s coverage of the release:

Great! More tobacco science trying to push poisons into your body instead of promoting heathy [sic] living. By the way isn’t the HPV vaccine for cervical cancer? Boys do not have a cervix! Also, read the package insert and find out that this HPV vaccibe [sic] does not protect from cervical cancer at all! However, if you already have the human papillomavirus then it will accelerate the disease! Wake up people. Only if this post would actually make it onto this website!

Spelling errors aside, this individual displays several common misconceptions, the largest of which I’d like to dispel, because I can foresee this becoming an issue in the coming days.

The major “selling point” for the HPV vaccine is indeed its claim to prevent cervical cancer in women – so why should boys be vaccinated if they “do not have a cervix”?  Boys may not have a cervix, but they have a perfectly suitable vehicle for transmitting HPV to females, and that’s where the connection lies.

The connection between certain strains of HPV and cervical cancer are clear and established.  I’ve been asked why physicians consider certain, seemingly-unrelated, factors as risks for cervical cancer:

  • Early age of first intercourse
  • Multiple sexual partners
  • Unprotected sex

These three factors (and others) are directly related to risk of HPV infection, and therefore predispose to cervical cancer, because HPV is so common.  There is perhaps no better direct connection between a virus and a subsequent malignancy, and there is no other vaccine that has the potential to protect so many individuals from a life-altering diagnosis of cancer.

It’s a good idea to vaccinate people, male and female, before they’re exposed and can spread the virus.

James Haddad is a medical student who blogs at Abnormal Facies.

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  • http://www.dialdoctors.com Dial Doctors

    How thick can a person be? HPV is an STD which can be transmitted between partners which is why doctors encourage boys to be vaccinated as well. That person has probably never had a yeast infection or a partner who has. Wonder why your wife/girlfriend/hookup’s gynecologist sends a script for you too even though she has the yeast infection? Because you’re probably infected too yet you’re not showing symptoms. Besides you wouldn’t want to bounce the infection around within the same partners. It’s important to keep in mind that HPV can’t just lead to cervical cancer. Genital warts are not pleasant… for boys or girls. Be responsible towards your partners

    • http://Abnormalfacies.wordpress.com Jim

      I believe science literacy (and thus health literacy) is a major issue in America. Some of the anti-HPV vaccine propaganda I’ve read has been ridiculous – one source suggested the vaccine is a government attempt to de-populate the US by making young women infertile.

      The incredible thing is not that people make this stuff up, it’s that others believe it.. Carl Sagan must be turning over in his grave.

  • http://Abnormalfacies.wordpress.com Jim

    Physicians and other health care providers need to do a better job educating patients so we don’t have misconceptions like these circulating.

    It’s difficult to spend the time doing so, but if we don’t, we ultimately lose to those who spend all of their time propagating misinformation.

  • Angela Caffaratti, MD

    Vaccines are safe, and there is nothing wrong with promoting herd immunity. Also, once you have genital warts, you always have genital warts. Men and women can also die of anal cancer. Farrah Fawcett just died of it. Also, babies can get endotracheal warts which are life-threatening and never curable. Only downside is minor risks and cost. My sin will be vaccinated, and I expect him to only have one sexual partner in his future.

  • Nurse Pam

    Great expectations, but dream on~!

  • Dave

    Uhm it can cause more than just warts. As Dr. Caffaratti has pointed out Anal cancer (mainly a concern in the gay/bi community) can also occur. Plus there have been confirmed cases of penis cancer. Given the rate of HPV associated penile cancer is only about 1/100,000 in the male population but still, don’t know about you, but I sure the heck don’t want penis cancer.

    • http://Abnormalfacies.wordpress.com Jim

      Dave,

      That is true and is of concern in the LGBT community, but was not the focus of the article. Vaccinating a randomly-selected young man against HPV 16 & 18 is more likely to save the life of a woman, not the man himself. However, that doesn’t mean there aren’t certain populations who would benefit from vaccination for the reasons you stated.

  • Finn

    We vaccinate boys against rubella primarily to protect women’s fetuses from infection, so why not vaccinate boys against HPV primarily to protect women from infection?

  • skeptikus

    First, do we have any long-term studies about the safety of this vaccine–or long-term side effects? I think the answer is no.

    as for the bizarre benefits commenters have dreamed up, do you have any training in cost/benefit analysis. We all drive, and assume the risk of dying in an accident, which has a probability of several orders of magnitude HIGHER than any of those horrible cancers you use to scare the children.

    Given that the long term risk of the HPV vaccine is UNKNOWN, it seems at least rational to forgo the vaccine and accept the risk. Especially, because the virus is completely avoidable via abstinence.

    • http://Abnormalfacies.wordpress.com Jim

      As someone who works in an underserved/impoverished community, I know it’s quite impossible to adopt “Choose Abstinence” as a public health policy.

      Just as you suggest we all accept the risk of driving, accepting potential risk from a recombinant vaccine (which are exceptionally safe, as they contain no live/attenuated viruses) as a trade-off for protection from cancer seems reasonable.

      No one is forced to receive this vaccine, and with proper informed consent, why should a patient be encouraged to avoid this? Unknown risk? What about the known risk of contracting/spreading HPV?

      As a physician (and now, as a student), I will be recommending this vaccination.

    • gzuckier

      following that logic, we’d be better off trying to market abstinence from driving, which has the higher mortality rate, than sexual abstinence to avoid STDs.

  • Taylor

    Not to mention some of you are acting like you drop dead of cancer once you get HPV. Not true, especially if it is mild or moderate dysplasia. You just have to keep a close eye on it with regular pap smears. The cancer could take 5-10 years to develop! Most that develop cancer from HPV are those that do not stay up to date with their health and follow-ups, or they don’t have access to healthcare. As far as avoiding it through abstinence, well that’s a nice thought, but not very realistic.

    • http://Abnormalfacies.wordpress.com Jim

      You seem to stand somewhere between myself and skeptikus, admitting that abstinence is not realistic. But again, I would encourage you as I did above to think about those who you’ve mentioned – women who can’t (or just don’t) go for screenings.

      It’s true that, just as in the development of colon cancer, cervical cancer develops over a period of years and regular Pap smears have greatly lowered the incidence of this malignancy. Vaccination against HPV, while it doesn’t eliminated the need for Pap smears, can go a long way in prevention, especially in those without access to care or who become negligent of their health.

      What do we do when they show up with full-blown cervical cancer some day, when a shot could have potentially prevented that from occurring?

  • Julie

    It would be great if more media attention would be placed on HPV being a leading cause of head and neck cancers for men. Many of these cancers could be prevented with this vaccination. I believe more parents would vaccinate their boys against HPV if they understood all of the risks associated with the virus (not just cervical cancer or genital warts) along with the alarming high percentage of men in the US who test positive for HPV in studies. The “selling point” of the vaccine for the parents of boys should be all of the different types of cancers HPV can cause in men and the prevalence of the virus in the population. That alone is enough for me to want to get my son vaccinated.

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