In October 2009, the FDA voted to recommend the expansion of the use of Gardasil, the HPV vaccine already approved for use for girls between the ages of 9-26, to boys of the same age.
This approval has sparked controversy on whether it is necessary to vaccinate boys since the strains of HPV that Gardasil protects them from specifically – types 6 and 11 – have an extremely low rate of causing anal and penile cancer. In 2008, the American Cancer Association estimated that about 1,250 men were diagnosed with penile cancer and about 2,020 men were diagnosed with anal cancer.
Each year, about 12,000 women are diagnosed with cervical cancer, 70% of which are caused by HPV, and another 7,400 are diagnosed with other HPV-associated genital cancers. Recent studies have also shown a possible link between certain oral cancers in both men and women due to HPV.
Also, according to the CDC, over 20 million people are infected with HPV at any given time and another 6 million will be infected annually. It has been estimated that more than 50% of sexually active men and women will have HPV at some point in their life.
In addition to the risk of certain types of cancer, HPV can be damaging psychologically, especially if there are visible symptoms of the disease. HPV can appear as a single wart or as a cluster resembling cauliflower on or around the genital areas of both men and women. The physical warts can be treated through medication or medically removed, which can require multiple trips to a doctor, but there is no known cure for the virus itself.
Generally, 90% of HPV cases clear up on their own within two years of contraction of the disease, but HPV can still be transmitted to a non-infected partner even if there are no visible symptoms of the disease.
Some opponents of vaccinating for HPV believe that promoting a vaccine for a sexually transmitted disease may encourage promiscuity or premarital sex in adolescents. Others report that pediatricians are uncomfortable discussing sexual activity with patients as young as 11 or 12, the recommended age to begin routine vaccinations.
Still other opponents believe that the economic cost of vaccinating boys for HPV overrides any potential health benefits. Researchers at Boston’s Harvard School of Public Health conducted a cost-effective analysis that compares the vaccination program of U.S. pre-adolescent females only with the inclusion of pre-adolescent males. They found that the cost of including pre-adolescent males in a HPV vaccination program would far exceed any economic benefit if the already existing vaccine coverage is adequate and thorough for pre-adolescent females.
However, many experts support expanding vaccinations for HPV to include boys. Clinical trials on boys in the U.S. have shown that Gardasil was 90% effective in preventing the genital lesions associated with HPV and 99% effective in preventing strains 6 and 11. Experts also believe that vaccinating boys before they become sexually active would help prevent the spread of HPV, potentially resulting in a decline in genital cancer rates in females and a decline in the health care costs associated with diagnosing and treating genital cancers.
Another argument for vaccinating boys against HPV is from a recent survey conducted at Washington University School of Medicine in St. Louis. According to the six states who responded, only 34% of girls between the ages of 13 and 17 had received the first dose of the vaccine, suggesting that the vaccine is not routinely used. Lastly, many advocates of the HPV vaccine have suggested that it become part of the series of vaccines that adolescents typically receive, thus eliminating the need to discuss sexual activity with very young patients.
Ultimately, the decision to vaccinate a child – boy or girl - for HPV is between the parent or guardian and the child’s pediatrician. There are many good online resources to get the facts about HPV and the HPV vaccine. As with any vaccine, there are some risks, including pain or discomfort at the injection site, fainting and/or nausea, headaches, fever, and blood clotting. Please consult your doctor for more information.
Written by Mark Riegel, MD
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