US CDC recommends HPV vaccine for young men

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Young men and adolescent boys between the ages of 11 and 21 should be vaccinated against human papillomavirus, the cause of genital warts, anal and cervical cancer, the Advisory Committee on Immunization Practices has recommended, in a new Adult Immunization Schedule published in Annals of Internal Medicine.

The committee also recommends that all gay and bisexual men and HIV-positive men aged 26 and under should be vaccinated.

US guidelines already recommend that young women and girls aged 11 to 26 should receive the vaccination.

Glossary

human papilloma virus (HPV)

Some strains of this virus cause warts, including genital and anal warts. Other strains are responsible for cervical cancer, anal cancer and some cancers of the penis, vagina, vulva, urethra, tongue and tonsils.

cervix

The cervix is the neck of the womb, a tight ‘collar’ of tissue that closes off the womb except during childbirth. Cancerous changes are most likely in the transformation zone where the vaginal epithelium (lining) and the lining of the womb meet.

In the United Kingdom, HPV vaccination is offered to girls aged 12 and 13 through a National Health Service vaccination programme, although girls in the 14-to-17 age group can also be vaccinated.

At present, the only HPV vaccine licensed for use in males is Gardasil, manufactured by Merck, which protects against four cancer-causing types of HPV (types 6, 11, 16 and 18). Gardasil is licensed for use in boys aged 9 to 15 years in the United Kingdom.

Vaccination has been shown to reduce the subsequent risk of genital warts, pre-cancerous cervical changes and cervical cancer in women. In young men, the vaccine has been shown to reduce the risk of HPV infection.

In an accompanying editorial, Dr Sandra Fryhofer of Emory University, Atlanta, notes that although clinical data are not available, the rationale that vaccination also protects against oropharyngeal cancers caused by HPV is “certainly plausible”.

A recent review of the impact of HPV vaccination in Melbourne, Australia, found that the risk of young men and women under 21 being diagnosed with genital warts fell by approximately 60% between 2007/8 and 2010/11 among patients attending the Melbourne Sexual Health Centre. This followed the implementation of a vaccination programme in girls and women aged 26 and under from 2007 onwards.

The number of sexual partners did not affect the reduction in risk.

In contrast, new diagnoses of genital warts did not fall significantly in heterosexual women and men aged 30 and over, nor in men who have sex with men, indicating that these groups are not benefiting from the effect of the current vaccination policy.

References

Advisory Committee on Immunization Practices Recommended Adult Immunization Schedule: United States, 2012 Ann Intern Med 156 (3): 211-17, 2012. (Full text article available here.)

Fryhofer SA Adult immunization 2012: Politics, process and progress Ann Intern Med 156 (3): 243-5, 2012. (Full text article available here.)

Read TRH et al. The near disappearance of genital warts in young women 4 years after commencing a national human papillomavirus (HPV) vaccination programme Sex Transm Infect 87: 544-47, 2011