Why we should vaccinate boys against HPV as well as girls

Gillian Prue, from the School of Nursing and Midwifery at Queen's University of Belfast, says that the human papillomavirus (HPV) infection is common in men and can lead to genital warts and the development of some head and neck, anal or penile cancers. She says incidence of this has increased in the past two decades with HPV causing 5% of all human cancers.

Since September 2008 a free vaccination has been available for 12-13 year old girls in the UK with a catch up programme for girls up to age 18. Australia, the US, Austria and parts of Canada have introduced a vaccination for both boys and girls.

Dr Prue says HPV related disease in men "is associated with considerable burden" and "vaccinating boys is likely to produce health and economic benefits": a study of 4065 males aged 16-25 found the HPV to prevent and penile and anal cancer.

She says that with low uptake in girls the "benefit of vaccinating boys is easily apparent" with a European study showing that vaccination of 12 year old boys being associated with substantial clinical benefits such as reduced incidence of HPV-related genital warts and carcinomas.

Prue says vaccinated boys would be protected against non-vaccinated girls and other men whilst also helping to protect girls. She says the current girls-only vaccination leaves men who have sex with men (MSM) at particular risk but warns that a programme targeted at MSM in the UK may limit benefit "because many MSM acquire HPV as teenagers and many have been exposed to HPV already".

Prue concludes that economic costs are also considerable but any decision "should not be based solely on cost effectiveness" and that public health, equity and the human costs of HPV-related diseases "must be the main consideration".

Authors of a linked editorial also ask "What about the boys?". Professor Stanley, Dr O'Mahony and Dr Barton say they "share the Royal College of Surgeons' disappointment" about the lack of response to concerns about the "inequity of vaccinating only girls against HPV".

They say it is easy to see why the programme was initially targeted at young girls but evidence is now "conclusive that HPV also causes oral cancers" with most cases caused by HPV. They add that an estimated "90% of cases of anal cancer in the UK are also linked to HPV infection".

They support Prue's views on MSM adding, however, that a strategy to just vaccinate these men "would be seen to discriminate against young heterosexual men".

They say the only "sensible" answer is a "gender neutral vaccination strategy in schools" and conclude that "if the price is right, we can't afford not to".

More information: BMJ 2014;349:g4834 DOI: 10.1136/bmj.g4834

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