HPV vaccination for boys; just do it

When Gardasil was released several years ago, I was excited but puzzled.  The vaccination effectively prevents cervical cancer in women (if given to them before they become sexually active).  And while HPV can be transmitted from women to women as well as from men to women, most cases are heterosexually transmitted.  Why leave out the usual vector for the disease—men?

Additionally, men suffer HPV related cancers: those of the penis and the anus and head and neck, cancers that are not restricted to men of any particular sexual identity.  In my clinical experience, men who have genital warts on their penis often have them around their anus as well (genital warts are caused by strains of HPV that don’t generally cause cancer, but this gives an idea how the virus behaves).  Both men and women can develop cancers of the head and neck from HPV infection.

Addressing these problems, the CDC’s Advisory Committee on Vaccination Practices has just voted to recommend routine HPV vaccination for boys.  This is a huge step in preventing a significant public health problem.

Several decades ago, it was believed that viruses would be found to cause most cancers, a hypothesis that has not been confirmed, but certain cancers are viral in origin.  Among these are cervical, anal, penile, and some head and neck cancers.  All of these happen to occur in areas that are not readily visible, and that are often asymptomatic until they are advanced.  And now we have a tool to prevent this.  The only hook really is cost, but Americans are generally willing, as a society, to pay for medical care no matter the cost, and in this case,  the cost is likely worth it (according to various analyses, but ultimately it’s a value judgement).

This is a terrific advance in public health, and is completely amoral.  It is indefensible to claim that giving pre-adolescent children immunity from sexually transmitted infections in anything but a good thing.  There is no logic to objections based on morals.  None.  This is an unmitigated good.

 

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3 Comments

  1. I had this very discussion with my son’s pediatrician a couple of months ago. He advocates the vaccine for boys, but it’s cost-prohibitive because insurers won’t cover it. Hopefully now that it’s a routine recommendation, it will be covered by the time my little guy reaches the target age.

    RE viral cancer causes, at a cancer lecture I attended last night, the presenter said that there may be a link between viruses and cancer in that viruses cause inflammation, and inflammation can create the groundwork for a cancer to develop. I’ve heard Mark Crislip say something similar. Does inflammation lead eventually to abnormally regulated cell growth? What is the basic mechanism for HPV causing cancer? Does the virus reprogram healthy cell growth instructions?

  2. I checked that out. Wow… lots of great links from the comments. Thanks!

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