Combating Infection: Should males be vaccinated against HPV?
Sarah Bennett Johnston MSN, RN

June 2011 
Volume 41  Number 6
Pages 62 - 63
  PDF Version Available!

THE FDA HAS licensed the human papillomavirus quadrivalent vaccine, Gardasil (HPV4), for use in males ages 9 to 26 for the prevention of genital warts caused by human papillomavirus (HPV) genotypes 6 and 11; anal cancer caused by HPV genotypes 16 and 18; and anal intraepithelial neoplasia grades 1, 2, and 3 caused by HPV genotypes 6, 11, 16, and 18.1,2 Before October 2009, HPV4 was approved for use in females of the same age, but marketed for the prevention of cervical cancer. Seventy percent of cervical cancers are caused by HPV 16 and 18.3The Advisory Committee on Immunization Practices (ACIP) recommends HPV4 for routine use in females but doesn't recommend it for routine use in males.1 Opponents of HPV4 male vaccination argue that public health initiatives should be geared toward increasing immunization rates in young girls because females carry the greatest HPV-related disease burden. Studies have shown little benefit derived from including males in vaccination programs when female vaccination rates are high.4HPV is a sexually transmitted infection currently affecting over 20 million Americans. At least 50% of sexually active men and women will acquire it at some point in their lives.5 Ninety percent of HPV infections are cleared naturally within 2 years by the immune system. The remaining 10% of people with persistent infections are at increased risk for HPV-associated diseases, such as cancers and recurrent genital warts.6Most studies have found the prevalence of HPV in men as high as those reported in women. HPV type 16 was the most common genotype. Men who have sex with men (MSM) are at the highest risk for HPV-associated diseases.1Besides causing approximately 70% of cervical cancers, HPV 16 and 18 have been linked to vulvar, vaginal, penile, anal, and head and neck cancers. HPV 6 and 11 cause 90% of genital warts and most cases of respiratory papillomatosis.6 HPV4 specifically targets these four genotypes.7HPV4 is most effective when given before exposure

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