HPV Infects Millions of Men: Vaccinate the Boys!

From the Daily Beast
BY DANIELLE FRIEDMAN

A new study claims HPV, the STD linked to cervical cancer, may be found in half of all adult men. Danielle Friedman on why the disease is no longer just a women’s issue.

The statistic is explosive: A whopping half of adult men may be infected with HPV, the sexually transmitted disease that can lead to a host of cancers in men and women.

The finding, published online in the journal The Lancet, lit up headlines this week. But it’s just the latest in a string of studies that drive home what many doctors have known for years: Human papillomavirus isn’t just a women’s problem. As Howard Markel, a pediatrician and medical historian, said of its incidence: “It takes two to tango.”

The figure also presents perhaps the fiercest case yet that parents, doctors, and public health officials should embrace the vaccines that help prevent the disease—for girls and boys. “One of the most interesting aspects of this study is how it can reframe the debate," said Alexandra M. Stern, a medical historian and Markel’s colleague at the University of Michigan. "It could lead to broader acceptability.”

HPV is the leading cause of cervical cancer, but it’s also linked to anal, penile, and head and neck cancers, as well as genital warts. While most people show no symptoms of the disease, it can be passed along through mere skin-to-skin contact.

Before considering the future of the vaccine, it’s helpful to look back. In 2006, drug giant Merck released Gardasil, the first HPV vaccine, and the CDC recommended that 11- and 12-year-old girls be routinely immunized. (In 2009, GlaxoSmithKline released a second HPV vaccine, called Cervarix.) Merck also launched a major ad campaign, featuring young women declaring that they wanted to be “one less”—one less victim of cervical cancer—ingraining the notion that HPV is a women’s issue. And it is, to an extent: Most women will be exposed to a strand of the virus, at some point, and it poses a greater cancer risk for women than men.

And yet: It’s tough not to view this single-sex approach as part of a larger trend of women bearing a greater burden for society’s sexual health. Women shoulder greater responsibility for contraception, for example, and maternity care. All the while, society still judges women more harshly than men for their sexual behavior. “It’s like how we used to put scarlet letters on women, while men got off scot-free,” said Markel. “Maybe this approach is a vestige of this male/female hegemony.”

Meanwhile, lawmakers began proposing measures that would require girls to receive the vaccine, seizing the opportunity to curb a public-health crisis (or perhaps, nursing political ties to Merck). But conservative groups and legislators fought many of the efforts, arguing that the vaccine would encourage promiscuity.

"Getting a tetanus shot doesn't make you romp merrily through rusty fields," said Paul Offit, director of the Vaccine Education Center at The Children's Hospital of Philadelphia and author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. "You don't get the vaccine and say, 'Now I can step on a rusty nail and not worry about it.'"

Today, the HPV vaccine still hasn’t taken off—which is especially puzzling as it’s one of the only proven means of warding off cancer. While a quarter of girls receive the first of the vaccine’s required three doses, only 11 percent get the full batch, according to the CDC.

The reasons? Perhaps it’s because the HPV vaccine is still new, says Stern; the public has rejected or feared new vaccines since the dawn of vaccination. Or maybe it’s because the HPV vaccine is expensive, at over $300—though most insurance companies cover it for women through age 26, and the federal program Vaccines for Children helps out in some cases. Research also suggests that people still don’t understand the disease and its consequences. And because the vaccine is inherently connected to sex, it makes some parents uncomfortable, said Markel: “People still get really nervous about all sorts of issues involved in sexuality.”

Yet studies like the one released this week have the potential to change the way we think about the disease and the vaccine. “It takes the pressure off adolescent girls and their sexuality,” said Stern.

History offers hope: When the hepatitis B vaccine was first introduced in the 1980s, it was stigmatized, since the virus was contracted through sharing needles and having sex. “It was seen as dirty,” said Offit. But pediatricians began vaccinating infants of both sexes, and eventually, it lost its charge. Today, hepatitis B is nearly eradicated in the U.S.

Even if HPV didn’t affect men directly, a strong case is made for vaccinating boys and men to protect women. History offers a precedent here, too: The rubella infection doesn’t pose a great threat to boys, but if a pregnant woman contracts the illness during the first trimester of a pregnancy, her baby is at high risk for developing severe birth defects. So we vaccinate everybody.

"We’re all responsible for each other," said Offit. "In 2005, we declared the U.S. rubella-free, and that’s only because boys took the vaccine."

But HPV does affect men. Although most men show no symptoms of the STD, studies show that the virus leads to thousands of cases of penile and anal cancer in men every year, along with genital warts. And research published in the New England Journal of Medicine last month (and funded by Merck) revealed that Gardasil, which the FDA approved for men in 2009, lowers rates of genital warts in men.

Last month, for the first time, the American Academy of Pediatrics also included the HPV vaccine on its list of recommended vaccines for boys. And Offit expects the CDC to officially recommend it for boys and men within the year.

On a practical level, some question if vaccinating both sexes is cost-effective. At least one study suggests that when vaccination rates among females are low, improving these rates is more beneficial than vaccinating males. But some medical practitioners have a tough time buying this approach, at least in theory. “Boys benefit directly from the HPV vaccine,” Offit stressed.

At the very least, this week’s data—with its shock value and media blitz—will likely raise awareness of the disease. "Maybe we’re just too early” in the vaccine's history, said Markel of its bumpy path. Maybe a decade from now, we’ll look back on these first few years as growing pains.