This post was written by one of our contributors; medical student – Roshni Patel
I’m sure you’ll be familiar with HPV vaccines being given to girls, but what about boys? A quick internet search will quite easily show the push for boys to now be vaccinated too, and as of August 2018, the government has announced that this vaccine will be provided to both girls and boys.
But Why? What is HPV?
Human papillomaviruses, HPV, are a group of over 200 related viruses that primarily affect the skin and moist linings of your body, for example, the cervix, vagina, vulva, anus, mouth and throat (1). HPV is extremely common, with approximately 70-80% of men and women developing infection at some point during their life (2). However, most infected individuals fight off the virus without ever developing any signs or symptoms. Of the 200 HPV strains, approximately 40 are thought to affect the genital area of the human body (3). They spread via intimate skin-to-skin contact and although it is a common sexually transmitted infection, intercourse is not necessary for the infection to be acquired (4). This suggests how easy it is to get infected by HPV.
Human papillomaviruses are categorised into two types: low-risk and high-risk. Low risk HPV typically cause genital warts and high-risk HPV (most commonly 16 and 18) are cancer causing. Individuals who have repeated exposure to high-risk HPV are more likely to develop HPV-associated cancers such as: cervical cancer, anal cancer, and head and neck cancers (5).
Is vaccinating girls not enough?
As of 2008, the UK introduced a vaccination scheme, aiming to ensure that all girls between the ages of 12-13 years are vaccinated against HPV to help prevent cervical cancer. Cervical cancer commonly affects women under the age of 35 years (6). The vaccine against HPV used in the UK is called Gardasil, protecting against four strains of HPV: types 6, 11, 16 and 18 (7).
Since the introduction of the vaccine, studies have shown that it effectively reduces that chances of getting cervical cancer by 79% (8). The vaccine has proved to prevent and protect us against cervical cancer, but there are many other HPV-associated cancers that not only affect girls, but boys too! Scientific research has allowed medicine to expand so vastly that we are now being able to recognise so many different kinds of cancers and fight them earlier on with all the knowledge we have. Then why not use this opportunity to fight cancer by getting all girls and boys vaccinated against HPV to prevent the other cancers that we know this virus causes.
HPV vaccine for boys
The benefits of HPV vaccine are clear, with reduced rates of cervical cancer in vaccinated women. Previously, arguments were made that vaccinating girls indirectly helps to protect boys from HPV-associated cancers through “herd immunity”. This is where a significant proportion of the population is vaccinated and, not only does this provide immunity to them, but also may provide a measure of protection for those who have not been vaccinated (9). However, this is a benefit not applicable to men who have sex with men (MSM) (10).
There is a high burden of HPV-associated conditions amongst MSM, for example, MSM are approximately 20 times more likely than heterosexual men to develop anal cancer (11). Countries such as Australia and USA have been providing vaccination against HPV to boys as well as girls since 2010, helping to reduce the burden of HPV-positive cancers that affecting both men and women. As of August 2018, the UK now also offers HPV vaccinations to all boys aged 9-15 years.
There has been ongoing debate regarding the topic of HPV vaccination for boys, but the consensus now lies in favour of offering this vaccine to boys as part of a gender-neutral national vaccination programme. Some organisations have argued that vaccinating boys against HPV infections is not cost-effective as a large proportion of men are indirectly protected against the infection through successful uptake of the vaccination programme by girls. However, this argument has been counteracted by the benefits of the new vaccination programme, providing adequate protection against HPV infections to all. Hopefully, this initiative will generate a good response to the vaccination programme being offered, further helping to ensure good protection against HPV-associated cancers.
(1) NHS (2018). What is HPV?. [online] nhs.uk. Available at: https://www.nhs.uk/common-health-questions/sexual-health/what-is-hpv/ [Accessed 15 Dec. 2018]
(2) Baseman J, Koutsky L. The epidemiology of human papillomavirus infections. Journal of Clinical Virology. 2005;32:16-24.
(3) Money D, Provencher D. Epidemiology and Natural History of HPV Infection. Journal of Obstetrics and Gynaecology Canada. 2007;29(8):S7-S10.
(4) Braaten K, Laufer M. Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Reviews in Obstetrics and Gynaecology. 2008;1(1):2-10.
(5) Cutts F, Franceschi S, Goldie S, Castellsague X, de Sanjose S, Garnett G et al. Human papillomavirus and HPV vaccines: a review. Bulletin of the World Health Organization. 2007;85(09):719-726.
(6) Oxford vaccine group. HPV Vaccine (Human Papillomavirus Vaccine) | Vaccine Knowledge [Internet]. Vk.ovg.ox.ac.uk. 2018 [cited 16 December 2018]. Available from: http://vk.ovg.ox.ac.uk/hpv-vaccine
(7) Abdelmutti N, Hoffman-Goetz L. Risk Messages About HPV, Cervical Cancer, and the HPV Vaccine Gardasil: A Content Analysis of Canadian and U.S. National Newspaper Articles. Women & Health. 2009;49(5):422-440.
(8) Arbyn M, Xu L, Simoens C, Martin-Hirsch P. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews. 2018;(5).
(9) British society for immunology. Herd Immunity and Types of Immunity | British Society for Immunology. Immunology.org. 2017. [accessed 31 Jan 2019] Available from: https://www.immunology.org/public-information/immunology-related-activities-and-resources/herd-immunity-and-types-immunity
(10) BMA. Case for HPV vaccination for boys. BMA; 2018.
(11) Daling J, Madeleine M, Johnson L, Schwartz S, Shera K, Wurscher M et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer. 2004;101(2):270-280.