STD Awareness: Gardasil and Males

menIt’s Men’s Health Month, and yesterday was the last day of Men’s Health Week, which means we’re going to look at a men’s health issue that is usually ignored: the impact of human papillomavirus (HPV) on the male population.

You’ve probably heard of HPV in discussions about cervical cancer and Pap testing. But HPV doesn’t care about gender, and is perfectly content to invade cells in anyone’s genital tract, mouth, throat, or anus. In males, HPV can cause genital warts as well as anal, oropharyngeal (mouth and throat), and penile cancers.

HPV will cause more oral cancer than cervical cancer by 2020.

The good news is that most HPV infections can be prevented by a vaccine called Gardasil, and you don’t need to be female to get it. However, few males are actually getting the HPV vaccine: In 2012, 20.8 percent of U.S. males 13 to 17 years of age had received at least one dose of the HPV vaccine, but only 6.8 percent completed the three-dose series.

Gardasil Is for Everybody: Good News from Australia

This huge disparity in promoting Gardasil to female patients rather than male patients has real-world consequences. In Australia, girls have been vaccinated with Gardasil since 2007, covered by their national health system. Four years into the program, genital wart rates fell by 93 percent in females less than 21 years of age. Even though males weren’t being routinely immunized, genital wart rates fell by 82 percent among heterosexual males in the same age group. That’s because their female partners had received the vaccine, which had the effect of protecting much of the male population. That might sound pretty nifty, but the female-only vaccination policy left out gay and bisexual males, whose genital wart rates saw no corresponding decline.

If vaccination rates among Australian males were equal to those of their female counterparts, it is predicted that genital warts could be virtually wiped off of their continent. We could do that in the United States, too, if our vaccination rates were high enough. Plus, vaccinating everyone against HPV — not just girls — would protect gay and bisexual men as well as transgender women. Members of these populations are already often marginalized by the health care system, so including them in vaccination efforts would bring us one step closer to addressing the injustices they face.

HPV doesn’t just cause genital warts — other strains of the virus can lead to cancer. For example, males who give oral sex to females are at increased risk for oropharyngeal cancer, while men who receive anal sex from male partners are at increased risk for anal cancer.

Gardasil and Heterosexual Men

Between 75 and 80 percent of heterosexual males between the ages of 15 and 44 report giving oral sex to a female partner — and oral sex transmits HPV, which can cause cancer in the mouth and throat. Dental dams, which could provide protection against HPV during oral sex, are, anecdotally, not thought to be popular, raising the possibility of employing Gardasil in the fight against oropharyngeal cancer.

Cases of HPV-positive oropharyngeal cancer are estimated to surpass cases of cervical cancer by 2020, and oral HPV infections and cancers are most common in males. Oropharyngeal cancer strikes men at three times the rate that it strikes women, and disproportionately affects heterosexual men. It is speculated that the vulva’s thin mucous membranes are more permeable to viruses than the penis’ thicker skin, making performing oral sex on a female riskier than performing it on a male.

The efficacy of HPV vaccines against oropharyngeal cancer is not well studied, but one small trial conducted on female subjects found that vaccination reduced risk of the presence of HPV DNA in the mouth. Future studies are expected to show that Gardasil protects recipients from oropharyngeal cancer, just as it has been shown to protect against genital warts, cervical cancer, and anal cancer.

Gardasil and Men Who Have Sex With Men

The United States has seen more than a 35 percent increase in anal cancer over the past two decades. Anal cancer is primarily caused by HPV, which can be spread by anal sex. One estimate states that two-thirds of gay and bisexual men have anal sex, but they aren’t protected when only females receive Gardasil.

Among this population, anal-cancer rates are about as high as cervical-cancer rates were back in the days before the Pap test, which dramatically reduced cervical cancer rates by screening for treatable “precancer.” Gay and bisexual men also have high rates of anal “precancer”: between 18 percent and 23 percent. A study of HIV-negative men found that 59 to 66 percent of gay and bisexual men harbored one of the four strains of HPV targeted by Gardasil. We can bring these numbers down by including boys in vaccination efforts.

Arm Yourself Against Genital Warts and Cancer!

Gardasil doesn’t protect against every strain of HPV — just the most common ones. And, if you were vaccinated after becoming sexually active, it’s possible you’ve already been exposed to at least one strain. Luckily, your immune system puts up a pretty good fight against these viruses, and usually gets rid of them within a year or two.

You can give your immune system an extra boost by quitting smoking: Everyone knows that smoking causes lung cancer, but did you know that cigarettes can aggravate an existing HPV infection, possibly hastening cancer progression? Males are more likely to smoke than females: A recent study showed that 21.6 percent of U.S. men are smokers, and gay men are reported to be more than twice as likely to smoke as their heterosexual counterparts. Another study found that 33 percent of the LGBTQ population smokes. We can improve both men’s health and LGBTQ health by helping members of these populations kick tobacco for good.

Regardless of your sexual orientation, Planned Parenthood Arizona is here for you, whether you need nonjudgmental sexual health services, including immunization with Gardasil, or would like to try out our smoking cessation program to help you ditch cigarettes!

Click here to check out other installments of our monthly STD Awareness series!