Correspondence

Human Papillomavirus Vaccine in Males

N Engl J Med 2008; 359:863-864August 21, 2008

Article

To the Editor:

In 2006, the Food and Drug Administration (FDA) licensed the human papillomavirus (HPV) vaccine for use in females 9 to 26 years old. The vaccine helps prevent cervical cancer, precancerous genital lesions, and genital warts. Trials of the vaccine in males are currently under way. If these trials demonstrate protection against HPV for males and if the FDA licenses the vaccine, should we promote its use in males?

HPV infection is the most common sexually transmitted illness in young people — those who are 15 to 24 years old. It is estimated that in 2000 there were 4.6 million new cases of HPV in this age group.1 Many studies strongly link HPV to cervical cancer. Despite Papanicolaou testing and cytologic surveillance programs, there are around 11,000 new cases of cervical cancer annually in the United States, with about 4000 deaths each year.

I have encountered some difficulty convincing my female patients that they should accept the vaccine. Older female adolescents and young adults are worried about short- and long-term side effects. Parents voice objections, saying that their daughters are not sexually active and are not at risk. They also have concerns about efficacy.

It will be a much more formidable task to convince males and their parents that males should have the vaccine. In discussions with some of my male patients, they question their need for cervical cancer vaccination. Among male patients, there is very little understanding that they have an extraordinarily important role in the transmission of HPV and the long-term clinical sequelae. If health insurers do not pay for HPV vaccination in males, then it will be an almost insurmountable task to convince male patients, and their parents, that they should undergo vaccination.

Males who are vaccinated against HPV will protect themselves as well as their partners. As is consistent with herd immunity, immunization of large groups of people means that those who have not been immunized against HPV will have greater protection from acquiring the disease.

Many younger male adolescents do not have the future-thinking capabilities to understand the implications of HPV or vaccination against HPV. Adolescents probably are not going to admit that they are having sex or are even contemplating it. Parents need to accept the responsibility to ensure that their sons are vaccinated, and males should accept responsibility also.

The argument for vaccination of males should be focused not only on the diseases it can prevent but also on the implications for their sexual partners. In addition to males and their parents, physicians should acknowledge that responsibility and support vaccination of males. And health insurers have a responsibility to provide reimbursement for HPV vaccination in males.

Mark A. Goldstein, M.D.
MassGeneral Hospital for Children, Boston, MA 02114
mgoldstein@partners.org

1 References

1. 1

   Weinstock H, Berman S, Cates W Jr. Sexually transmitted disease among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004;36:6-10
   CrossRef | Web of Science | Medline