Five years after recommending girls get vaccinated against the human papilloma virus (HPV), a federal health panel now says boys should receive the shots too.
Males ages 11 to 21 should have the vaccine, which is given in three doses over a six-month period, according to the Centers for Disease Control's advisory panel on immunization practices.
HPV is the most common sexually transmitted disease, affecting 75 percent to 80 percent of people in the U.S. at some point in their lives. In most instances, the infection resolves itself without treatment. However, certain strains, notably HPV 16 and 18, can lead to cellular changes that cause warts or cancer, including cervical, vaginal and vulvar cancer.
HPV is also implicated in throat cancer in women and men, the rates of which have been rising steadily. A recent article in the Journal of Clinical Oncology described a significant increase in throat cancer caused by HPV transmitted during oral sex. These oropharyngeal cancers typically go undetected until symptoms such as persistent sore throat, earache or swollen lymph nodes occur.
The rate of vaccination against HPV among girls has been low, with 48 percent of girls ages 13 to 17 having received at least one dose of the vaccine. Of those girls who begin the series of shots, 30 percent do not have all three. There is no data on the effectiveness of the vaccine if all three shots are not completed.
The recommendation that boys receive the vaccine might increase the immunization rate for girls as well, says Dr. Rodney Willoughby Jr., a member of the American Academy of Pediatrics committee on infectious diseases. He is also a professor of pediatrics at the Medical College of Wisconsin and on staff at Children’s Hospital of Wisconsin in Milwaukee.
“Many pediatricians think that considering HPV a routine vaccination for both boys and girls will actually improve vaccine uptake for both genders. For one, it diminishes the sex/gender angle that whips up so much consternation,” he says.
The vaccine will prevent cancer in about one of every 200 girls and one of every 400 boys, Willoughby notes. “That’s a lot of cancer to get rid of so easily.” With more than 40 million doses administered, there are no known major adverse effects other than rare cases of allergy to the vaccine, he adds.
Parents of young boys might find it difficult to think about health risks related to sexual activity. But it’s important to take a long-term view. Just as the hepatitis B vaccine is given to newborns mostly to prevent liver disease later in life, the HPV vaccine safeguards boys as they mature.
Preventing Other Health Risks
Parents also need to be aware the HPV vaccine prevents other significant health risks, says Dr. Sheila Overton.
“The risk of acquiring HPV is very high among teens who are sexually active,” says Overton, an OB-GYN and author of Before It’s Too Late: What Parents Need to Know About Teen Pregnancy and STD Prevention (Full disclosure: I had the privilege of working with Overton on her book). Overton also co-founded a Los Angeles teen pregnancy and STD prevention program.
HPV infection can lie dormant for years. Clinicians typically see young women with cervical dysplasia, abnormal changes in the cells on the surface of the cervix, rather than cervical cancer, which doesn’t show up until the women are older, Overton says. Moderate or severe cervical dysplasia can require surgery and can lead to long-term problems, including infertility, pregnancy loss and pre-term birth.
Because HPV often resolves itself in one to three years without treatment and to avoid unnecessary procedures, new medical guidelines recommend testing women at age 21. The later screening raises the risk that younger women who have not had the vaccine and who are infected with HPV might not be identified and treated early. Boys will not be screened for HPV, according to Willoughby.
Vaccinating boys protects them from HPV-related cancer and helps cut transmission of the virus to girls, Overton notes. “Boys are reservoirs of the virus. Almost 100 percent of girls get it through boys.”
The HPV vaccine does not protect against every strain of the virus, but it does fight infection by the two strains that cause up to 70 percent of cervical cancer cases, Overton says. “As time goes on and as technology improves, there may be other vaccines to protect against other strains of HPV,” she says.
The HPV vaccine is covered by the Vaccines for Children Program and most private insurers. Willoughby calls the vaccine an investment in children's health. “It’s a spectacular gift to give your child,” he says.