Blog | Tuesday, November 8, 2011

HPV vaccination for boys; just do it


When Gardasil was released several years ago, I was excited but puzzled. The vaccination effectively prevents cervical cancer in women (if given to them before they become sexually active). And while human papillomavirus (HPV) can be transmitted from women to women as well as from men to women, most cases are heterosexually transmitted. Why leave out the usual vector for the disease--men?

Additionally, men suffer HPV related cancers: those of the penis and the anus and head and neck, cancers that are not restricted to men of any particular sexual identity. In my clinical experience, men who have genital warts on their penis often have them around their anus as well (genital warts are caused by strains of HPV that don't generally cause cancer, but this gives an idea how the virus behaves). Both men and women can develop cancers of the head and neck from HPV infection.

Addressing these problems, the CDC's Advisory Committee on Vaccination Practices has just voted to recommend routine HPV vaccination for boys. This is a huge step in preventing a significant public health problem.

Several decades ago, it was believed that viruses would be found to cause most cancers, a hypothesis that has not been confirmed, but certain cancers are viral in origin. Among these are cervical, anal, penile, and some head and neck cancers. All of these happen to occur in areas that are not readily visible, and that are often asymptomatic until they are advanced. And now we have a tool to prevent this. The only hook really is cost, but Americans are generally willing, as a society, to pay for medical care no matter the cost, and in this case, the cost is likely worth it (according to various analyses, but ultimately it's a value judgment).

This is a terrific advance in public health, and is completely amoral. It is indefensible to claim that giving pre-adolescent children immunity from sexually transmitted infections in anything but a good thing. There is no logic to objections based on morals. None. This is an unmitigated good.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.