By Alex Hale
A sex induced epidemic could be sweeping across the western world. 80% of people get some form of a human papillomavirus (HPV) infection at a point in their lives. This is one of the most common sexually transmitted diseases and is the cause of many preventable types of cancer, but why are only women vaccinated against it? The HPV vaccine is in widespread use to help prevent cervical cancer and several other types of cancer in women. However, it’s now widely accepted that this fantastic vaccine could also benefit males by reducing cancers in areas like the mouth, anus and penis. Should men be vaccinated for the savour of their manhood’s?
The human papillomavirus has over 120 different types, which are generally fairly mundane in nature. It is mostly transmitted by sexual activity of all varieties and although it currently isn’t curable, it clears itself up within a year in 90% of cases. When the more malicious types are present however, diseases like genital warts and skin warts develop, usually these are treatable by doctors. In some uncommon cases, the infection progresses and causes some cells to turn cancerous.
Those cancerous cells originate in the sensitive parts of the body that the virus is most prone to infecting like skin cells and mucosal membranes. The mouth and vagina are perfect example of mucosal membranes, they cover areas of the body that are involved in secretion and absorption and have outside exposure. This makes a perfect environment for the virus to live and then get passed on. Sex makes that process so much easier as most of the mucosal membranes susceptible to HPV infection happen to be pleasure related as well.
The vaccine for the most malevolent forms of HPV was introduced in 2008 to help prevent the second most common cancer in women, cervical cancer. As many as three quarters of all cervical cancer cases are caused by two specific types of HPV, types 16 and 18. The new vaccine defended against those two types as well as types 6 and 11, which are the cause of 95% of genital warts. On top of massively reducing the chance of getting this horrible disease, the vaccine also reduced the chance of getting several other types of cancer including vaginal, vulval, anal, oral and penile cancer in men.
With the mention of anal, penile and oral cancer, there is obviously some vested interest for males here as well. Oral cancer is a major problem for men around the world. There are four times as many male oral cancer sufferers than there are women sufferers, with almost a third of those being caused by HPV. A big push towards vaccination could help a massive group of people by protecting them from this disease.
Who needs protection?
The idea that is being discussed in government now is that all boys should be vaccinated at around ages 11 to 12, before sexual activity starts. The campaign to vaccinate girls at the same age has gone really well in the UK with the government claiming 80% coverage of girls last year. This full coverage in girls raises the question of whether vaccinating the boys is really worth it and affordable. So called ‘herd immunity’ is an effective way of controlling rising infection levels, the greater the proportion of people who are resistant, the smaller the probability that a susceptible person will come into contact with an infectious person. Six years into the programme and a substantial amount of the teenage girl population is now immune to the virus and wouldn’t be able to be infected or be infectious to anyone else.
Nevertheless, the vaccination of men and boys should not be ruled out. There are still a substantial number of adult men and women unprotected that could easily be exposed to the virus; the vaccine should be available to all if they want it. The other group that would be unaffected by a virus free female population are homosexual males who are 20 times more likely to be diagnosed with anal cancer, which affects about 2 in 100,000 people, than a heterosexual male. It wouldn’t be possible to know which boys will become homosexuals at 11-12 so how can they be protected? Statistics like that would never be enough to convince a government to vaccinate all boys though.
Dr Krupar Patel, a GP and sexual health specialist from Dorset would like to see the vaccine available widely and freely. “It’s so frustrating every time I see young people come into my surgery with entirely preventable diseases” she said “I see a lot of patients about HPV related illnesses, mostly it’s people with things like genital warts but I do Pap smears [the test for cervical cancer] for ladies and I know several men with oral cancer. I’m not even allowed to give out the vaccine when I think someone could benefit from it, they have to pay privately and not everywhere offers that” she added. Krupar considers having the HPV vaccine available to everyone as a “vital step forward” in both reducing the number of sexually transmitted diseases and in reducing the number of cancers in the general population. “To be honest with you, I don’t think giving all boys the vaccination is worth it, especially not in today’s financial climate” she went on to say “but I would really love the option to give it to anyone who needs it”.
Some other options?
What else can the government do to help reduce the levels of infection then? Increasing pressure is being put onto policy makers to use sex education and public awareness campaigns to increase the public’s knowledge of this virus. It’s fairly common knowledge that HPV is the cause of most cervical cancers, the media frenzy around the vaccination of girls made sure of that. An increase in the general knowledge around HPV infection could help both reduce the chance of infection and allow more people to make an informed decision on whether they want to be vaccinated.
Dr Patel said “I would love to see a big campaign letting everyone know that they can be protected from it [HPV], it’s just a shame the politicians keep stalling over what to do”. She went on to outline some other methods that could be used in increasing general knowledge of the disease and for getting more people vaccinated. “…it could be a mandatory vaccine to get into secondary schools. England doesn’t have any mandatory vaccinations for schools at the moment but some other countries do like the US [USA], I know Greece has compulsory HPV vaccinations for school”.
Mandatory vaccination to get into secondary schools would certainly make sure parents got their children vaccinated but it does raise questions of compulsory mass medication. The government always wants to avoid any rumours of that sort of thing, it smells too much of political totalitarianism. If you use the public water fluoridation debate as an example, the media and the public rebelled heavily against any suggestion that they couldn’t be in control of what went into their bodies. Programmes like this are potentially very expensive though and the cost to the government may not be worth it compared to the cost of treating the patients in hospital or cheaper, easier programmes like ad campaigns or better education in schools.
Dr Patel’s colleague, Dr Roland Sedoo agreed with most of the Dr Patel’s
comments but had one major point to make that he thinks could make the difference if done by everyone. “I’m a big believer in the condom, it’s just so easy to use, super cheap and almost 100% effective” he said “the other doctors in my surgery think I’m a bit excessive but I hand out a ludicrous amount of them. I like to think that the more you give out the higher the chance that people will use them”. He went on to talk about how a big push to increase the use of condoms in young people could mean the world of difference. “Condoms have been around for ages now and there was a brief period a few years ago when there was a big push to get people to use them, especially in kids. But it’s sort of trailed off a bit now and I get lots of people come to see me who tell me they’ve never used a condom. Mostly it’s people in their twenties who have forgotten their sex education lessons at school and then went and had a great time at university or something”.
There are bigger problems and more serious problems in the world, no one is denying that. This however, is not something to be ignored. The Department of Health recently stated that “there are currently no plans to extend HPV vaccination to males, based on an assessment of available scientific evidence”. Does there need to be detailed scientific evidence if there are very few risks and the potential to save many lives? Dr Patel and Dr Sedoo are both optimistic however, “we think that give it a few years and we will at least be able to give out the vaccine to at risk patients, maybe the boys won’t need it. We will just have to wait and see”.
The efficacy of the vaccine in stopping the spread of the virus will take several more years for the full effect to be seen. Those girls who first had the vaccine in 2006 will be coming up to 20 years old now, so it will be a while before the vaccinated population will make an impact on cancer incidence rates. The true test of whether the girls only vaccine is enough is time.