Dear Dr. G,

I am sure you would agree that the Covid-19 pandemic has made all of us more aware about health matters, especially when it comes to protection and vaccination. Personally, I have begun reading up about the development of other vaccines and protection against other viruses and was surprised to find that the Human Papilloma Virus does not only affect women as apparently, the infection rates are in fact higher in men.

I am a nineteen-year-old man who will be starting university in the new year.

The university encourages us to take the Covid-19 vaccine before the semester begins and its health advisor also recommends that we consider other vaccines, such as the HPV vaccine.

I would like to put Dr. G on the spot for more details on the issues of HPV infection.

What exactly is HPV? How and when do we get infected with HPV?

Do men really get infected with HPV and what are the risks for men? Additionally, is such a vaccine new and safe for men?

I also read that Gender-Neutral Vaccination for HPV has been rolled out in many countries? Why are such programmes not available in Malaysia?

Thanks for clarification.

Gender-Neutral Garrett

The HPV (Human Papillomavirus) is a common virus that is transmissible through direct skin-to-skin contact.

There are more than 150 subtypes of HPV viruses, and nearly 40 are known to be transmissible by sexual contact.

Therefore, the virus is often considered the most common form of sexually transmitted infection, to the extent that nearly all sexually active men and women would get the virus at some point in their lives.

Most transmission of HPV have no identifiable symptoms, but with certain strains such as HPV6 and 11, the infection can result in the emergence of genital warts.

The transmission of HPV 16 and 18 are also linked to 70% of cervical cancers. In addition, scientists have also associated other cancers such as those of the penis, anus, and mouth with many strains of HPV infections.

One of the landmark discoveries in modern times is the link of HPV to cervical, oral, anal, and penile cancers. The German virologist Professor Harald Zur

Hausen was initially ridiculed by the medical world but won the 2008 Nobel Prize for his work in the last thirty years.

Of course, his work had also paved the way for the development of vaccines against HPV, with the hope of the eradication of the deadly cervical cancer.

The vaccine against HPV was approved in 2006 and has resulted in manyvaccination programs across the world.

The efficacy of the vaccines in preventing two strains of HPV that cause most cervical cancers were never in dispute.

However, critics argue that these two strains only account for 70% of the cancers, with the remainder being linked to other strains and as such vaccination programs may not deliver enough public health benefits to justify the cost.

In fact, in response to such concerns, the use of 9-valent HPV strain vaccines is already approved, targeting five additional strains of HPV. This adds 14% more protection for girls and 5% more for boys against several types of cancers.

For the last decade, The World Health Organization (WHO) has put the vaccine on the list of essential medicines and recommends routine vaccinations for girls in countries that can afford them.

In Malaysia, the Ministry of Health has provided the vaccines for 13-year-old schoolgirls attending government schools.

Even though parents have the option to opt out of the vaccination program, the take up rate in Malaysia is reported to be impressive at nearly 95%.

That said, although the vaccines have been shown to provide protection for boys from genital warts, certain cancers, and the potential to generate herd immunity for the future, the vaccination programs for boys is routine in only a handful of countries. In most countries, parents must decide to vaccinate their sons.

Recent publications have highlighted other alarming facts about the HPV infections in men.

Contrary to common belief, the prevalence of HPV infections is higher in men.

Studies have also revealed that the incidence of infection declines with advancing age in women, but a similar trend is not observed in men.

In keeping with such an observation, the generation of natural antibodies against HPV infection is noted to be deficient in men. The exact science behind the inability of men to raise enough natural protection against HPV is unknown, however it provides more argument for Gender-Neutral Vaccination.

One of the countries that has adopted a vaccination programs for both boys and girls is Australia.

The campaign is showing promising signs of generating herd immunity against the virus in the community. With such high-coverage vaccination and cervical cancer screening, cervical cancer is on track to be eliminated as a public health problem in Australia within one generation. The Greek philosopher and Scientist, Aristotle, once said that the “ultimate value of life depends upon awareness and the power of contemplation rather than upon mere survival.”

When Dr. G is put on the spot for his view on HPV vaccination for men, his opinion is: “The power of contemplation and awareness of Gender Equality in the fight against HPV is crucial, rather than mere survival!”

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