Dear Dr. G,

I am rather curious after reading something about HPV infections in men; I think most people would agree HPV is a condition affects women and as such I am perplexed as to why the HPV vaccination would be applicable to men?

I am a 32-year-old man who is heterosexual, my wife and I have been married for two years and we are lucky as we are blessed with a gorgeous son.

When I read about how boys are more vulnerable to HPV infection, I began to think of getting protection for myself and my son in the future.

Truthfully, I am somewhat confused as to how a disease that predominantly affects women can also affect men?

In the spirit of Movember November, I am hoping to put Dr. G on the spot about male HPV infections and vaccinations.

Can HPV infections affect men? If so, does it result in serious diseases like in women? Is HPV infection more likely to happen to men who have sex with other men?

I also read somewhere men are more vulnerable to get HPV than women, how so?

Additionally, I also understand that countries like Australia ensure that both boys and girls are vaccinated against HPV to eliminate cervical cancer; how can vaccinating boys help with this?

Basically, can you explain why are men more vulnerable to HPV?

Protective Dad

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

For most cases of HPV transmission, the infected individuals can eliminate the virus through natural host immunity. However, certain strains of HPV persist, and this results in debilitating genital warts and cancers. Worldwide HPV infections are known to be responsible for all cases of genital warts and around 5% of all new cancers occurring in both men and women. Globally, HPV is well recognized to be responsible for 100% of cervical cancers. In addition, HPV also causes 88% of anal cancers, 70% of vaginal cancers, 43% of vulvar cancers and is also known to be associated with oral and penile cancers.

Studies have highlighted that men are ironically more vulnerable to HPV infections than women. They also demonstrated that HPV infections affect all sexually active men, and not just a small group of men having sex with men. HPV infections are prevalent for both men and women in the initial sexually active years.

The infections seem to be naturally declining in women with age but stay persistently high in men, resulting in high rates of infections across age groups in men. Such observation is associated with men having a low rate of seroconversion following viral infections. The exact reason for such vulnerability in men is unknown, however it is believed the natural immunity for men against the HPV virus is deficient when compared to women.

Men also have other vulnerabilities when it comes to HPV infections, as they are susceptible to new and recurrent infections. The HPV transmission rate from female to male is noted to be higher, with the infection rate of 12.3 per 1000 persons/month, compared to 7.3 per 1000 persons/month from transmission from men to women. Lastly, female HPV screening is common amongst women in most countries, but there is no routine screening for HPV in men. This leads to the disease being detected in men in much later stages.

Since the associations of HPV infection with cancers have been identified in 1982, scientists have been working hard to create the vaccine that can prevent the transmission of the virus in the first place. The first HPV vaccines became available in 2006 against the crucial HPV subtypes 6, 11, 16 and 18, providing protection of up to 70% of cervical cancers and genital warts.

The subsequent development of the vaccine that prevents the transmission of 9 types of HPV was approved by the in 2014 has been shown to be successful as the additional protection against HPV 31, 33, 45, 52 and 58 have been demonstrated to prevent up to 90% of the 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. Although the vaccines have been shown to provide protection for boys from genital warts, cancers and even generating herd immunity for both gender, parents must decide to vaccinate their sons out of their own pockets in most countries.

However, a gender-neutral vaccination program is routine only in a handful of countries and Australia is currently leading the drive for such an initiative, and is likely to be the first country to eliminate cervical cancer in women while at the same time protecting boys from debilitating HPV-related diseases.

On November 19, International Men’s Day celebrates the positive value men bring to the world, their families, and their community. One of the six pillars of International Men’s Day is to improve gender relations and promote gender equality for both men and women. Generally, men are well recognized to be vulnerable to physical and mental health. This is likely to be associated with as men have more risk-taking. In relations to HPV, it is also apparent men are more vulnerable to certain diseases, as it is demonstrated men have less immune protection resulting in higher prevalence and recurrence of infections.

When nature is not so kind to men, perhaps helping hands of science can provide protection. In view of the disparity between men and women’s life expectancies, it is obvious there are intrinsic and extrinsic reasons why “Mankind is not too kind to men”, especially when it comes to HPV infections.

Dr. G is often put on the spot for his view regarding Gender Neutral Vaccination of HPV. In the spirit of International Men’s Day, his opinion is: “If the virus does not discriminate infecting both genders, why should we when it comes to HPV vaccination?”

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