health
H
PV, or Human papilloma virus,
is a family of over 150 viruses
called papillomaviradae
which cause infections in
humans. Different members of the
papillomaviradae family, each denoted
as a number, cause infections in
different types of skin or mucous
membrane. HPV-6 and HPV-11 cause
up to 90 per cent of genital warts.
Fact –‘Gardasil 9’ vaccine covers HPV
6, 11, 16, 18, 31, 33, 45, 52 and 58.
HPV is spread by genital-to-genital
contact, penetrative and oral sex. People
can contract HPV even if they only have
one partner. A small percentage of
people infected will become chronically
infected and a proportion of those will
get pre-cancerous changes which, given
time, may progress to cancer. HPV- 16
and HPV-18 are responsible for 71 per
cent of cervical cancer worldwide.
For this reason HPV-16 and HPV-
18 were the first viruses to be targeted
with a vaccine, approved in 2006.
Fact – the HPV vaccine was introduced
in Australia for girls in 2007.
The rate of HPV in women aged 18-
24 reduced from 22 per cent to 1 per
cent when comparing 2005 to 2015.
Vaccination is targeted at children
before they become sexually active.
It can be given from the age of nine,
but most people have it between 11
and 12 years of age. Two vaccines are
given six months apart. Older children
and adults (15 years or older) require
a third vaccination as they have a less
strong response.
So why would boys benefit?
Vaccinated women in countries like the
UK, Australia and Hong Kong have seen
personal benefits by being covered from
the highest risk HPV strains.
HPV has also been shown to cause
cancers in men. It has been shown to
cause oral, anal, penile, genital and
some head and neck cancers.
HPV-16 and HPV-18 have been
linked with Oropharyngeal squamous
cell carcinoma (OSCC). This form of
cancer has been increasing worldwide,
including in the UK, particularly
among men and younger age groups.
In Scotland the rate of OSCC has
increased more than any other cancer.
Heterosexual boys and young
men in countries with high rates of
vaccination against HPV in girls receive
an indirect benefit. Vaccinated female
sexual partners do not have active HPV
infections and so do not shed the virus
for the young men to contract.
However, vaccinating only girls will
not fully protect young men for several
reasons. Firstly, not all girls will be
vaccinated, especially in countries such
as Hong Kong where having the vaccine
is not mandatory and involves financial
outlay by parents. A Lancet article from
2016 showed that in Europe, of the girls
targeted by vaccination programmes
only 52.8 per cent had been vaccinated,
and in northern America it was only 39.3
per cent. 1
Secondly, it does not protect
men who have sex with men.
This population of men are also
disproportionally affected by sexually
transmitted infections including HIV,
chlamydia, gonorrhea and syphilis.
Thirdly, girls will receive further
protection against contracting HPV
infection if boys are vaccinated. This has
been mathematically modelled to reduce
cervical cancer rates even further.
For this reason, in 2018 public
health England introduced vaccinations
against HPV for men who have sex with
men. It is administered through sexual
health clinics for men up to the age of
45. For some of these men, vaccination
will have come too late and they will
already have been exposed to a high-
risk HPV virus, leaving them at risk of
HPV related cancers
There is another approach to
protecting young men against HPV
related cancers and genital warts;
Australia introduced vaccination for
boys in 2013 and the UK is rolling out
vaccination for boys aged 11-12 in
schools from the coming school year.
Older boys up to the age of 25 will also
be able to access the vaccination.
Fact – vaccinations have helped
eradicate 2 diseases worldwide,
smallpox and a less well known cattle
virus called rinderpest similar to measles.
Dr Harriet Stuart-Clarke works as a
GP and can be consulted at Southside
Family Health Centre
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext
https://www.who.int/immunization/policy/position_papers/hpv/en/
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/813014/PHE_HPV_
universal_programme_guidance.pdf page 8
Winter 2019
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