Straight Men and HPV
What about men? HPV’s effects aren't limited to cervical
cancer—it can also cause genital warts and anal cancer in both men and women,
and although anal cancer is rare, incidence has been increasing over the past
several decades. In the past, I've talked to straight men who were upset that
they may have unwittingly given their girlfriends a virus that causes cervical
cancer (there are no routine tests to detect HPV in men), and I've talked to
gay and bisexual men who were frustrated that they didn't have the same access
to HPV vaccines that women did.
In October 2009, Gardasil was approved for administration in
young men, but its effects were seen as largely altruistic. Yes, the vaccine
would protect men against genital warts, but in the public health field, warts
are not perceived to be as serious a problem as cervical cancer (although many
individuals who have had to deal with warts would probably say that their
effect is not negligible!). Yes, the vaccine would protect against anal
infection among men who have receptive anal sex, but most scientists would
consider this a small slice of the population, and since the vaccine is
supposed to be given around age 11, before sexual activity has begun, it's
unlikely that parents are going to be factoring this into their
decision-making. "Hey, just in case your son turns out to be queer, would
you like to give him this vaccine?" We're talking about a country where
some parents don't even want to give girls the vaccine lest it encourage them
to have pre-marital sex.
However, a new study published last month in the Journal of Infectious Diseases
demonstrates that anal HPV infection is much more common among heterosexual men
than previously thought. While gay and bisexual men are estimated to be 17
times more likely to develop HPV-related anal cancer, there haven't been any
good estimates of how many heterosexual men might be at risk.
The study found that 12% of heterosexual men in the US, Brazil
had an anal HPV infection, and 7% of those with an infection carried a strain
related to cancer. By comparison, less than 1% of men in the U.S. are
infected with Chlamydia at any given time, and Chlamydia is considered quite
common. Some of the men in the study had previously had male sex partners, but
the majority had not. Study researchers speculated that HPV could have been
transmitted anally to men via their female partner's hands or could have moved
from the men's genitals to the anus.
An October 2009 study in the British Medical Journal found that vaccinating men with Gardasil was not a cost-effective public health measure, meaning that the benefits obtained in preventing disease were not greater than the costs incurred in administering the vaccine. However, this study looked only at preventing cervical cancer and genital warts, not at anal cancer. Our knowledge of HPV changes almost daily and this latest study is more evidence of how much we do not know about sexually transmitted infections and how many assumptions we make based on a person's sexual orientation. HPV vaccination for men may be more viable than it appears.