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What is your stand on HPV vaccine for men?
Dec 30, 2009

Dear Dr. McGowan,

I'm HIV undetectable, HPV neg, 43 y/o man. I understand having anal sex (sometimes unprotected), especially as the receptive partner, puts me in high risk for HPV. Though there are no guidelines for males in my age group - would getting the Gardasil vaccine (off-label) be a wise thing to do?

Thank you very much!

Response from Dr. McGowan

Thanks very much for your question.

HPV (Human Papilloma virus) is a huge problem for both men and women, and especially men who have sex with men. HPV has many types (strains, some of which can cause warts and some can cause cancers. HPV has been associated with cervical and anal cancer in women, and anal and penile cancers in men. Screening should be done for HPV for men and women (cervical and anal Paps for women and anal Paps for men). The PAP smear alone will not indicate if you have HPV infection or not, a separate genetic probe (tests for prescence of the viral DNA) should be done. In my practice most men test positive for carrying HPV. If a person is negative for HPV by testing they may be a candidate for HPV vaccine. Currently the vaccine (Gardasil) is recommended for women aged 9 to 26 years to prevent warts and cancer and for men of the same age to prevent warts. The vaccine can protect against 4 strains of the virus (2 most likely to cause cancer and 2 linked to warts). This is not a live virus vaccine, but it has not been tested extensively in people with HIV, so its effectiveness for people with HIV is not known. I would recommend it for someone who is negative for HPV, but this should not replace the need to use condoms for protection or to continue to have anal PAP screenings to prevent cancer. There may be difficulty getting insurance to cover it since this use would not be in line with the current approval for people outside the age range.

Joe



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