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follow up question on "What is your stand on HPV vaccine for men?
Jan 28, 2010

Dear Dr.,

Thank you for your reply and your explanation. I was only given a PAP smear test and was told I was HPV-. According to what you say, if the PAP alone is not sufficient, it can only be misleading (me thinking I'm neg while in fact I could be poz?!?). Why do they even give the Pap if it's not indicative to whether a person is HPV poz or neg?

Regarding the other test you mentioned - the genetic probe - is that a difficult/expensive test to get or just a simple blood test as part of the routine lab? I guess I need to ask for that test if I want to get the vaccine, to make sure I'm HPV neg.

And my last question - you mentioned different strains of HPV. By saying someone's HPV neg do you mean he doesn't have any strains of the HPV or just none of the "Big-4" that the vaccine works against? If the genetic probe test show I do have some strains of HPV (like most MSM do) which are OTHER than the "Big-4" strains - would it still be beneficial to get the vaccine? And what if it is one of the "Big-4"? Would the vaccine be recommended against the other 3? I reckon there are no studies/books to answer my questions, so I guess I'm asking for your personal opinion...

Thank again!!!

Response from Dr. McGowan

Thanks for your follow-up.

The Pap test is important because it shows what effects HPV have on the mucous membranes. Just having HPV does not mean that it is causing disease or cancer. It depends on the strain you have, how long it has been there and the body's reaction to it. The PAP test will show what, if any, treatment would be needed.

The genetic screening for HPV is not a blood test, it requires a brush of the cervix or anal cells. It costs more (about $90) than the PAP ($10-$20). It is very sensitive (picks up HPV in about 95% of people who have pre-cancerous lesions). The PAP test is still needed, but since it can miss some of the pre-cancerous lesions, if a person was known to be infected with HPV by the genetic test, you would follow-up more closely and repeat the PAP regularly. Most insurance will pay for the genetic test.

Yes, even if you test positive you should still consider the vaccine because it is unlikley that any one person is infected with all of the "Big-4" (as you say) strains.

Joe



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