By: Madison Davis MPH Candidate, Brown University School of Public Health Background: Human Papillomavirus The human papillomavirus (HPV) is associated with cervical, anus, penile, vagina, vulva, and oropharynx cancers and is the most common sexually transmitted infection in the United States as of 20151-3. The virus is associated with a wide range of anogenital cancers due to its wide range of genotypes1. Cervical cancer specifically is the fourth most common cancer among women making it a significant health burden1. Furthermore, the HPV virus accounts for approximately 70% of cervical cancers and is also responsible for the majority of vaginal and vulvar cancer diagnosis among women. Given that cervical cancer is a major public health issue, it is often the disease that is most commonly associated with HPV; however, the HPV virus is significantly associated with other types of cancers found in both men and women. The HPV virus is attributed to 95% of anal cancer cases among men and women which have an incidence rate that has increased by more than 50% in the United States4, Scotland5, Denmark6, and Australia7-9. Furthermore, men who have sex with men have higher rates of HPV infection and HPV-associated anal cancer10. Additionally, the incidence rate of HPV-associated penile cancer has also increased in developing countries where it makes up 10% of cancer diagnosis11. HPV Vaccine for Women The FDA has approved three different HPV vaccines: quadrivalent vaccine for males and females, a bivalent vaccine for females, and a 9-valent vaccine for males and females12. A study of over 17,000 women between the ages of 15 and 26 showed 100% efficacy in preventing HPV-associated cervical intraepithelial neoplasia 2 and 3, and cervical adenocarcinoma13. HPV Vaccine for Men Despite targeted marketing toward female patients, the rate of HPV infection is nearly the same among men and women14. Furthermore, the prophylactic HPV vaccine shows significant protection from anogenital infection and external genital lesions associated with HPV among men between 16 and 26 years of age2. Specifically, the vaccine showed 60.2% efficacy against HPV infection in a 2011 study of 4065 heterosexual men and men who have sex with men2. An additional study in 2019 showed an 83.3% efficacy rate after six months15. To further support this, a 10-year longitudinal study also found an 85.6% efficacy rate at preventing HPV infection among men16. Although the efficacy rate of the vaccine is higher in women, the confidence intervals overlap which suggests that the vaccine is effective for both populations2. Implementation Into Practice The development of screening programs has been a pivotal change in the approach to treating cancer. Like many other cancers, the stage at which cervical cancer is detected is one of the best prognostic factors for survival1. Although screening measures have been important in diagnosing cancer early, and thus reducing the mortality rate, there has been little change in the incidence rate of cancer in areas that have strong screening programs thus highlighting the need for increased vaccination1. The HPV vaccine has been shown to be effective in both men and women at preventing devastating cancers with little to no reported side effects thus it should be marketed to both populations. The previous argument for only vaccinating women was that if herd immunity was reach among the female population, then it would limit transmission to the male population; however, this excludes men who have sex with men, a vulnerable population to HPV infection17. Therefore, vaccination of both men and women is the best way to reach all vulnerable populations and limit the spread of HPV. In your own practice, consider speaking with both your male and female patients about the HPV vaccine to determine if partaking in the immunization series would be best for them. References Wakeham K, Kavanagh K. The burden of HPV-associated anogenital cancers. Current oncology reports. 2014;16(9):1-11. Giuliano AR, Palefsky JM, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. New England Journal of Medicine. 2011;364(5):401-411. Hariri S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. Journal of Infectious Diseases. 2011;204(4):566-573. Johnson LG, Madeleine MM, Newcomer LM, Schwartz SM, Daling JR. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer. 2004;101(2):281-288. Brewster D, Bhatti L. Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975–2002. British journal of cancer. 2006;95(1):87-90. Frisch M, Melbye M, Møller H. Trends in incidence of anal cancer in Denmark. British Medical Journal. 1993;306(6875):419-422. Daling JR, Madeleine MM, Johnson LG, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer. 2004;101(2):270-280. Jin F, Stein AN, Conway EL, et al. Trends in anal cancer in Australia, 1982–2005. Vaccine. 2011;29(12):2322-2327. Baricevic I, He X, Chakrabarty B, et al. High-sensitivity human papilloma virus genotyping reveals near universal positivity in anal squamous cell carcinoma: different implications for vaccine prevention and prognosis. European journal of cancer. 2015;51(6):776-785. Palefsky J. Human papillomavirus and anal neoplasia. Current HIV/AIDS Reports. 2008;5(2):78-85. Ornellas AA. Management of penile cancer. In. Vol 972008:199-200. Food U, Administration D. Vaccines, blood, and biologics: human papillomavirus vaccine. In:2015. Group FIS. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. The Journal of infectious diseases. 2007;196(10):1438-1446. Yoshida T, Ogawa T, Nakanome A, et al. Investigation of the diversity of human papillomavirus 16 variants and L1 antigenic regions relevant for the prevention of human papillomavirus-related oropharyngeal cancer in Japan. Auris Nasus Larynx. 2022. Mikamo H, Yamagishi Y, Murata S, et al. Efficacy, safety, and immunogenicity of a quadrivalent HPV vaccine in Japanese men: a randomized, Phase 3, placebo-controlled study. Vaccine. 2019;37(12):1651-1658. Goldstone S, Giuliano A, Palefsky J, Luxembourg A, team V-s. Long-term effectiveness and immunogenicity of quadrivalent HPV vaccine in young men: 10-year end-of study analysis. In: American Society of Clinical Oncology; 2018. Spînu AD, Anghel RF, Marcu DR, Iorga DL, Cherciu A, Mischianu DLD. HPV vaccine for men: Where to? Experimental and Therapeutic Medicine. 2021;22(5):1-6.