HPV is a tricky little virus: Most people who catch it — and according to the CDC, almost everyone who has sex will, in fact, catch it at some point in their lives — never know they have it, because there are no symptoms. More confusing is that HPV can simply resolve itself in about 18 months to two years. That makes it sound like no big deal — everyone’s got it, and nobody knows, and, hey, it probably goes away, anyway. Except certain strains of it can cause cervical, anal and oral cancer in women — as well as penis, anal and oral cancer in men. That’s troubling, because the majority of vaccination and awareness efforts have been focused on protecting girls and women. And now, a new study, the first to publish on HPV rates in men, finds that some 45 percent of men currently have the virus, including those riskier strains. Is it too late for a 20something dude to get inoculated? Not necessarily.
In a study published this month in JAMA Oncology, researchers swabbed the penises of 1,868 men aged 18 to 59 and found that the overall infection rate for HPV — the most common sexually transmitted disease, which currently affects about 80 million people in the United States — is hovering at 45.2 percent in men. Half of those infections occurred before a person’s 24th birthday.
Some 25.1 percent of the 45.2 percent of men in the study who were infected had at least one of the high-risk strains of the infection. Those strains translate to about 9,000 cases of penis, anus or oral cancers annually in the United States, the researchers say. And it’s not that the symptom-free version is no big deal either — it’s responsible for 90 percent of cases of genital warts.
So what is to be done? Part of the trouble here is that in 2006, the CDC initially began recommending the vaccine for girls only. It wouldn’t be recommended for boys as a routine suggestion until 2011. Children of both genders are now encouraged to get the vaccine at age 11 — and up to age 26 for women, and 21 for men.
The CDC extends that recommendation age range for a few circumstances: men who have sex with men through age 26, transgender adults through age 26, and young adults with HIV or other immunocompromising conditions through age 26. That age range targets people who are less likely to have contacted any strain of the virus.
But the current vaccination rates reflect the result of that discrepancy in how preventive measures were targeted: Some 60 percent of adolescent girls nationwide are vaccinated, but only about 50 percent of adolescent boys. The JAMA paper found that only 10.7 percent of a sample of 3 million men aged 18 to 32 in the United States were vaccinated.
But on to the important part: What if you’re a guy in your mid-to-late 20s or older who still wants to get vaccinated? Jake Harper, 29, decided to figure out what would happen if he tried. In October of last year, he realized he’d never been vaccinated, and was now single and sexually active, and wanted to find out his options. He’d been aware of the virus and the vaccination for about eight years, back when a college girlfriend got immunized on that lady-aimed recommendation. He assumed that was good enough to cover him, too.
But he later learned that men are affected by HPV too, and wondered if it was too late for him to try to get the vaccine. The answer? It’s complicated. “For men, there’s no commercially available test to find out if you have been exposed,” he writes at NPR. “Women can be checked for HPV exposure as part of a Pap test.”
He wonders if there’s any chance he’s actually been spared the virus in spite of the statistics that everyone is exposed. “The chances you’ve been exposed to all nine types [protected by the vaccine] are actually vanishingly small,” John Schiller, a microbiologist who studies HPV and HPV vaccines at the National Cancer Institute, tells him.
So could he get the vaccine despite being outside the targeted age group? “You’re past the age where your health insurance is going to pay for it,” Schiller tells him. But he can still pay for it himself.
Harper decides it’s better to be safe than sorry, banking on the idea that even if has been exposed to some strains, he could still protect himself against other strains he hasn’t been exposed to, but might contract in the future. He ends up shelling out $130 per dose out of pocket for the shot (the CDC recommends three of them in total if you’re over 14). That put his total cost at around $400 for what he realizes is some peace of mind, but no guaranteed benefit.
If your insurance won’t cover the vaccine for you and you can’t decide whether to spend the money on something that won’t guarantee full protection at your age, consider the higher-risk groups: The JAMA paper found that men older than 22 were twice as likely to be infected. Those who weren’t college educated had a 40 percent greater chance of being infected. Single men were twice as likely as married or divorced men. The researchers conclude that “male HPV vaccination may have a greater effect on HPV infection transmission and cancer prevention in men and women than previously estimated.”
It’s not the first time men have wondered if it’s worth the money. In 2011, Medscape hosted Dr. Sandra Fryhofer to run the cost/benefit analysis. She concludes that “Men are at risk for HPV-related disease, and yet even though there is a clear and proven medical benefit for vaccinations in boys and men, the cost effectiveness remains controversial.” And a researcher on the JAMA paper told The Huffington Post that the age cutoff should be re-evaluated in light of the data on HPV prevalence in older men.
So Harper’s decision to go ahead and shell out $400 at age 29 wasn’t for nothing — he may still ward off trouble. “It could help me, even if it just calms my anxious inner voice,” Harper he writes. “And it might keep me from spreading the virus to someone else.”