News that 1 in 9 men now have oral HPV has us asking (again) whether all men should get the HPV vaccine, even though the CDC only recommends it for men up to age 21, and up to age 26 for a higher-risk group.
“Yes, there’s definitely a benefit for a man over 26 to be vaccinated because of the increased incidence of reported oropharyngeal cancer related to HPV,” urologist Dudley Danoff, author of The Ultimate Guide to Male Sexual Health and the founder of the Cedars Sinai Urology Group in Los Angeles, told MEL by email.
“If a man over 26 is having active oral sex, he should spend whatever money it takes to be immunized,” Danoff said. “Whether it’s straight or gay oral sex, the HPV vaccine will decrease the incidence of oropharyngeal cancer in men and cervical cancer in women.”
The study, published in the journal the Annals of Internal Medicine, is a nationally representative study of adults aged 18 to 69 pulled from the National Health and Nutritional Examination Survey from 2011 to 2014. It found that HPV is six times as prevalent in men than women — or 11.5 percent of men, compared with just 3.2 percent of women. High-risk HPV, which is most likely to cause cancer, is also more prevalent in men.
The CDC has long warned that HPV is super common for everyone. Pretty much anyone who has sex will pick up HPV at some point or another without even knowing. It’s easily transmitted via skin contact, and there are often no symptoms of an HPV infection (though some strains can produce genital warts); it can even resolve itself in a year and a half. The trouble is, some strains can also cause a number of cancers — cervical, anal or oral cancer in women, and penis, anal and oral in men. It may cause up to 70 percent of oropharyngeal cancers.
Making matters worse, there is no currently approved HPV test for men. Senior study author Ashish Deshmukh told CNN that in addition to the worrisome overall higher infection rate, HPV also persists longer in men and may not clear up as easily; They may even pick it up more readily than women do. Or, he said, it’s possible women develop a better resistance more quickly. Researchers aren’t sure why.
All this makes it more alarming that, as Deshmukh notes, men get vaccinated at lower rates than women. The CDC did not begin recommending the vaccine to boys and men until 2011 (two years after girls). It typically recommends the vaccine for people aged 11 to 21; for gay men who are sexually active, trans adults, and boys or men with HIV or compromised immune systems, they extend that recommendation to age 26.
“The CDC often makes recommendations based on economics (i.e., cost effectiveness), so it’s basing its age-related recommendation on the fact that these cancers are rare,” Danoff explains. In one study, half the infections in men happened before they turned 24.
“Still, any man, particularly uncircumcised men engaging in oral sex, should spend his money to get immunized for the benefit of his partner and himself,” Danoff says.
Money is the other major deterrent for men over 26. Since insurance won’t cover the vaccine past the CDC’s age of recommendation, men seeking the vaccine will have to pay out of pocket. You’ll need three doses total if you’re over 15, and according to two separate investigations into the expense, that can cost anywhere from $130 to $150 per shot.
Last year, 29-year-old Jake Harper asked whether he was too old for the shot and wrote up the experience of finding out for NPR. In essence, he finds out that yes, a vaccine could help if he hadn’t been exposed, but given that by age 45 some 80 percent of people are, he probably has been. That said, his exposure could’ve already resolved, and on top of that, a microbiologist at the National Cancer Institute tells him there are dozens of strains, so it’s unlikely he’s been exposed to all of them.In the end, he forks over the money for the benefits, dubious as they may be.
Vice writer Justin Lehmiller asked the is-it-worth-it question last year, and his research turned up the same thing: There are likely some benefits, and it’s not a risky proposition to get it. And being monogamous won’t guarantee your sexual health. In the end, Lehmiller spent $600, and had to find a clinic willing to give him the shot. Many clinics, including Planned Parenthood, told him their policy was to not even give the shot to anyone over 26, even if they could pay. He advises shopping and calling around to get the best price.
That cost is nothing to sneeze at, but given the pervasive and persistent trouble HPV continues to give us, it appears to be worth it for some protection and peace of mind.