Men act as reservoir for HPV

Research published today in The Lancet shows that about half of the general population in the US, Brazil and Mexico are infected with the HPV virus, and that every year, 6% of men with be infected with HPV 16, the virus which causes cervical and other cancer in women (and men).

Other cancers caused by HPV include those of the genitals, anus, head and neck, and mouth.

The study’s authors suggest that, while condom use and safe sex practises are still to be promoted, vaccination of men (as well as women) will help protect not only them, but also their partners.

Our colleagues at the UK SMC have gathered expert comment on the research (below), and the paper can be accessed by registered journalists through the SMC Resource Library.

Dr Loretta Brabin, Reader in Women’s Health, Manchester University, comments:

“This paper addresses a controversial issue, so will be discussed at length. HPV infection is very common and there is a case for arguing for universal vaccination of both sexes during adolescence. Any sex-specific vaccine raises concerns.  Men feel disadvantaged, although their risks are generally much lower than the risk of abnormal cytology and cervical cancer among women – except among MSM (homosexual men) as their male partners are unvaccinated. Women’s groups also complain about making women solely responsible for protecting against the undesired consequences of sexual behaviour. From an individual/group perspective, universal vaccination therefore seems self evident.

“The public health perspective is different.  It searches for the most cost effective way to reduce the greatest burden of disease and the epidemiological data in this new research paper will be useful in generating new economic models. In future this may lead to country-specific policies favouring male vaccination.  In the UK we are fortunate in that our school-based programme for vaccinating 12-13 year olds is very successful and has high HPV vaccine coverage.  As a result, the UK cervical screening programme will gradually change to take advantage of the expected lower rates of HPV-16/18 in the population. A clear and effective vaccine policy makes it easier to plan for, and to accomplish, these changes.  In countries like the US that have low HPV vaccine uptake, expanding the total vaccinated population may be appropriate. It will, however, lead to demands in the UK and elsewhere for males to be vaccinated, even if it is not cost-effective to do so.”

Professor Lawrence Young, Pro-Vice Chancellor and Head of the College of Medical and Dental Sciences, University of Birmingham, comments:

“Although the study is a little unclear about how incidence is defined, it confirms something that we have suspected for some time – that men are a reservoir of HPV infection and transmit this virus to women. Thus, HPV vaccination of men would not only contribute to preventing cervical cancer in women but also impact on the rising incidence of HPV-associated oral cancer – a tumour which has risen by 50% in men in the UK since 1989 and accounts for almost 2000 deaths per year.”

Dr Anne Szarewski, Clinical Consultant and Honorary Senior Lecturer, Wolfson Institute of Preventive Medicine, comments:

“This study highlights the high incidence of HPV infection in men, which emphasises their role in transmission of HPV to women. It must surely strengthen the argument for vaccination of men, both for their own protection, and that of their partners.

“It is interesting that HPV infections remain common in men as they get older, whereas in women they tend to become less common. This may be because men are less likely than women to develop immunity, even after repeated exposure. It may also reflect behavioural differences, in that older men often have considerably younger partners, who are more likely to be infected.”