The next issue of Treatment Guidelines from The Medical Letter (September, 2013) will be on Drugs for Sexually Transmitted Infections. It will include a short section on the most common sexually transmitted infection in the US, which can cause cancer and has no effective treatment, but can be prevented by use of a completely safe vaccine.
Obviously I am referring to human papillomavirus infection and the HPV vaccine. A recent press release from the CDC (July 25, 2013) estimated that 79 million Americans are currently infected with HPV, about 14 million become newly infected each year, and that nearly all (presumably unvaccinated) sexually-active men and women will become infected with at least one type of HPV at some point in their lives. Types 6 and 11 cause genital warts. Types 16 and 18 cause neoplasia of the anogenital tract and oropharynx. No HPV infection, no cervical cancer. Fantastic!
But it’s not fantastic yet, because boys and girls are not getting the vaccine. The first approvals were for use in girls, presumably because they are the ones at risk for cervical cancer. That seems short-sighted, because boys transmit the infection just as much as girls do (probably more, since they still seem to have more sexual partners), and interruption of transmission is the goal here. And it’s not as though boys have nothing to gain. About 10% of them will grow up to become men who have sex with men, putting them at risk for HPV-induced anal cancer, and some higher percentage will be exposed to oropharyngeal transmission.
Some parents of girls are reluctant to have them vaccinated at the desirable (before sexual exposure) early age of 11 or 12 because they are afraid that vaccination will encourage sexual activity. Parents of boys may not be aware that they are at risk too and may not be high-minded enough to want to protect their girl friends. And according to the CDC, many children who receive other vaccines for less common diseases do not receive this one because the doctor never mentioned it. That is especially sad.