What about the boys?

The commentary by Dr Leon1 gives the “usual” data published about the human papillomavirus (HPV) vaccine, cervical cancer, penile cancer, and the costs and benefits of a widespread vaccination program. It pays lip-service to the burden of disease in men.

For a moment, consider a young pubescent boy who is not yet sexually active. His sexual preference might be for males or females … it is simply a matter of time before he indulges in one or all forms of sexual activity. All this publicity about HPV and women might lead him to conclude that you “catch” HPV from an unvaccinated female. It surely cannot be something males have, because this fact is not commonly mentioned in any ads about HPV or in discussions with doctors.

I believe we are propagating potentially damaging information when we do not present a balanced view of the true effect of HPV on the population at large, based on age, sex, incidence of warts, and the incidence of cancer in all the areas that the 4 strains (6, 11, 16, and 18) affect.

The number needed to treat (NNT) for genital warts in girls is 8 and the projected NNT (based on a mathematical model) for prevention of cervical cancer is 324.2 Despite the evidence that points to the effectiveness of the prevention of genital warts, why do we not see any discussion of the “prevention” of morbidity associated with HPV in men and women? When we speak of prevention, the data are often related to mortality, seldom morbidity. But each of us, in our daily practice of medicine, supports hundreds of youth “struck by” genital warts and the suffering that goes with them. What is the NNT for genital warts in men?

The data on the prevention of cancer to date are based on mathematical projections. Rather than only focusing on the outcome of genital-to-genital contact, should we not consider the effects of oral sex, anogenital sex, and digital sex? Do we not have any data on men or the ability to come up with a mathematical model for cancer prevention in men? What is the total burden of cancer in all these anatomical sites in men and women?

Should we not inform the public that the infection affects both men and women and that ladies are first mainly because we have more data by which to justify the cost of this public health venture? Should we not support men by advocating for development of mechanisms by which we can measure the morbidity and mortality in men that is linked to HPV? Should we not present a more balanced approach and prevent the perception that HPV is an infection that predominantly affects women? Should we ever forget that it took decades to erase the perception that another sexually transmitted virus was linked with homosexual activity in men?

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