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Offer all young gay men HPV jab, say experts

Gay men have 15 times higher risk of anal cancer than straight men

Louise Prime

Tuesday, 16 July 2013

All young gay men should be offered the human papillomavirus vaccination, say sexual health experts writing today in Sexually Transmitted Infections. They argue in their editorial that this would be cost-effective as well as clinically effective.

The authors, from the Royal Liverpool University Hospital, Homerton University Hospital, and Chelsea and Westminster Hospital, say that the current UK policy, of offering the HPV jab only to girls on the assumption that herd immunity would cut the level of infection in men, has been proven correct in Australia. There, the incidence of anogenital warts – among heterosexual men as well as women – fell dramatically within a year of the start of the country’s quadrivalent HPV (qHPV) vaccination programme.

However, they point out that this policy does not help men who have sex with men (MSM), in whom rates of HPV-related cancer, especially anal cancer, are 15 times higher than among straight men; rates of anal cancer appear to be raised even among MSM who are HIV negative. And in February this year, Australia extended its national school-based HPV vaccination programme to include boys aged 12-13 years, with a catch-up programme for 14-15-year-old boys.

The authors point to research demonstrating the clinical efficacy of qHPV vaccination in HIV-negative MSM. They write: “[It] was highly immunogenic and effective in preventing infection, reducing HPV persistence and preventing development of external genital lesions. Additionally, vaccination reduced rates of anal intraepithelial neoplasia.”

They add that although vaccination is most cost-effective in those who haven’t already been exposed to HPV, data have shown that targeted HPV vaccination of MSM is still cost-effective.

The authors argue that sexual health clinics “are ideally placed” to provide qHPV vaccination – STI clinics in England were attended by 17,000 MSM aged 17-26 years in 2010 alone.

They conclude: “While the biggest challenge will be to identify and vaccinate before HPV acquisition, recent data illustrate HPV vaccination of sexually active MSM is effective, and modelling using conservative analyses suggests vaccination is cost-effective. In the light of this evidence, and in the absence of universal vaccination of boys, the argument for introducing targeted HPV vaccination for MSM up to age 26 years is strong.”

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