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Column originally published Jan 18, 2011

Boys Should Get HPV Vaccine Also

Question: I have a sixteen-year-old son. He just started dating a girl at his school. He is not sexually active as yet, but I am worried. Our younger daughter received the HPV vaccine last year at school, but they are not giving it to boys. From what I have read, this virus can infect both boys and girls. Why are boys not given the vaccine to protect them also? Since I am on this subject, I want to ask you whether I should get this vaccine. I am in my forties, and was divorced from my former husband a couple of years ago. I am planning to start dating again. I wonder whether this vaccine is useful for me or not.

Answer:

You have two very important questions here. Let me begin by explaining about the virus as well as the vaccines before answering your questions.

Human Papilloma Virus, also called HPV, is not a single virus. There are over 100 types of HPV, many of them produce warts on our hands and feet. They can cause pain, especially when they are on the bottom of our feet (these are called plantar warts), but they are relatively harmless.

However, about 40 strains of HPV can infect the genitalia and other mucus membranes of the body. They can produce warts in the genitalia (these are called genital warts), and some are responsible for cancers of the cervix, vagina, vulva, anus, as well as the penis.

HPV is spread from person to person through direct and indirect contact. Children can develop warts by touching other children who have warts on their hands. Playing around swimming pool is an easy way to spread plantar warts from one child to another. However, HPV infection of the genitalia and anus is almost always through direct sexual contact, either during intercourse or sexual touching.

Although genital HPV infection is most common in young people under 25 years of age, recent research has shown that sexually transmitted diseases (STD) are becoming more common in older adults and seniors. There are many reasons for the increase of STD in this age group; re-entry into the dating world and not using protection are some of the contributing factors.

There are currently two HPV vaccines being licensed in Canada: Gardasil and Cervarix. Both of them are effective against HPV types 16 and 18, which are responsible for about 80% of cervical cancer in North America. In addition, Gardasil also protects against HPV types 6 and 11 which cause most of the genital warts.

Both of these vaccines were initially approved for females between 9 and 26 years of age. There are good data showing that these vaccines are effective in preventing HPV infections caused by the types of virus covered by the vaccines. By preventing HPV infection, they greatly reduce the chance of cancers that I mentioned earlier, as well as genital warts for those who have received Gardasil.

All provinces and territories in Canada have implemented immunization programs to provide HPV vaccine to girls before they become sexually active, although the age of vaccination varies slightly among provinces.

Last year, after much consultation and deliberation, Health Canada has approved HPV vaccine for boys also. Research has shown HPV vaccines are equally effective in boys and girls. Because genital strains of HPV are spread through sexual contact, it just make sense to vaccinate both boys and girls. This has been proven to be true in Australia, where they have vaccinated children, boys and girls, with HPV vaccine, in the past few years. They have shown that the spread of HPV has decreased markedly since the vaccination began.

However, none of the provinces and territories have implemented this recommendation as yet. Judging from the way HPV vaccine was first implemented for girls several years ago, it is quite possible that this will be rolled out in a similar fashion: vaccinating boys 11 to 13 years of age. Because your son is already sixteen, most likely he will not receive it through the government program. You will likely have to get this through your family doctor, and it is fairly expensive.

There is also much research showing that both vaccines are effective in women in their 40s and 50s. This is not surprising because our immune system can respond to infections and vaccines until some time after sixty years of age.

We donʼt know when Health Canada will approve these vaccines beyond the current recommendation, which is between 9 to 26 years of age. If you are going to start dating and have new sexual partners, you should protect yourself by getting vaccinated with one of the HPV vaccines. You should discuss this with your family doctor. The only caution is that your private health insurance may not cover the cost of the vaccine if Health Canada has not approved it for your age group.

Please keep in mind that HPV vaccine does not prevent all HPV infections, and it doesnʼt protect you against other sexually transmitted diseases. It is most important that you use condom protection, as well as getting regular PAP test to prevent cervical cancer.