Men need vaccine against anal warts, cancer

Image: Shutterstock
Image: Shutterstock
South Africa's state-funded roll-out of the HPV vaccine this year does not include vaccinations for boys.

This exclusion is particularly worrisome with regards to MSM (men who have sex with men), said Dr Kevin Rebe, HIV and infectious disease specialist at the Ivan Toms Centre for Men's Health (Cape Town), as this group is at higher risk for HPV-related disease.

Read: Quick facts on anal cancer

Rebe was speaking at a recent media discussion in Cape Town, organised by MSD South Africa, on the impact of HPV in the country.

The HPV roll-out is currently targeting Grade Four girls. The rationale is that vaccinating this group is the best use of funds to protect against the most important consequence of the virus – cervical cancer in women.

HPV linked to anal warts and cancer

HPV is also a major cause of other diseases: anal and vaginal warts, anal cancer, and cancer of the vulva and penis.

Of particular concern is the prevalence of anal warts and anal cancer in young South African MSM men, which is much higher than for heterosexual men.

Not making the vaccine easily available to boys and young men is “a missed opportunity to help prevent cancer.” said Rebe.

Vaccinating only girls against HPV does provide some protection for boys too, but, as Rebe pointed out, this is likely to benefit heterosexual males primarily.

In Australia, for example, HPV vaccination of girls provided boys with some protection, because of "herd immunity" (when enough of the population is immune to the infection to make its spread to unvaccinated people unlikely). However, a significant decrease in HPV infection was only seen in heterosexual men; MSM men did not benefit from herd immunity.

Kanye's story

To illustrate the importance of HPV risk for males, Rebe described one of his patients at the Ivan Toms Centre for Men's Health in Cape Town:

 “Kanye” is a 16-year-old living in Imizamo Yethu township in Hout Bay. He had experienced much psychological distress in his struggle to come to terms with being gay, and had suffered suicidal depression. He was doing well after after receiving counselling and life skills training.

Then a couple of weeks later, he called Dr Rebe to say "I have a serious problem – can I come see you?" Kanye had had two sexual partners, and had used condoms during sex. However his last partner had removed his condom before ejaculating on the perianal area. Kanye had developed anal warts both internally and externally.

He screened negative for HIV, but needs treatment for anal warts which involves weekly sessions of cryotherapy (freezing skin lesions).

Commonest STI in young township MSM

Kanye's case is not unusual; Rebe said that HPV is the commonest sexually transmitted infection seen among young black MSM living in the townships. At the Ivan Toms Health Centre, doctors see HPV infection presenting early, at around the age of 28 years.

This has serious implications for the general population too: Rebe points out that 50% of South African MSM also have sex with women.

In addition, HIV-positive individuals of both genders are more likely to get HPV.

In cases where anal warts become large they can develop secondary bacterial infections. This can essentially lead to sexual dysfunction for individuals who have anal intercourse.

Slideshow: What genital warts look like. (Graphic images, not for sensitive viewers.)

Rebe explained that screening for diseases like anal warts and anal cancer is currently difficult, “especially not in the state sector; it's just not done. There's no straightforward access to an anal pap smear, and there's even uncertainty as to which medical discipline is responsible for these conditions. A male patient could be sent to a gynaecologist for an anal pap smear, but this is unusual.”

“The best option is vaccination against HPV.”

Studies indicate that the vaccine can bring about a 94% risk reduction in external genital lesions in men, and around an 85% reduction of persistent HPV infection. It has an 80% risk reduction in anal cancer.

HPV vaccine awareness: a marketing issue

Rebe said that one of the obstacles in protecting MSM is the current difficulty of “marketing” the HPV vaccine to parents. “It's easier to talk to parents of girls about the issue, the parents of potentially gay boys.”

Thus, as a starting point it might be more effective to “market” use of the vaccine to older males.

Read more:
Get your child vaccinated against HPV
Genital warts

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