This section will cover:
- How HPV can affect men
- Why men and boys are not vaccinated
- Benefits of vaccination for men and boys
- Updates for men who have sex with men
- Cost of vaccination outside of the NHS
Worldwide human papillomavirus (HPV) is the most widespread of all sexually transmitted viruses. Four out of five (80%) people will contract some type of the virus at least once in their life . Both men and women can catch HPV and most people’s immune systems will clear the infection without them needing any further treatment.
Around 40 of over 100 identified types of HPV can affect the skin and mucosa (any moist membrane) of the genital areas of both men and women.
In men, HPV can affect the skin of the penis, anus and rectum, and the lining of the mouth and throat .
Around 13 of these 40 genital HPV types (most commonly HPV 16 and 18) have been linked to the development of cancer in the infected cells. These types of HPV are called ‘high-risk’. In men, high-risk HPV infection is linked to penile, anal and some head and neck cancers. For more information on these please visit our page on other HPV-related cancers. Overall, 5% of all cancers worldwide are linked to high-risk HPV .
The genital HPV types that are not linked to cancers are sometimes called ‘low-risk’ types. In both men and women, some types of low-risk HPV infection (most commonly HPV 6 and 11) can lead to the development genital warts.
Currently the NHS only offers the HPV vaccine to girls aged 11–17 in Scotland and 12–17 in the rest of the UK (until their 18th birthday) free of charge. Of these girls, only those aged 11–13 in Scotland and 12–13 in the rest of the UK are routinely offered the vaccine in the school-based programme.
Boys are not included in the school-based vaccination programme. This is because the HPV vaccination programme, which began in the UK in 2008, was introduced to specifically help protect women against cervical cancer, as high-risk HPV causes 99.7% of all cervical cancer cases. For the other cancers, including those that affect men, far fewer cases are linked to high-risk HPV, so vaccination does not provide as much protection as it does from cervical cancer. You can find more details on the percentages of these cancers that are linked to HPV on our other HPV-related cancers information page.
Vaccination of girls/young women does not directly protect boys and men, but it does offer them ‘herd protection’. Herd protection means that the group of people who are immunised against a condition (in this case vaccinated girls and women) help to protect the group of people who are not immunised (in this case unvaccinated boys and men). Since HPV vaccination prevents infection, men who have sexual contact with vaccinated women will not be infected with high-risk HPV and will therefore be protected. Therefore, heterosexual men (men who have sex with women) will benefit for the vaccination of girls and women without needing to be vaccinated themselves.
However, men who have sex with men (MSM) do not have sexual contact with immunised women, so they do not benefit from herd protection against high-risk HPV. This means that MSM, as well as heterosexual men who have sex with unvaccinated women, are still at risk of contracting high-risk HPV and possibly developing cancer in the infected cells.
Because of their lack of herd protection and increased risk of contracting these cancers, NHS Wales, Scotland and England have announced that men who identify as MSM will now be able to access the vaccine in sexual health, GUM and HIV clinics. In England and Wales this applies to men aged 16–45, in Scotland there is no lower age limit. Please see our section below, on updates for MSM, for more details.
Vaccinating boys against HPV would help to protect them against types of cancer that are linked to high-risk HPV infections, as well as against genital warts . The vaccine that is currently used in the HPV vaccination programme is called Gardasil and it protects against four different types of HPV:
- Types 16 and 18: linked to anal, penile and some head and neck cancers
- Types 6 and 11: cause 90% of genital warts.
Vaccinating boys would therefore decrease their risk of contracting genital warts or developing an HPV-related cancer. It would also strengthen the herd immunity already provided by vaccinated girls, helping to protect anyone, male or female, who is not vaccinated . However, it is important to remember that because not all cases of anal, penile, and head and neck cancers are linked to HPV, vaccinating boys would not fully protect them against these cancers.
The Joint Committee on Vaccination and Immunisation (JCVI) is the organisation that advises the government about their immunisation and vaccination programmes. They are looking at the evidence for extending the existing school-based vaccination programme to cover boys as well as girls in early 2017.
In November 2015, the JCVI recommended that the NHS high-risk HPV vaccination programmes should include targeted vaccination for MSM up to the age of 45 . They suggested that the vaccinations should take place in GUM (sometimes known as sexual health) clinics and HIV clinics. The reason that they have recommended offering the vaccine to MSM up to the age of 45, rather than 18 like it is with women, is because there wouldn’t be a enough of a drop in the transmission of HPV to make vaccinating MSM cost effective if only those up to 18 were vaccinated.
In December 2015, the Welsh government announced that NHS Wales would be following the recommendations of the JCVI by launching a HPV vaccination programme for MSM, aged up to 45, who attend sexual health clinics . This programme is currently being planned and further announcements will be being made about how and when it will be being rolled out.
In March 2016, the Scottish government announced that they would also be introducing vaccination for MSM aged up to 45. This will begin in January 2017 and the vaccine will be available free of charge through sexual health and GUM clinics. It will be being offered to MSM when they attend these clinics, even if they are attending for another reason. This is called opportunistic vaccination.
In June 2016, Public Health England began trialling the vaccination of MSM at a select number of GUM and HIV clinics in England. Based on the results of this trial they will make a decision on whether or not to roll this programme out across the whole of England.
Information on how MSM can access these HPV vaccination programmes will be available at the clinics where it is being rolled out in England, Scotland and Wales. The vaccine will be available to MSM free of charge by NHS Wales, NHS Scotland and NHS England, and it will be offered only in sexual health, GUM and HIV clinics. These programmes will be completely separate from the school-based vaccination of girls.
Heterosexual men, boys and women over the age of 18 are not currently eligible for high-risk HPV vaccination from the NHS. However, they can pay to have the vaccine privately if they wish to and are able to. It has been suggested that HPV vaccination could be beneficial to those over 18, but more research is needed on this and it may not be effective for everyone.
The complete course of the vaccine requires two doses for people under the age of 15 and three doses for people over 15, and each dose costs around £130–150 . Please speak to your GP if this is something you would like to know more about. Many travel clinics and pharmacies also offer the vaccine privately.
- Moscicki AB et al., 2012. Updating the natural history of human papillomavirus and anogenital cancers. Vaccine 30 (Suppl. 5), F24–F33.
- Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine 26 (10), K17–K28.
- National Cancer Institute, 2015. HPV and cancer. www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv.... Accessed: 21.07.2016.
- NHS Choices, 2013. HPV vaccine could be offered to boys. www.nhs.uk/news/2013/11November/Pages/HPV-vaccine-could-be-offered-to-bo.... Accessed: 21.07.2016
- Alexander KA et al, 2012. HPV-beyond cervical cancer (online resource center). American Journal of Medicine. 125 (7), S1.
- Joint Committee on Vaccination and Immunisation (JCVI), 2014. JCVI statement on HPV vaccination of men who have sex with men. Accessed: 21.07.2016.
- House of Commons, 2016. HPV vaccinations for men who have sex with men. http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CDP-2016.... Accessed: 21.07.2016.