This site is intended for health professionals only


Call for HPV vaccination to be extended to young gay men



Sexual health experts are calling for young gay men under the age of 26 years to receive the HPV vaccination, because they are at a high risk of developing anal cancer.

The team argues targeting young gay men would be cost effective even though a small proportion of young, identifying men who have sex with men (MSM) may already be infected with HPV 16 or 18, the two strains that account for most genital cancers.

Gay men have 15 times the risk of developing genital cancer, particularly anal cancer, as a result of HPV infection compared with straight men.

Writing in an editorial in the BMJ journal Sexually Transmitted Infections, the experts said that young gay men could be targeted through sexual health clinics, where they are already offered hepatitis B vaccination – and that this would also help to improve access to services for such men, who are also vulnerable to HIV infection.

They wrote: ‘While the biggest challenge will be to identify and vaccinate before HPV acquisition, recent data illustrates 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 or MSM up to age 26 years is strong.’

The call comes after a move by the BMA earlier this year urging ministers to widen the HPV vaccination programme to include gay men.

But GPs have expressed concerns over targeting young gay men for HPV immunisation, because of the difficulty of identifying them and getting them to come forward at such a young age.

Dr Catti Moss, RCGP advisor on sexual health and a GP in Northampton, said: ‘The practicalities of identifying those gay men before they have already picked up HPV would be very difficult. Many men are unsure of their orientation in early teens.’

Dr Moss said targeting this group could be done ‘in theory’ by a combination of sexual health and outreach clinics and general practice. But she said it would be more effective to vaccinate both sexes in their early teens – and that the current HPV programme run through schools could vaccinate boys equally as well as girls.

Dr Moss said: ‘If we wish to cut the impact of HPV on anal, cervical, penile, and other cancers really effectively, the best way is to immunise both sexes (together, in their early teens). This would have the good side effect that herd immunity would have a chance to build up.’

Sex Transm Infect 2013; 89: 342–343