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HPV Vaccine Uptake in Men
Promoting HPV Vaccine Uptake: Best Practices for Men

Released: August 12, 2024

Expiration: August 11, 2025

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Key Takeaways
  • Men who have anal and oral sex are at risk for anal, penile, oropharyngeal, and laryngeal cancers
  • Human papillomavirus is the common cause of these cancers, which can be prevented with early vaccination. 
  • Other positive sexual health practices for men include pre-exposure prophylaxis for HIV and Doxy PEP for certain sexually transmitted infections.

Human papillomavirus (HPV) is a skin-to-skin or sexually transmitted infection (STI). Most HPV infections are transient and go away on their own. These infections can occur in people of all genders, regardless of their sexual orientation or preferred sexual activities. Unlike HIV testing, HPV diagnosis is done via cancer screening, not for infection identification. Further, identification of HPV types 6 and 11 infection happens with the manifestation of genital warts, and a vaccine is available to prevent, but not cure, these HPV types. In general, the focus of HPV vaccination has been centered on its cancer prevention potential.

Relationship Between HPV and Cancer
HPV vaccination has provided documented reductions in cervical cancer in countries with large population uptake. Likewise, some vaginal, vulvar, penile, anal, oropharyngeal, oral cavity, and laryngeal cancers resulting from HPV infection are preventable with HPV vaccination. Evidence of long-term follow-up indicates at least 14 years of HPV type-specific antibody protection remain after initial immunization. This response is sufficient at protecting against cervical cancers until people become of age for cancer screening initiation per guidelines, where the remaining 7 high-risk HPV types that may cause new cervical cancer precursors can be detected. Primary HPV testing is the most valuable test for understanding whether one’s specific HPV type infection is a persistent infection, creating oncogenic potential.

Best Practices for HPV Prevention Among Men
For cancers without validated population-based screening procedures, paying attention to symptoms is crucial for early detection. Men who have anal and oral sex are at particular risk for anal, penile, oropharyngeal, and laryngeal cancers, in that order.

Penile, Anal, and Oropharyngeal Cancers
It is stipulated that penile cancer can be partially prevented by circumcision. In addition, this cancer most often occurs on the glans of the penis and, if not circumcised, under the foreskin. Penile cancer is most often recognized by a mass, bleeding, or discharge. HPV types 16 and 18 cause approximately half of all penile cancers, and the bivalent and quadrivalent HPV vaccine prevent up to 80% of these cancers; the other 5 high-risk HPV types that are covered in the 9-valent HPV vaccine (ie, 31, 33, 45, 52, 58) cause 20% of penile cancers.

Research shows that 15% to 50% of men who have sex with men have high-risk HPV found on anal sampling. Further, HPV causes 91% of anal cancers. Well over half of all anal cancers are caused by HPV types 16 and 18, which are preventable by the bivalent and quadrivalent HPV vaccines. In addition, the other 5 high-risk HPV types cause 8% of anal cancers, which the 9-valent HPV vaccine addresses. Studies including men who have sex with men show 10-year protection from anal precancers due to high HPV 16 antibodies from the quadrivalent HPV vaccine.

Oropharyngeal cancers are the most common HPV-associated cancer among men. Approximately 60% of these cancers are caused by HPV, with the majority being associated with HPV type 16—preventable with the bivalent and quadrivalent HPV vaccines.

HIV- and Other STI-Related Considerations
Other protective interventions that men can take for their sexual health include pre-exposure prophylaxis (PrEP), an oral medication to prevent HIV infection. Unlike HPV vaccination, these active anti-HIV agents must be taken daily or on-demand (just before/after sex) to be effective. Also, unlike HPV-associated diseases, people often undergo active testing or screening for HIV, syphilis, gonorrhea, and chlamydia every 3 months while on PrEP.

Finally, certain bacterial infections can also be sexually transmitted. To combat this, the CDC published clinical guidelines on using doxycycline postexposure prophylaxis (Doxy PEP) to prevent some bacterial STIs (eg, chlamydia and syphilis) after sex. Doxy PEP is recommended as an on-demand therapy and should be taken within 24 hours, no later than 72 hours, after insertive or receptive sex. 

Your Thoughts?
Men now have more options for preventing STIs and certain cancers and having more control over their sexual health than ever before. How often are you discussing HPV prevention strategies, including immunization, with your male patients? You can get involved in the discussion by posting a comment below.