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by Robert MacKay, Friday, 22 June 2012 | Categories: Sexual Health

The British Association for Sexual Health and HIV (BASHH) are emphasising the importance of having gay men vaccinated against the human papilloma virus (HPV), a sexually transmitted virus that has the potential to cause cancer. Gay men are considered a high risk group and yet the vaccine is still only recommended by NICE for girls from the age of 12. BASHH are suggesting that this is discriminatory and that if these men were vaccinated under the age of 26 that the rates of anal cancer caused by HPV would decrease significantly. They also recommend that gay men under the age of 26 be administered the vaccination free of charge when they attend their sexual health clinic. At approximately £400 pounds a pop, this would be a very expensive investment in public health but it is also argued that by vaccinating this group now, the number of patients being treated for HPV related cancers will decrease in the future, thus lessening the financial burden on health services.

The HPV vaccine is not currently recommended for use in the NHS for men, even though HPV is known to cause certain cancers. However it has not been established that all oral, penile and anal cancers are caused by HPV and it is therefore difficult to know what percentage of those cancers would be prevented by the vaccine. BASHH feel that by vaccinating young girls, heterosexual men would become indirectly protected over time, leaving gay men the only group without protection. The organisation feels that this is unacceptable but this debate is a complicated one.

The vaccine is available for anyone willing to pay for it. There is no empirical evidence to prove that the vaccine even works after exposure to HPV but there has been anecdotal evidence which suggests that being vaccinated even post exposure will have benefits. Some might have a certain strain of HPV and be vaccinated against another strain for example or their body may have rid itself of the virus on its own by the time they decide to get vaccinated. Unfortunately, there is no way of testing a man for HPV and so these men would have to be vaccinated blindly. Although gay men are a high risk group, vaccinating those in their twenties may or may not reduce the number of HPV related cancers depending on whether or not the men are virus free at the time of vaccination and depending on how many of these cancers are in fact caused by HPV.

Heterosexual men cannot walk into a GUM clinic and get this vaccination and neither can women who are over the age of 26 and these groups are not considered to be discriminated against. This is the recommendation. The vaccine is administered to those who have the best chance of benefitting from it. If evidence proving the benefit of having the vaccination post exposure is presented then vaccinating gay men under the age of 26 would indeed be considered but for now it is clear that between the cost of the vaccine and how little we know about its benefits post exposure to the virus, we cannot justify this implementation. Not only would we be spending a substantial amount on these vaccines but the cost of treating HPV related cancers could potentially remain the same.

The debate is on-going about whether or not we are using this vaccine to prevent cancer in the most appropriate way and if we are accessing the right groups, but in the meantime engaging in a dialogue with your GP about your concerns over this common virus, having regular PAP smears and having genital warts treated when they appear, is the best way to deal with this extremely common infection.

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