Why Should Boys Be Vaccinated Against Human Papillomavirus?

The HPV vaccine in boys helps to reduce the circulation of the HPV virus, which helps to prevent both cervical cancer in women and other cancers in men.

For several weeks, Mario had been experiencing pain while swallowing. The lymph nodes in his neck were swollen. He thought it was probably COVID-19, but his partner urged him to see his doctor. She had just been to the gynaecologist for treatment of a papillomavirus lesion. Based on what she had heard, she thought that Mario’s condition might be related. Tests showed that Mario had early-stage oesophageal cancer. Further testing confirmed that human papillomavirus (HPV) 16 was present in the tumour. Mario began treatment right away. Fortunately, the prognosis is good and he is once again leading a normal life. At the hospital, the doctors told him that this type of tumour is becoming more and more common and that HPV is associated with other cancers.

Why are these cases happening? Why are they happening in men? We are familiar with the idea of preventing HPV infection to avoid cervical cancer in women, but what about cancer-associated HPV in men?

What is the Human Papillomavirus (HPV)?

HPV is actually a family of viruses that infect humans and cause lesions on the skin and mucous membranes. In the vast majority of cases, the infection is transmitted by sexual contact. It is estimated that more than 80% of sexually active men and women will be infected by some strain of HPV at some point in their lives. Most infections resolve spontaneously. If this does not happen, however, there is a risk of developing lesions that in some cases can lead to cancer. The most common type of cancer caused by HPV is cervical cancer in women, followed by anal cancer, vulvar cancer, vaginal cancer and cancer of the oral cavity, mainly the oesophagus. HPV is also associated with genital warts, which are unpleasant but benign lesions.

Does Human Papillomavirus Affect Men?

As in the case of Mario, men can also develop HPV-associated cancer, including penile cancer, anal cancer and cancer of the oral cavity. It is possible that Mario’s oesophageal cancer is associated with his partner’s cervical lesions. However, it would be very difficult to prove this association, as the tumour may also be due to a previous relationship with another partner.

Is There a Human Papillomavirus Vaccine that Can Prevent Cancer?

Mario does not smoke. He drinks beer occasionally. He is physically active and has a healthy diet. Could this cancer have been prevented? Although most oesophageal cancers are linked to tobacco and alcohol, in Mario’s case, the cause is HPV 16. We now know that there is an excellent vaccine against HPV. If administered before the individual comes into contact with the virus, there is a very good chance of preventing infection, preventing the infection from becoming persistent and preventing associated lesions like Mario’s.

Is the Human Papillomavirus Vaccine Recommended for Boys?

This year, we received wonderful news: the Spanish Ministry of Health has recommended making the HPV vaccine available to school-age boys, as it has been for girls aged 9 to 14 years since 2007. The HPV vaccine is highly effective at preventing infection with the viral strains contained in the vaccine. HPV is a family of more than 200 different viral strains, but only 13 of them are associated with a high risk of cancer. The vaccines commercially available in Spain include the highly carcinogenic strains HPV 16 and HPV 18. One vaccine covers as many as nine strains of HPV. All of Spain’s autonomous communities administer the HPV vaccine to girls and are progressively rolling it out to boys, as well.

Why Is It Important to Vaccinate Boys Against Human Papillomavirus?

As mentioned above, the most common cancer caused by HPV is cervical cancer. Initial efforts have therefore been focused on offering the vaccine to girls and women before they are exposed to HPV infection. Extending HPV vaccination to boys implies a considerable economic cost. Therefore, the reasons for recommending the vaccination of boys must be well defined. To understand the importance of this decision, we need to understand how these viruses behave. HPV infects men and women who are sexually active. The infection can originate in the man and be transmitted to the woman, or vice versa. Although both sexes can be infected, the mucous membranes of the cervix are especially susceptible to infection, making this the most common site for HPV lesions. But we now know that HPV also infects and—if it persists over time—causes damage to the anal mucosa, the vagina, the vulva, the penis and the oesophagus. Fortunately, this happens less frequently than cervical cancer. Most infections resolve spontaneously, thanks to the response of a healthy immune system. In a small percentage of cases, the infection becomes chronic, giving rise to precancerous lesions that can progress to cancer and put the affected person’s life at risk.

Are Human Papillomavirus Vaccines Effective?

Existing HPV vaccines have proved to be very effective at preventing these infections in mucous membranes that are “sensitive” to the virus. Many countries have seen a decrease in rates of cervical cancer in women vaccinated against HPV.

Vaccinating boys accelerates the impact on women, since vaccination reduces the circulation of the HPV virus. The higher the vaccination coverage, the less room there is for the virus to infect people. At the same time, vaccination of boys will make it possible to prevent cancer in men more effectively and more rapidly. These vaccines have been administered to millions of girls and have been shown to be extremely safe. For all these reasons, we celebrate the fact that boys will now have the same opportunity.