HPV Vaccination for Adult Males with History of Genital Warts
Yes, HPV vaccination is recommended for adult males with a history of genital warts, regardless of their prior HPV infection or genital warts history, provided they fall within the appropriate age guidelines. 1
Age-Based Recommendations
The strength of the recommendation depends critically on the patient's age:
Males Through Age 26 Years
- Catch-up HPV vaccination is routinely recommended for all males through age 26 years who are not adequately vaccinated, irrespective of history of genital warts. 1, 2
- For males aged 13-21 years, routine vaccination is recommended with either quadrivalent (4vHPV) or nonavalent (9vHPV) vaccine. 1
- For males aged 22-26 years, vaccination may be administered and is particularly recommended for men who have sex with men (MSM). 1
Males Aged 27-45 Years
- Catch-up vaccination is NOT routinely recommended for all adults over age 26. 1, 2
- Shared clinical decision-making is recommended for adults aged 27-45 years who are not adequately vaccinated. 1, 2
- The public health benefit in this age range is minimal, with the number needed to vaccinate increasing from 202 (current program) to 6,500 when extending to age 45 years. 2
Males Over Age 45 Years
Critical Point: Prior Infection Does Not Preclude Vaccination
A history of genital warts is explicitly NOT a contraindication to HPV vaccination. 1 The CDC guidelines specifically state:
- Vaccination should be given irrespective of history of genital warts. 1
- HPV vaccine can be administered to persons with a history of genital warts, abnormal test results, or positive HPV DNA test results. 1
- No prevaccination testing (e.g., HPV testing) is recommended to establish appropriateness of vaccination. 1
Rationale for Vaccination Despite Prior Infection
The reasoning behind vaccinating individuals with prior genital warts includes:
- HPV vaccines protect against multiple types. Genital warts are typically caused by HPV types 6 and 11, but the quadrivalent and nonavalent vaccines also protect against oncogenic types 16 and 18 (and additional types in 9vHPV). 1
- Most sexually active adults have been exposed to some HPV types, but not necessarily all vaccine-type HPV. 1, 2
- No clinical antibody test can determine whether a person is immune or susceptible to any given HPV type. 1, 2
- HPV vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV before vaccination. 1, 2
Important Caveats About HPV Vaccines
HPV vaccines are prophylactic only—they prevent new HPV infections but do not treat existing infections or HPV-related diseases. 1, 2 This means:
- The vaccine will not clear existing genital warts or accelerate their resolution. 1
- The vaccine will not prevent progression of existing HPV infection to disease. 1
- The vaccine will not decrease time to clearance of current HPV infection. 1
- However, vaccination can still protect against other vaccine-type HPV infections the patient has not yet acquired. 2
Dosing Schedule
- For males initiating vaccination before age 15: 2-dose schedule at 0 and 6-12 months. 2
- For males initiating vaccination at age 15 or older: 3-dose schedule at 0,1-2, and 6 months. 1, 2
- For immunocompromised males: 3-dose schedule regardless of age at initiation. 2
Special Populations
- Men who have sex with men (MSM) should be vaccinated through age 26 years, as they may especially benefit from prevention of condyloma and anal cancer. 1
- Immunocompromised males through age 26 years should be vaccinated, though vaccine effectiveness might be lower in this population. 2
Clinical Decision-Making for Ages 27-45
When considering vaccination for males aged 27-45 years with history of genital warts, factors favoring vaccination include:
- Having new sex partners or anticipating new partners in the future (increased risk for acquiring new HPV infections). 1, 2
- Not being in a long-term, mutually monogamous relationship. 1, 2
- Being MSM or immunocompromised. 1
Factors suggesting lower benefit: