Is the Human Papillomavirus (HPV) vaccine necessary for males?

HPV Vaccination in Males: Essential for Cancer Prevention and Public Health

Yes, HPV vaccination is absolutely necessary for males and should be routinely administered at age 11-12 years to prevent HPV-related cancers, genital warts, and to provide herd immunity protection to the broader population. 1, 2

Why Males Need HPV Vaccination

Direct Cancer Prevention Benefits

Males face substantial risk from HPV-related malignancies that vaccination can prevent:

• Oropharyngeal cancer: 72% of cases in males are HPV-associated 2
• Anal cancer: 89% of cases are HPV-related 2
• Penile cancer: 63% of cases are HPV-associated 2
• Genital warts: 90% are caused by HPV types 6 and 11, which vaccines prevent 2

The burden of HPV-related disease in men is high and increasing, particularly oropharyngeal and anal cancers. 3, 4 While direct evidence for cancer prevention in average-risk males is limited due to small numbers of disease outcomes in trials, vaccine efficacy against persistent infections and anogenital warts in young males, combined with efficacy against precancers in men who have sex with men (MSM), provides strong evidence that vaccination will be effective against cancer outcomes in the general male population. 1

Herd Immunity Benefits

Male vaccination provides critical indirect protection to females beyond direct male benefits:

• Australia demonstrated an 80% decrease in genital warts among adolescent boys before males were included in the national vaccination program, showing strong herd immunity effects 1
• Modeling results consistently show that vaccinating males provides additional protection to females through reduced HPV transmission 1

Official Vaccination Recommendations

Routine Vaccination Schedule

For males aged 11-12 years (can start at age 9):

• 2-dose schedule when starting before age 15: second dose given 6-12 months after the first 2
• 3-dose schedule when starting at age 15 or older: second dose at 1-2 months, third dose at 6 months 2

Catch-up vaccination:

• Routinely recommended through age 21 for all males 1
• Males aged 22-26 years may be vaccinated, though efficacy is lower at older ages 1

Special High-Risk Populations

Men who have sex with men (MSM): Routine vaccination through age 26 years due to higher burden of HPV infection and HPV-related cancers, particularly anal cancer and precancers 1, 2

Immunocompromised individuals (including HIV-positive males): Vaccination through age 26 years with a 3-dose schedule regardless of age at initiation 2, 5

Vaccine Options and Efficacy

Available Vaccines for Males

• Quadrivalent vaccine (4vHPV/Gardasil): Protects against HPV 6,11,16, and 18 1
• Nonavalent vaccine (9vHPV/Gardasil 9): Protects against HPV 6,11,16,18,31,33,45,52, and 58 1

Both vaccines are FDA-approved for males. 1 The nonavalent vaccine can prevent approximately 90% of HPV-related cancers. 5

Demonstrated Efficacy in Males

Against anal disease: Vaccine efficacy ranges from 89.6% to 93.1% against anal intraepithelial neoplasia (AIN) grades 1-3 and anal cancer 6

Against genital warts: 89.9% efficacy in HPV-naïve males, with 66.7-67.2% efficacy in intention-to-treat populations 6

Immunogenicity: Vaccine efficacy and immunogenicity in males is comparable to that demonstrated in females, with stronger immune responses observed in younger individuals (ages 9-14 years) compared to older age groups 1, 2

Critical Timing Considerations

Why Early Vaccination Matters

Vaccination must occur before HPV exposure to be maximally effective:

• Nearly 40% of individuals acquire HPV infection within the first 2 years after sexual initiation 2
• The vaccine generates immunity through serum IgG antibodies to the L1 capsid protein, which requires administration prior to infection 1
• Younger adolescents (9-14 years) mount stronger immune responses than older individuals 2

Vaccination at older ages (22-26 years) is significantly less effective because most individuals in this age group have already been exposed to one or more HPV types. 1 Providers should inform individuals aged 22-26 years who have not been previously vaccinated that vaccination at older ages is less effective in lowering cancer risk. 1

Safety Profile

The HPV vaccine has an excellent safety record in males:

• Safety is comparable to that observed in females 1
• Most common side effect is headache (up to 50% of patients) 1
• Risk of syncope exists (as with other intramuscular vaccinations); 15-minute observation period is recommended post-vaccination 1, 2
• No severe complications directly linked to vaccine administration 1
• Contraindicated only in individuals with yeast allergy 1
• Safe even in immunocompromised individuals because the vaccine contains virus-like proteins, not live virus 1

Practical Implementation

Administration Details

• Given as intramuscular injection 1
• Can be administered at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites 2
• No prevaccination HPV testing is necessary 7, 5

Common Pitfalls to Avoid

Do not defer vaccination expecting later vaccination will be equally effective - this is a critical error. Adherence to routine vaccination at age 11-12 years should be emphasized. 1

Do not withhold vaccination from sexually active males - while the vaccine is most effective before sexual debut, sexually active males still derive benefit from protection against HPV types they have not yet encountered. 5

Do not assume prior HPV infection negates all benefit - males already infected with one HPV type are still protected against disease caused by other vaccine HPV types. 5

Real-World Impact

Population-level data demonstrates substantial vaccine impact:

• From the prevaccine era to 2015-2018, 4vHPV-type prevalence decreased 88% among females aged 14-19 years and 81% among those aged 20-24 years 8
• Significant declines occurred even among unvaccinated females (87% among 14-19 year-olds, 65% among 20-24 year-olds), demonstrating herd protection 8
• In Europe, the 9-valent vaccine could prevent more than 350,000 cases of genital warts, 5,485 oropharyngeal cancers, 2,303 anal cancers, and 1,113 penile cancers per year in men 4

Key Takeaway for Clinical Practice

HPV vaccination in males is not optional - it is a critical cancer prevention tool endorsed by the CDC, ACIP, American Cancer Society, and American Academy of Pediatrics. 1, 2 The vaccine prevents multiple cancers in males, prevents genital warts, and provides herd immunity to protect females. Routine vaccination at age 11-12 years, before sexual debut, maximizes individual and population-level benefits.