Why HPV Vaccination is Recommended for Males
HPV vaccination is recommended for males to prevent anal and penile cancers, genital warts, and to reduce transmission to sexual partners, with routine vaccination recommended at ages 11-12 years for all boys. 1, 2
Direct Protection Against Male Cancers and Disease
Males benefit from direct protection against multiple HPV-related diseases:
Anal cancer prevention: The vaccine demonstrates 89.6-93.1% efficacy against anal intraepithelial neoplasia (AIN) grades 2/3 and anal cancer in males. 3 This is particularly important as approximately 2% of all male cancers are attributable to HPV. 4
Penile cancer prevention: Up to 50% of penile cancers are driven by HPV, with HPV-16 being the most frequently isolated subtype. 4 The vaccine provides protection against this oncogenic strain.
Genital warts prevention: The quadrivalent vaccine shows 89.9% efficacy against genital warts in HPV-naïve males, with 66.7-67.2% efficacy in intention-to-treat populations. 3 HPV types 6 and 11 cause 90% of genital warts. 5
Potential oropharyngeal cancer prevention: While not yet an FDA-approved indication, vaccination is believed to provide downstream benefits against oropharyngeal cancers and is endorsed by most healthcare professionals. 1 However, direct evidence for oropharyngeal cancer prevention remains limited. 1
Herd Immunity Benefits for Female Partners
Vaccinating males provides substantial indirect protection to females through herd immunity:
Mathematical modeling demonstrates that male vaccination offers additional protection to females beyond female-only vaccination programs, particularly when female vaccination coverage is suboptimal. 1
Real-world evidence from Australia showed an 80% decrease in genital warts among adolescent boys before males were included in the national vaccination program, demonstrating powerful herd immunity effects. 1
Male vaccination prevents transmission of HPV to female sexual partners, reducing their risk of cervical, vulvar, and vaginal cancers and precancerous lesions. 1, 6
Optimal Timing and Schedule
Vaccination timing is critical for maximum effectiveness:
Routine vaccination at ages 11-12 years is recommended (can start as early as age 9), ideally before sexual debut when individuals are HPV-naïve. 2, 7 Approximately 24% of teenagers report sexual activity by 9th grade and 58.1% by 12th grade. 2
For males aged 9-14 years: A 2-dose schedule is recommended, with the second dose given 6-12 months after the first. 2, 7
For males aged 15-26 years: A 3-dose schedule is required (at 0,1-2, and 6 months). 2, 7
Catch-up vaccination is recommended through age 21 years for all males not previously vaccinated. 1, 7 The American Cancer Society endorses ACIP recommendations with the caveat that vaccination effectiveness decreases with age due to likely prior HPV exposure. 1
Special High-Risk Populations
Certain male populations warrant extended vaccination recommendations:
Men who have sex with men (MSM): Vaccination is recommended through age 26 years due to the exceptionally high burden of HPV infection, anal cancer, anal precancers, and anogenital warts in this population. 1
Immunocompromised males (including HIV-positive individuals): Should receive a 3-dose schedule regardless of age at initiation, even if starting before age 15. 7
Current Vaccine and Coverage
The 9-valent HPV vaccine (Gardasil-9) is the only vaccine currently available in the United States:
Protects against 9 HPV types (6,11,16,18,31,33,45,52,58), preventing approximately 84% of HPV-related cancers. 7, 5
Gardasil is FDA-approved for both males and females aged 9-26 years, unlike the bivalent Cervarix which is approved only for females. 1, 5
The vaccine is safe with comparable safety profiles in males and females, with headache being the most common side effect (up to 50% of patients). 1
Population-Level Impact
Male vaccination has significant public health implications:
HPV vaccination can prevent approximately 28,500 cancers annually in the United States across both sexes. 2, 7
Mathematical modeling projects that including 12-year-old boys in vaccination programs could reduce HPV-16 infection by 68-82% in males and 88-94% in females by 2050. 6
Male vaccination reduces disease burden in both males and females, with efficacy of up to 80% against external genital lesions. 4
Critical Implementation Points
Key considerations for clinical practice:
No pre-vaccination testing is required: No Pap smear, HPV testing, or antibody testing is needed before vaccination. 2, 7
Provider recommendation is paramount: It has been consistently identified as the primary factor in HPV vaccine acceptance and utilization. 1
Do not delay vaccination based on speculation about when the child will become sexually active—the cumulative incidence of HPV infection approaches 40% within the first two years after first sexual intercourse. 2
Vaccination rates among males remain extremely low (only 4% of men worldwide were fully vaccinated as of 2019), representing a significant missed opportunity for disease prevention. 3