Information for men who have sex with men
Human Papillomavirus (HPV) is the name for a group of viruses that affect the skin and moist areas around the body. (It is completely different from HIV, the virus that causes AIDS.)
There are around 200 types of HPV. Many are harmless. But some types are dangerous and can cause cancer while others cause genital warts.
HPV infection is very common – it is spread by sexual contact.
Condoms reduce the risk but do not eliminate it because HPV can infect areas not covered by a condom. (Some studies suggest that deep kissing spreads HPV but this has not been proven.)
Vulnerable areas for HPV infection in males include the penis, anus, mouth and throat.
You cannot catch the dangerous types of HPV from toilet seats, hugging, holding hands, swimming pools or hot tubs or sharing food or cutlery.
Nearly all sexually active people will be exposed to HPV at some point in their lives. Because the infection is so common, many people are infected shortly after becoming sexually active for the first time. A person who has had only one sexual partner can get HPV although people who have many partners, or who have sex with someone who has had many partners, are more at risk.
Most people with HPV don’t know they are infected and never develop a health problem as a result. HPV usually goes away on its own without any long-term consequences. Having HPV does not mean you will automatically get cancer or genital warts. But HPV infection can persist in some people and cause health problems, sometimes years later.
It is not possible to predict which people with HPV will go to develop health problems but people with weak immune systems are thought to be more at risk. People with HIV/AIDS are among those at greater risk. Smoking may also be a factor.
HPV vaccination is by far the best way of preventing infection and the diseases caused by the virus.
The high-risk types of HPV include HPV 16 and 18. These types can cause cancer. Genital warts are caused by HPV 6 and 11. The cancer-causing and wart-causing types are different. This means that genital warts are not an early-warning sign of cancer.
HPV is estimated to cause 5% of all cancers. Doctors who treat cancer have found that HPV can cause cancers of the penis, anus, head and neck in men. About 2,000 men a year in the UK develop a cancer caused by HPV and some of these cancers are becoming more common.
Head and neck cancers
The clinical evidence shows that HPV causes cancer in different parts of the head and neck, especially the oropharynx. (The oropharynx includes the back third of the tongue, the soft area at the back of the roof of the mouth, the tonsils and the back wall of the throat.) Up to three quarters of oropharyngeal cancer cases are caused bv HPV. This cancer mostly affects men – they are twice as likely to be affected as women. Mouth and throat cancers caused by HPV have become far more common over the past 30 years, a trend that is expected to continue over the next 20 years.
HPV causes the vast majority (90%) of anal cancer cases. This cancer is relatively rare in the UK with around 430 new cases in men in the UK in 2014 (it is about twice as common in women). But the number of cases in men is expected to more than double in the period up to 2035. Anal cancer is much more common in men who have sex with other men. Over 140 men in the UK died from anal cancer in 2014.
Clinical studies suggest that HPV infection causes up to half (48%) of penile cancer cases. This cancer is relatively rare in the UK: there were around 630 new cases in the UK in 2014, an average of two new cases every day. However, penile cancer is becoming more common with 25% more cases now being diagnosed each year than in the early 1990s. There were 130 penile cancer deaths in 2014.
HPV causes genital warts, the second most common sexually transmitted infection. In men, warts can develop on the penis, scrotum, urethra (the tube which urine goes through from the bladder to the penis), the upper thighs and on, or inside, the anus. Both men and women are affected but the problem is much more common in men. UK-wide data on the number of cases of warts is not available but HPV Action estimates that about 40,000 cases are diagnosed in men each year.
Recurrent respiratory papillomatosis (RRP)
People with RRP have wart-like growths on their airways. These can seriously affect breathing. RRP affects both children and adults. Children are infected while still in the womb or at birth. Males and females are about equally affected.
Doctors treating breathing diseases have found that HPV is the cause of this rare but distressing problem. It can affect children as well as adults of both sexes and can be difficult to cure.
These are the main arguments for having a HPV vaccination if you have sex with men:
- Men are as susceptible to HPV infection as girls and women and vaccination provides a high level of protection against the HPV types that cause cancer, genital warts or RRP. Men who have sex with men are at much greater risk of anal cancer in particular.
- Men who have sex with men are not protected at all by the vaccination programme for girls. That only benefits men who have sex with women.
- Vaccination offers protection against infection for at least 10 years and probably for much longer.
- Vaccination is most effective when a boy is aged under 15 because, at that age, he is unlikely to have been exposed to HPV. But vaccination is still a good idea for adults because it can protect you against high-risk types of HPV that you may not have been exposed to yet. It can also prevent re-infection by a high-risk type that you may already have been exposed to but which your body has previously cleared.
- There is no screening programme for men that can detect cancers caused by HPV at an early stage. There is no male equivalent of the cervical cancer screening programme so anal and other cancers caused by HPV are often diagnosed late.
- Vaccination could offer you peace of mind.
- Vaccination is socially responsible – the more people who are protected, the less easily HPV can circulate in the whole population and affect unvaccinated men and women.
- The UK government’s vaccination advisory committee has decided that men who have sex with men up to 45 years of age should be offered HPV vaccination at sexual health (GUM) and HIV clinics.
Yes. These are the arguments against vaccination:
- HPV vaccination on a private basis is expensive. Typically, it costs about £150 per dose and men over 16 need three doses. However, vaccination is currently free for men who have sex with men who are using sexual health (GUM) or HIV clinics for another reason.
- HPV vaccination can sometimes cause side-effects, almost always mild and short-lived such as soreness, swelling and redness in the arm. There is more information on the safety of the HPV vaccine here.
- Most HPV infections do not lead to a health problem – only a small proportion of people with HPV go on to develop cancer or another disease caused by HPV.
- The older you are, and the more partners you have had, the more likely you are to have already been exposed to the high-risk HPV types. This means that vaccination may not actually be of any benefit. However, there is no way of finding out if this is the case.
- Vaccination does not provide a cure or treatment for an existing HPV infection.
There are occasional stories in the media suggesting that some teenage girls’ health has been seriously affected by the HPV vaccine but the overwhelming evidence from scientific and medical studies is that HPV vaccinations are, in fact, very safe. The European Medicines Agency, the World Health Organisation and the UK Department of Health believe that HPV vaccinations are safe. There are no known reports of any serious or long-term side-effects caused by HPV vaccination in adults.
The NHS says that the most common side effects of the HPV vaccine include swelling, redness and pain at the site of the injection, and headaches.
A much smaller group of people might experience fever, nausea (feeling sick) and painful arms, hands, legs or feet. More rarely still, some people develop an itchy red rash. Very rarely, in about one in 10,000 cases, there may be a restriction of the airways and breathing problems. One person in a million may have a severe allergic reaction.
These problems, which may be unpleasant and even distressing, are treatable through self-help (e.g. painkillers) or by healthcare staff. They are also short-lived and people make a full recovery. The staff who give the vaccines are trained to spot and deal with any allergic reactions.
The small risk of having one of these side-effects must be balanced against the risk of developing a disease caused by HPV such as cancer.
Most 12/13 year-old girls in the UK have been vaccinated each year since 2008. It is a very common procedure that for the vast majority is quick, painless and uneventful.
Men who have sex with men aged up to 45 are eligible for free HPV vaccinations at sexual health and HIV clinics. It is now possible to attend just for a vaccination (it is no longer the case that you have to be there for another reason such as a check-up, treatment of a sexually transmitted infection or a vaccination against hepatitis B).
There is no lower age limit for HPV vaccinations at sexual health and HIV clinics for men who have sex with men.
Men who have sex with men who are in prison are also eligible for free HPV vaccinations from prison health services.
The vaccination service for men who have sex with men was set up because they are at greater risk of HPV infection and the diseases it causes.
To be eligible for vaccination, you will need to disclose to clinic staff that you have sex with men. If you prefer not to do this, you will not be offered the vaccination. This means that if you still want to be vaccinated you will have to arrange this privately.
Your NHS GP service is very unlikely to provide HPV vaccination to men. If it is available, it would be on a private basis.
HPV vaccination is now provided privately for adult men at three national pharmacy chains: Boots, Lloyds and Superdrug.
The vaccination is also available from a number of private health centres and travel clinics. An online search along the lines of “Where can I get HPV vaccination privately in [insert nearest town/city] UK” should be helpful.
Three types of vaccine are available:
- Cervarix. This vaccine was used by the NHS in the early years of the girls’ vaccination programme. It protects against two HPV types (16 and 18) that can cause pre-cancers and cancers of the cervix, vulva, vagina and anus. Cervarix does not offer protection against the HPV types (6 and 11) that cause genital warts. It can be given from the age of 9.
- Gardasil. This is the vaccine currently used for girls by the NHS for the national HPV vaccination programme. It can be given from the age of 9 and protects against infection by the four most significant HPV types, 16 and 18 that can cause cancer and 6 and 11 that can cause genital warts. It is used to prevent pre-cancers and cancers of the cervix, vulva, vagina and anus as well as genital warts.
- Gardasil 9. This is the newest HPV vaccine available. It protects against 9 HPV types, 16,18 and five others that can cause cancer and 6 and 11 that can cause genital warts. It can be given from the age of 9 years to prevent pre-cancers and cancers of the cervix, vulva, vagina and anus as well as genital warts.
The vaccine manufacturers do not claim that their products protect against the development of HPV-caused penile, head and neck cancers. However, most scientists, doctors and dentists believe that, due to the similarities in the diseases, the vaccines do offer protection against these cancers as well as penile and anal cancers. The UK government’s vaccination advisory committee (known as JCVI) is among those sharing this view.
If you are aged 15-45, the vaccine is given through a course of 3 injections over 4-12 months. The second dose is given at least one month after the first. The third is at least three months after the second dose (and ideally within 12 months of the first dose).
There is an NHS leaflet on HPV vaccination for men who have sex with men.
You can listen to the podcasts on this website.
For more information on head and neck cancers:
- Throat Cancer Foundation
- Mouth Cancer Foundation
- Oral Health Foundation
- Mouth Cancer Awareness Month
- Cancer Research UK
- The Swallows
- Oral Cancer Foundation (USA)
For more information on anal cancer:
For more information on penile cancer:
For more information on genital warts:
For more information on RRP:
For more information on vaccine safety:
You could also read the section for health professionals which includes all the links and references to the information.
Pharmacy chains offering the vaccine to men: