Information for parents and guardians
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 can cause genital warts.
HPV infection is very common – it is spread by sexual contact.
Condoms reduce the risk but don’t eliminate it because HPV can infect areas not covered by a condom. (Some studies suggest that deep kissing spreads HPV but this hasn’t been proven.) Even after HPV vaccination, condoms should still be used to prevent pregnancy and other sexually transmitted infections like HIV, chlamydia and gonorrhoea.
Vulnerable areas for HPV infection in males include the penis, anus, mouth and throat.
The dangerous types of HPV can’t be caught from 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 someone 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.
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 types 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.
These cancers very rarely affect boys or young men – the vast majority appear when men are middle-aged or older.
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 (73%) of oropharyngeal cancer cases are caused by HPV. This cancer mostly affects men – they are twice as likely to be affected as women. Head and neck 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 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.
Boys cannot currently be vaccinated free of charge by the NHS, unlike girls who are covered by a national vaccination programme.
Girls are offered the vaccine, usually at school when they are 12/13. However, a growing number of boys are now being vaccinated privately (which means there is a charge) and the vaccine is becoming more widely and easily available.
These are the main arguments for opting for a private vaccination:
- Boys and men are as much at risk of HPV infection as girls and women and vaccination provides a very high level of protection against the HPV types that most commonly cause cancer, genital warts or RRP.
- Vaccination offers protection against infection for at least 10 years and probably for much longer.
- Vaccination is more effective when a boy is aged under 15. This is because he is unlikely to have been exposed to HPV yet and because younger people have a stronger immune response (which is why two doses of the vaccine are adequate for younger people – people aged over 15 need three doses). HPV vaccinations can be given from the age of 9.
- Although men cannot get HPV from a woman who has been vaccinated, 15% of girls are not currently vaccinated in the UK. Also, men can get HPV from a woman who was too old to be vaccinated by the NHS (vaccination started for girls in the UK in 2008) or from a woman from another country where there is no vaccination programme for girls or a programme with a low uptake. (In France, for example, only about a quarter of girls are vaccinated). Men can also get HPV through sexual contact with other men; in fact, men who have sex with men are most at risk of infection.
- There is no evidence that HPV vaccination results in earlier or greater sexual activity or more sexual risk-taking by young people.
- 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).
- 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.
- HPV vaccination is now recommended for boys in an increasing number of countries including Australia, Austria, Bermuda, Brazil, Canada, Israel, Italy, New Zealand, Norway, Switzerland and the USA.
- Vaccination for boys is supported by many health organisations and doctors. The BMA (British Medical Association), British Dental Association, Oral Health Foundation, Faculty of Public Health, Royal College of Obstetricians and Gynaecologists and Royal Society for Public Health are among those backing the vaccination of boys. Cancer Research UK states: ‘As HPV is linked to cancers in men as well as women, offering HPV vaccination to men would help reduce the risk of disease.’ A recent HPV Action of survey of almost 1,700 GPs and dentists found that 95% thought that boys should be vaccinated.
Yes. These are the arguments against vaccination
- HPV vaccination for boys is expensive. Typically, it costs about £150 per dose. Adolescents need two doses; older boys (over 15 years) and men need three doses.
- HPV vaccination can sometimes cause side-effects, although these are 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.
- Men who have sex with women who have been vaccinated will not be exposed to HPV. Most women aged up to 26 who grew up in the UK have been vaccinated.
- The UK government’s vaccination advisory committee (known as JCVI) announced in July 2017 that it did not believe boys should be offered HPV vaccinations as part of a national NHS programme. (This is an interim recommendation which may change following a consultation exercise and further analysis. It is not yet known when a final decision will be made.) The JCVI recognized that vaccination would protect more men but considered that the extra cost to the NHS of a programme for boys would outweigh the health benefits to the population as a whole. The JCVI did not give any advice on whether individual boys should be vaccinated privately.
If you are unsure about whether to have your son vaccinated, you may want to discuss this with your GP or school nurse.
Parents and guardians will want to be sure that the vaccination is safe for boys.
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, World Health Organisation and NHS state that there is no solid evidence linking the HPV vaccine with long-term health problems.
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 (85%) 12/13 year-old girls in the UK are vaccinated each year. It is a very common procedure that for the vast majority of girls is quick, painless and uneventful.
Your NHS GP service is very unlikely to be able to provide HPV vaccination for boys . If it is available, it would be on a private basis which means that there would be a charge.
HPV vaccination is now provided for boys at two national pharmacy chains: Boots 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.
The private clinics very occasionally run out of the HPV vaccine but any delay is likely to be fairly short.
Men who have sex with men aged up to 45 attending a sexual health/GUM (genito-urinary medicine) or HIV clinic for another reason should be offered a HPV vaccination. Doctors in these clinics can also offer HPV vaccination to transgender people. There is no lower age limit for vaccinations for men who have sex with men so males under 16, if they are attending a sexual health clinic, are also eligible for a free vaccination.
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.
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.
Boys aged 15 or under will need two injections, with the second between six and 12 months after the first (although it can be given up to 24 months later). The second injection is important as, without it, your son will not be fully protected. The youngest age for an HPV vaccination is nine years.
A boy has the right to refuse a HPV vaccination so a parent or guardian cannot force them to have one. Parents/guardians should make sure they discuss the vaccination with boys in advance. Boys can also read the Information For Boys section of this website.
You can listen to the podcasts.
For more information on head and neck cancers:
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 on this site for health professionals which is more detailed and contains links to background information.
Pharmacy chains offering the vaccine to boys: