Early Acquisition of Anogenital Human Papillomavirus Among Teenage Men Who Have Sex With Men

Journal of Infectious Diseases
Volume 209 Issue 5 March 1, 2014

Young Gay Men and the Quadrivalent Human Papillomavirus Vaccine—Much to Gain (and Lose)
Ross D. Cranston
Department of Medicine, University of Pittsburgh, Pennsylvania
Human papillomavirus (HPV) is the world’s most common viral sexually transmitted infection [1, 2]. Approximately 40 HPV types infect anogenital squamous epithelium and can be broadly divided into low-risk (eg, HPV 6, 11) and high-risk (eg, HPV 16, 18) phenotypes based on their historical association with cervical cancer. This relationship also holds true for other anogenital (anal, vulvar, vaginal) and oropharyngeal malignancies. Although most HPV infections are asymptomatic, when symptoms do occur, they often reflect the presence of warts, dysplasia, or frank malignancy.

Anogenital HPV infection is mostly transient in both sexes, with persistent high-risk HPV infection associated with the development of squamous-cell cancers [3, 4]. HPV prevalence data vary by gender, with men being more likely to have higher-level detection over a wider age range than women, whose prevalence decreases from a peak in their early 20s [3, 5] However, it is men who have sex with men (MSM) who have the highest rates of anogenital HPV infection and also HPV-associated malignancy, particularly HPV 16–associated anal cancer [6, 7].

HPV vaccination has been shown to be safe and effective in preventing the acquisition of anogenital HPV infection and the development of dysplasia [8–10]. The challenge ahead is to ensure that vaccinations are available to those at risk in a manner that optimizes their efficacy.    There are 2 licensed HPV vaccines: a bivalent vaccine directed against HPV 16 and 18 (Cervarix, GlaxoSmithKline, London, UK) licensed for females aged 9–25 years, and a quadrivalent HPV vaccine (qHPV) directed against HPV 6, 11, 16, and 18 (Gardasil, Merck, Whitehouse Station, NJ) licensed for females and males ages 9–26 years. Both vaccines’ indications include prevention of…

Early Acquisition of Anogenital Human Papillomavirus Among Teenage Men Who Have Sex With Men
Huachun Zou1, Sepehr N. Tabrizi2,3,4, Andrew E. Grulich5, Suzanne M. Garland2,3,4, Jane S. Hocking6, Catriona S. Bradshaw1,7,8, Andrea Morrow7, Garrett Prestage5,9, Alyssa M. Cornall3,4, Christopher K. Fairley1,7,9,a and Marcus Y. Chen1,7,9,a
Author Affiliations
1School of Population and Global Health, University of Melbourne, Melbourne, Australia
2Department of Obstetrics and Gynaecology, University of Melbourne
3Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
4Murdoch Children’s Research Institute, Melbourne, Australia
5Kirby Institute, University of New South Wales, Sydney, Melbourne, Australia
6Centre for Women’s Health, Gender and Society, University of Melbourne, Melbourne, Australia
7Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
8Central Clinical School, Monash University, Melbourne, Australia
9Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia

Background. Anogenital human papillomavirus (HPV) is common among men who have sex with men (MSM) and causes anal cancer. This study examined the determinants of initial anogenital HPV infection among teenage MSM.

Methods. Two hundred MSM aged 16 to 20 years were recruited via community and other sources. Men were tested for HPV DNA from the anus and penis.

Results. The proportion of men with anal HPV of any type increased from 10.0% in men reporting no prior receptive anal sex to 47.3% in men reporting ≥4 receptive anal sex partners (P < .001).A similar pattern was also seen with HPV type 16 (P = .044). The proportion of men with penile HPV increased from 3.7% in men reporting no prior insertive anal sex to 14.8% in men reporting ≥4 insertive anal sex partners (P = .014). Overall, 39.0% (95% confidence interval (CI), 32.2%−46.1%) of men had at least 1 HPV type: 23.0% (95% CI, 17.4%−29.5%) had a vaccine-preventable type (6, 11, 16 or 18).

Conclusions. Early and high per partner transmission of HPV occurred between men soon after their first sexual experiences. HPV vaccination needs to commence early for maximal prevention of HPV among MSM.