At Your Cervix, Sir

I write to clear up a misconception about the HPV vaccine. It protects against 4 strains of HPV, only 2 of which (16 & 18) are cancer related. It DOES work in males, clearly not to protect them from cervical cancer, but to innoculate them against the HPV viruses that causes genital warts (6 & 11), a painful, often intractable, and common STD, and to stop them from becoming carriers of the potentially fatal strains to women.

It ALSO may be indicated to protect against anal and penile cancer, caused by the same strains of HPV. The mianstream press isn't that interested in this part of things, but the word is out:

"The rate of anal cancer for gay men is similar to rates of cervical cancer before the use of Pap smears, a test used to detect precancerous cells. Many gay men are unaware that they have an increased risk of anal cancer.
Pharmaceutical giant Merck has made a vaccine called Gardasil that has been approved by regulators in Australia and the European Union for boys ages 9 to 15. Data shows it caused an immune response in boys, but its ability to prevent infection in sexually active men has not been demonstrated."(The Advocate)

Please recommend this diary to clear up these misconceptions. More below the fold.

I

http://www.gay.com/...

'The efficacy of the bivalent vaccine against HPV 18 infection is ... Penile cancer is rare, accounting for less than 1 percent of all cancers in men; ...

www.scienceblog.com/cms/node/4621 -

IT is because of the homosexual connection that the company is not pushing for this, in this country at least. If idiotic parents are afraid protecting their daughters against cancer is going to make them go and screw, then they might be just as afeared it will make their boys swing the other way.

In Europe, they recognize the need to protect boys AS WELL as the role of males in spreading a disease way more dangerous for women. If we all get German measles vaccines to protect pregnant women from catching the dieseas here, why is the concept of innoculating males agaisnt this STD so hard to grasp?

PRESS RELEASE:

"Merck & Co., Inc. announced today that GARDASIL® (quadrivalent human papillomavirus types 6, 11, 16, 18, recombinant vaccine), has received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) in Europe.  The CHMP opinion recommends that GARDASIL be approved for the immunization of children and adolescents aged 9 to 15 years and of adult females aged 16 to 26 years for the prevention of cervical cancer, high-grade cervical dysplasia (CIN 2/3), high-grade vulvar dysplastic lesions (VIN 2/3) and external genital warts caused by human papillomavirus types 6, 11, 16 and 18. "

16 & 18 do not always ( even remotely) turn into cancer. However, they are the 2 trypes of the HPV virus that are most often found to be the cource of the cancers (there are several others that are more rarely linked to the cancer). I don't believe 6 or 11 have been linked to the cancers at any point.

The reason to innoulcate when young is that if you have ever had a strain of the HPV, the vaccne may not work for you against that strain. If you've been exposed to 6, say, it will protect you against the others, though.

•  I Didn't Know

  The rate of anal cancer for gay men is similar to rates of cervical cancer before the use of Pap smears, a test used to detect precancerous cells. Many gay men are unaware that they have an increased risk of anal cancer.

  Listen up, homos.  This is yet one more reason to find a physician that you are comfortable with, and be completely honest and forthright with him/her.  

  by HarveyMilk on Sat Feb 03, 2007 at 06:58:07 AM PDT

  •  and yes, HarveyMilk..

    ..physicians who are knowledgeable with HIV-related issues DO anal pap smears on gay men who have had a history of HPV-related genital warts.
     At our office, we are offering Gardasil to people who may think that they are at risk - which to me, is anyone who is sexually active with anyone.  For some, they are willing to pay the out-of-pocket expense for the potential benefit of receiving this vaccine.
     So, beloveds (as my dear Molly used to address her readers), if you are sexually active with more than one partner in the last decade - think about getting immunized against sexually transmitted diseases - HPV and Hepatitis A and B.  It may put a hole in the bank account now, but it may save you from a world of hurt and bankruptcy later.

    by drchelo on Sat Feb 03, 2007 at 07:36:35 AM PDT

•  good diary

  If idiotic parents are afraid protecting their daughters against cancer is going to make them go and screw, then they might be just as afeared it will make their boys swing the other way

  Even more so if it has soy in it.

  I must admist I'm a bit bothered by the fact this is being required by Texas. You're not dealing with diseases that spread through minor contact or being around someone, the manditory vaccination trips my 'government coercion' sensors.

  found to be the cource of the cancers

  is that supposed to be 'source' ?

  by wondering if on Sat Feb 03, 2007 at 07:12:57 AM PDT

  •  It can spread through hand to hand contact

    It DOES spread easily--masturbation and handholding. Voila! This stuff is all over the place. It's not like HIV or syphilis, which require some genital or oral countact.

    MOST cases of the virus resolve on their own--most sexually adults in this country have probably had st least one strain. Most of the time nothing happens. Sometimes genital warts occur, or cervical dysplasia (where misshapen cells start forming on the cervix; this sometimes develops into cancer, but also often resolves on its own. And the cancer can take 10 to 20 yeaqrs to develop).

    This is why early vaccination is key, because once you've been exposed, even if the case has resolved, the vaccine is less effective at protecting you from that strain.  If unexposed, it's 100% effective.

    by MmeVoltaire on Sat Feb 03, 2007 at 07:25:16 AM PDT

  •  In Texas, any parent can opt out of the

    vaccination by simply signing a form saying they have "philosophical" objections to their child getting it. What the "mandatory" part does is make the vaccine available to children whose parents may not be able to afford to have them vaccinated. All mandatory vaccines are provided free by the state.

    by Demfem on Sat Feb 03, 2007 at 07:34:55 AM PDT

•  The way I see it

  A vaccine that can prevent any form of cancer is a good thing. The bad part is that it is so darn expensive. Making it mandatory might be a good thing, but only if the funding is there to allow low-income people to be able to afford it. I would hate to have to "opt out" my daughters, but there is no way I can afford to pay for even one series of the vaccines, much less two.

  by LynneK on Sat Feb 03, 2007 at 07:16:16 AM PDT

•  Too Much

  Reality for those fundy types.....

  I had no idea, my god we're all so ignorant.

  by LibChicAZ on Sat Feb 03, 2007 at 07:17:01 AM PDT

•  Good reporting, what about long-term?

  Thank you for a clear presentation of some of the science behind this new vaccine. I would like to know more about long-term safety studies.

  The relationship between estrogen in Hormone Replacement Therapy and birth control pills and increases in breast cancer is clear to us now. Unfortuantely, science about the cancer-causing potency of estrogen only came years after these interventions came on the market with the same kind of ballyhooed, "save the day" rhetoric we are hearing today.

  Since these are prepubescent children we are talking about vaccinating in many cases, what has the CDC and Merck done to assure parents that the 10-year-old we vaccinate today will not experience side effects in her childbearing years 10 to 15 years later?

  This question is crucial in the case of HPV, transmitted during sex and addressable with the same kind of educational intervention that has made such a decrease in the rate of HIV/AIDS infections.

  Until we have such information, no doctor on the order of no BigPharma-backed governor will put a needle in my daughter and inject her with this stuff.

  by wildhand on Sat Feb 03, 2007 at 07:36:39 AM PDT

  •  wildhand...

    ..to perhaps ease your mind a little on this issue, the kind of vaccine that Gardasil is resembles in every way (kind of inactivated virus)the vaccines we have been using to immunize children against measles and rubella for decades.  So far, the only adverse reactions long-term against the measles vaccine was that the old vaccine did not give complete immunity in a fraction of patients.  No such long-term effect has been found against rubella.
     The smallpox vaccine is a live-virus vaccine (using the cowpox virus that causes immunity to both diseases) and there have not been any long-term adverse effects from that vaccine.
     The long-term use of estrogens and their relation to later cancers is a completely different sort of issue - it has nothing to do with immunity against anything - the hormones used actually stimulate estrogen-dependent cells, and that is one of the reasons that they may increase the incidence of breast cancer

    by drchelo on Sat Feb 03, 2007 at 07:41:37 AM PDT

    •  Thank you . . .

      My purpose in bring up estrogen was to point to an historical instance when an intervention had unintended, unanticipated long-term consquences in a large population segment.

      Regarding the safety of attentuated viral vaccines, do I understand you correctly:

      You are comfortable in telling a patient that this Gardasil will likely have a good long-term outcome because other attentuated virus vaccines have?

      What about the case of the infamous RotaShield vaccine, which had to be recalled in 1999 (PDF alert) after less than a year on the market for causing intersussception in children. For those unfamiliar with the incident, intersussception is a dangerous, painful condition in which the intestines telescope in on themselves. The vaccine caused children to undergo emergency surgery and, according to some reports, to die.

      RotaShield was also modeled on the smallpox vaccine.

      by wildhand on Sat Feb 03, 2007 at 07:52:24 AM PDT

      •  There IS no long-term science yet

        You're absoutely right to weigh risks and benefits. Studies were started, I believe, about 10 years ago,  and so far no side effects aside from the usual local and very occasional anaphylactic shock (happens with any vaccine, extremely rare), which can be dealt with if in a trained doctor's office.

        But you're right. It's a dicey question.  Clearly, in some African countries where tens of thousands of women die of cervical cancer every year, the public health issue is easy to decide--this vaccine is a must for those countries.

        In this country, with availability of Pap smear and relatively low risk of cervical cancer, the odds are different. However, if you are a young, very sexually active person (I'm old and mongogamous now; very sexual in youth and probably already exposed to all the strains) you might want to consider it.

        Bottom line: It's a risk/benefit thing. The worst that can happen is cervical or anal cancer (penbile cancer is extremely rare in US). The next worst is genital warts--painful, sometimes hard to cure (or recurrent). The next issue is what responsibility to you play as a potential carrier to others. I'm not saying I know what the right decision is.  As the years go by, we'll find out what the true safety profile is. So far, it's as safe as other similar vaccines.

        by MmeVoltaire on Sat Feb 03, 2007 at 08:11:00 AM PDT

        •  Excellent balance sheet . .

          I didn't know studies were 10 years old. The oldest I know of are 5 years. I'll look for the decade old ones. Thanks. If you have some linky for us, that would be great.

          Your analysis regarding risks/benefits is right on the money and is the sort of process that every parent should go through when making this kind of decision for their child.

          I wish that I had been given a chance to go through this kind of analysis before the HepB shot (to prevent another sexually transmitted disease) was given to my son a few hours after his birth in 1999.

          by wildhand on Sat Feb 03, 2007 at 08:25:55 AM PDT

          •  You're closer than I was

            The first Phase I trial in humans on pubmed (published in English in a journal they accept) is this:

            Muderspach L, Wilczynski S, Roman L, Bade L, Felix J, Small LA, Kast WM, Fascio G, Marty V, Weber J. Related Articles, Links
            A phase I trial of a human papillomavirus (HPV) peptide vaccine for women with high-grade cervical and vulvar intraepithelial neoplasia who are HPV 16 positive.
            Clin Cancer Res. 2000 Sep;6(9):3406-16.
            PMID: 10999722 [PubMed - indexed for MEDLINE]

            Theories about HPV viruses and then animal studies began earlier (1993). But
            you're right--until there are long-term studies in humans, it's all theory.

            Thanks for the correction.

            by MmeVoltaire on Sat Feb 03, 2007 at 08:54:21 AM PDT

    •  was under the impression that the HPV vaccine(s)

      were not live, attenuated vaccines but instead used VLP (virus-like) proteins to basically build their vaccine.

      is the merck vaccine unique in that is IT a live, attenuated vaccine?  if so, when did they develop the technology to be able to actually culture HPV strains in the lab?  that would be amazing if they had, btw.

      but if the vaccine is in fact based on the VLP model, aren't the risks associated with it different than say a smallpox vaccine (given that one is an attenuated vaccine, smallpox; the other not)?

      _________________________________

      "Coimhéad fearg fhear na foighde."

      -9.75 (economic), -7.18 (social)

      by dadanation on Sat Feb 03, 2007 at 11:18:51 AM PDT

•  We need to vaccinate this thread...

  against the anti-vaccination crowd!

  by Diaries on Sat Feb 03, 2007 at 07:42:45 AM PDT

•  Another (somewhat related) reason to be aware

  of is the attitude of both gay & straight kids in the UK & Ireland: nearly 80% of them do not use condoms when engaged in sex. That is scary.

  by Asinus Asinum Fricat on Sat Feb 03, 2007 at 07:53:06 AM PDT

•  INterestingly Gov. "Goodhair" Perry

  just signed an order to require the vaccination of all girls in Texas overruling the "Lege." He said it was important to protect girls from this deadly cancer. Parnets can object due to religious beliefs (gee, I didn't know that getting cancer was a Christian thing to do). But it's interesting that Perry is not pandering to the Christian right. Of course, there's probably a kickback from Merck in there somewhre. Republicans only go against the Christian right when there's some money to be made.

  by MA Liberal on Sat Feb 03, 2007 at 10:10:37 AM PDT