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HPV and Men

One for the Boys: A Guy’s Guide When a Female Partner is Diagnosed with HPV

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Danielle Sepulveres, author of the just released book Losing It: The Semi-Scandalous Story of an Ex-Virgin, offers insight for male partners of women diagnosed with HPV or a related condition. Losing It is available online at amazon.com and barnesandnoble.com.

HPV, abnormal Pap tests, follow-up exams and treatments are confusing for the women dealing with them, but what about the boyfriends and husbands? There aren’t many resources to help a baffled guy understand what’s going on with HPV, or how to best support the woman in his life who’s dealing with a diagnosis. Danielle Sepulveres offers a quick FAQ to help men get a clue.

Describe the experience of an abnormal Pap. What’s it like when a woman first hears that something is abnormal?
DS: You get that sinking feeling in the pit of your stomach. Most often, there are no symptoms or any warning that something might be abnormal. You just think you’re going in for the annual checkup and then you get a phone call that something’s not quite right. It’s really scary, especially when it happens at a young age (I was 23), because there’s no way you’re prepared for it or expecting to hear something like that.

What does the guy need to do to support the woman when she is first dealing with an abnormal Pap (or a positive HPV test) and is just beginning to let it all sink in? What is it that she’d like to have from him?
DS: He needs to put his girlfriend or wife first. My boyfriend didn’t understand what was happening, so I spent most of the time reassuring him when it should have been the other way around. Instead of going into a panic yourself, she really needs you to be the more stable person. Get yourself informed and educated, and consider going to her appointment so you can ask questions, too. She needs to focus on keeping her cool and calm, so it’s not helpful if the man is just adding to her stress.

The boyfriend or husband is worried about his partner, but also wondering what it all means for him…
That’s true, which is why it’s a two-way street and he also needs to be informed. My doctor was wonderful and told me repeatedly that my boyfriend was more than welcome to come and ask questions, and I think most doctors have a similar mentality. They know the guy probably doesn’t understand what’s going on and would like information. I think the main things are to be supportive, be informed, and know what it is you’re talking about instead of blindly fumbling around the subject.

Talk about what it’s like going through follow-up exams such as colposcopy and biopsy.
It was funny for me because I’d never heard of colposcopy and I kept thinking he was saying “colonoscopy”, and I was thinking “What’s THAT got to do with all this?”

It was somewhat painful for me to go through the colposcopy/biopsy; I wasn’t quite prepared for it because a Pap test is so quick, painless, and easy. They had warned me that colposcopy takes longer than a Pap, as they really have to ‘scope you and see what’s going on, so it’s not as quick and simple. Unlike a Pap, with a colposcopy there’s a tendency to have cramping and discomfort from the speculum being inserted for such an extended period of time.

So I found it to be really uncomfortable, even after it’s over. It feels as if your body is rejecting whatever was happening to it, foreign, unnatural feeling of the exam. I remember thinking “Uh oh, if the biopsy shows there really are precancerous cells, what happens next? If this is so uncomfortable, what might an actual treatment be like?” My mind was already racing ahead!

How long does the recovery last after colposcopy/biopsy? Are you ok the next day or how long does it take?
I was fine by the next day. I felt kind of nauseous and sick to my stomach for the rest of the day, and I’m sure stress and nerves contributed to that. I just didn’t feel well for a day or so.

What should the guy do for her that night or the next day? Does he cook her dinner, give her a neck rub, or leave her the heck alone?
I would say he should set her up on the couch or in bed with DVDs of movies she likes, make her dinner but something she can handle in case she’s not feeling well, something light like chicken noodle soup or a comfort food. If she wants to talk about the experience or explain what she’s feeling let her do so, but also respect her and give some space if she doesn’t want to talk about it.

Talk about what it feels like when a woman first hears “HPV”.
I was terrified. I had read maybe one article about HPV and cervical cancer in Cosmo, but hadn’t paid much attention otherwise. My doctor called my work line to deliver my Pap test results, which made me think it was more urgent and “God, this can’t be good!” In the conversation he was reassuring, though, and stressed how common HPV is. He explained how we have options; the abnormal cells are something we can work with.

It just never even occurred to me I was at risk! I was angry about it, and it just felt unfair. I’m faithful, monogamous, only one partner, but there you go...

When you heard “precancer” what went through your mind?
How long does it take to turn into cancer? How do you get rid of it? What if you can’t get rid of it? I also wondered about being with my partner, and if we’d just keep giving it back and forth. I had so many questions, and was lucky to have a doctor who was constantly educating himself so he had the most up to date information. As nervous as I was, my confidence in my doctor made me feel better. I trusted him 100%, feeling sure he knew what to do for me. Having a good rapport with your doctor is essential.

You had two rounds of cryotherapy and a LEEP procedure. Give our men some perspective about that.
They should know the woman feels tired and maybe a bit nauseous. With cryotherapy, the cervix if being frozen which means it has to “melt” and recover, so for the next few weeks -as my doctor put it - the abnormal cells are just popping off and leaving your body. I was just hoping it was working! But it feels like your body is not your own for a few weeks. The second round I had was more intense than the first, so I really didn’t feel well after that one. Even the next day felt a little bit off.

With LEEP, they talk about removing part of your cervix which can potentially cause issues for women who want to get pregnant later. LEEP doesn’t prevent women from getting pregnant, but it can cause some issues when you are pregnant (like premature delivery), and from what I was told it’s just something that needs to be monitored a little more closely versus a woman who hasn’t had a LEEP. Men should know there are so many thoughts racing through her mind, so many worries over things like this.

So again, I encourage guys to do their best to be informed, be supportive, and don’t hesitate to ask questions. I think sometimes men are uneasy to bring it up, but it’s better to ask questions and know rather than being afraid to talk about it. It’s good for the woman to see he’s involved, engaged, and just making an effort to be there for her.

Read more about HPV and men at ASHA and Danielle’s blog.


ACIP Recommends Routine Use of Gardasil with Males

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In late October the Advisory Committee on Immunization Practices (ACIP) approved a recommendation for routine use of the quadrivalent HPV vaccine with males 11-12 years of age.

HPV vaccines first came on the market in 2006 with the approval of Merck’s Gardasil®. In 2009 another HPV vaccine, GlaxoSmithKline’s Cervarix®, was also approved in the U.S. Gardasil® and Cervarix® both protect against persistent infections and diseases related to two “high risk” HPV types found in most cervical and anal cancers. Additionally, Gardasil® also protects against a pair of “low risk” HPV types found with about 90% of cases of genital warts.

In 2009 Gardasil® was approved for use in males to prevent genital warts, and ACIP issued a “permissive” recommendation that essentially left the decision of using the vaccine in boys and young men to the discretion of health care providers. The more robust recommendation to use Gardasil® “routinely” with boys ages 11-12 brings ACIP’s guidance in line with what it has previously issued for girls. ACIP recommends routine use of either Gardasil® or Cervarix® with females ages 11-12 year, with catch-up vaccination through age 26 for those who haven’t had the shots.

Speaking at a press briefing about the updated recommendations, CDC spokesperson Anne Schuchat, MD, said it makes sense to give HPV vaccines early: “It turns out that the age of 11 or 12 is a very good time to be vaccinated. Antibody or immune responses are the strongest and that's well before girls or boys would become sexually active. So the vaccine works most well when given at the younger age. We know parents are confused about when they ought to vaccinate their daughters and we hope to improve that messaging going forward.”


Making the Case for Male Vaccination

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Submitted by the HPV and Anal Cancer Foundation

The Advisory Committee on Immunization Practices (ACIP) is the federal committee assigned to advise the Centers for Disease Control and Prevention (CDC) on national vaccine policy. The ACIP is currently deliberating over whether to issue a routine recommendation for the Gardasil HPV vaccine in the male population. This is an incredible opportunity to reduce the HPV-cancer burden on the US population. Each year in the United States over 28,000 people are diagnosed with an HPV-related cancer.

The HPV vaccine has already been approved to protect against HPV related cancers in men and women (as well as genital warts). It has been specifically approved for protection against anal, cervical, vulvar and vaginal cancers. HPV can also cause penile and head and neck cancers. The ACIP has issued a routine recommendation for girls and women to obtain the vaccine, to supplement the FDA’s approval. A routine recommendation has broader implications for insurance companies, as well as local and federal health programs, than permissive recommendations for vaccines.

On June 22, the HPV and Anal Cancer Foundation led a coalition of organizations in testifying to the ACIP to encourage a routine recommendation for men. The testimony addressed the moral and health imperative to expand the vaccine to males. HPV-caused cancers are often stigmatized and can be difficult to treat. Anal cancer is on the rise in women and men, especially in the HIV-positive population. HPV-related oropharyngeal cancers are increasing in the male population and it is difficult to detect the cancer early. Men and women equally carry and transmit HPV, which can result in the transmission of the virus between partners. The community of men-who-have-sex-with-men (MSM) is especially at risk, and they are not protected by herd immunity that may exist from female vaccination. To prevent cancer in the highest number of Americans, both the male and female population should be given the same access and encouragement to obtain the vaccine.

The U.S. has fallen dramatically behind other developed countries in HPV inoculation rates. The vaccine is America’s best chance to lower the burden from HPV-associated malignancies. Even with widespread knowledge of the need to visit a gynecologist, 12,000 women slip through cervical cancer screening programs each year and are diagnosed with the disease. Screening protocols for HPV-related cancers in other sites are either non-existent or not effectively implemented. Systemic therapies for those with advance HPV-associated cancer are limited in their efficacy.

Attached is the testimony submitted by the HPV and Anal Cancer Foundation, American Social Health Association, The Farrah Fawcett Foundation, Global Initiative Against HPV and Cervical Cancer, GMHC, International Rectal Microbicide Advocates , Kristen Forbes EVE Foundation, LGBT Cancer Network,The National Cervical Cancer Coalition, The Oral Cancer Foundation and Project Inform.

The ACIP will meet to continue their discussion in October.

The HPV and Anal Cancer Foundation is dedicated to reducing suffering of and ensuring quality care for those affected by anal cancer and the virus that causes the majority of cases, human papillomavirus (HPV). Visit them online.


Study: Half of Men Have HPV

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HPV was detected in half the men participating in a large international study, according to a paper published online in The Lancet.

Over 1,100 men between the ages of 18-70 from Brazil, Mexico, and the U.S. took part in the Human papillomavirus in Men (HIM) study. Penile samples were taken every six months and tested for HPV DNA. Subjects were followed for an average of 27.5 months. The study examined HPV incidence and clearance.

Principal investigatorHPVmen Anna Giuliano, PhD, and colleagues found 50% of subjects acquired some type of HPV during the study (age didn’t affect incidence). The presence of oncogenic or “high risk” HPV types (found in 30% of subjects) was linked with behaviors such as having a high number of lifetime sex partners (50 or more) and having three or more male anal sex partners.

With the HPV types covered by the Merck and GlaxoSmithKline vaccines, prevalence was 6% with HPV-16 and 2% with HPV-18, respectively. As for the two “low risk” types that cause approximately 90% of genital warts, 7% of subjects had HPV-6 while 1% had HPV-11 detected (Merck’s vaccine also protects against these HPV types).

Both oncogenic and non-oncogenic HPV infections cleared on average in about 7.5 months but HPV-16, the type most prominent in cervical and some other cancers, tended to last just over 12 months. Men with a higher number of female sex partners took longer to clear both "high risk" and "low risk" HPV. Regarding “high risk” types, clearance occurred more quickly in older men than their younger counterparts (the authors speculate this may be due to higher antibody levels in older subjects).

The authors say understanding natural history data like these will better inform estimates of cost-efficacy of including males in HPV vaccine programs.

Anna R Giuliano, Ji-Hyun Lee, William Fulp, Luisa L Villa, Eduardo Lazcano, Mary R Papenfuss, Martha Abrahamsen, Jorge Salmeron, Gabriella M Anic, Dana E Rollison, Danelle Smith. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. The Lancet, 2011. Published online March 1, 2011.


Emphasizing Cancer Prevention May Make HPV Vaccines More Acceptable to Men

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A new study finds that HPV vaccines are more acceptable to men when presented as preventing both genital warts and cancer.

Merck’s Gardasil® and GlaxoSmithKline’s Cervarix® vaccines are effective at blocking persistent infections and diseases associated with the two “high risk” HPV types (HPV 16 and 18) associated with cervical cancers. Gardasil also works in preventing infection with well as the non-cancer linked HPV types (HPV 6 and 11) that cause 90% of genital warts. While Gardasil is currently only approved for use with males to prevent genital warts specifically, the “high risk” HPV types covered by the vaccine are also associated with cancers that affect men, including those of the penis, anus, and head and neck.

Gardasil was initially approved in 2006 for use with women, and in 2009 was licensed for males. Given the vaccine is associated strongly with the prevention of gynecologic cancers, a natural question is how best to market it to males.

To examine how men respond to different approaches of “framing” HPV vaccines, researchers conducted an online survey with men ages 18 to 59 who identified as either heterosexual or gay/bisexual. The men were given four scenarios with an unidentified vaccine that included prevention of genital warts alone, or both warts and anal, penile, or oral cancer.

Only 42% of the men said they would have the vaccine when it was presented as preventing warts alone, but those willing to receive the vaccine jumped to 60% when any of the cancers were included. The outcomes were the same regardless of sexual orientation or which of the three cancers were included. The authors say their findings might be helpful as messages about HPV vaccines are developed for males.

Annie-Laurie McRee, Paul L. Reiter, Kim Chantala, and Noel T. Brewer. Does Framing Human Papillomavirus Vaccine as Preventing Cancer in Men Increase Vaccine Acceptability? Cancer Epidemiology Biomarkers and Prevention, 2010. 19(8); 1937–44.