Human papillomavirus vaccination in the United Kingdom: what about boys?

In September 2008 the UK Department of Health initiated a human papillomavirus (HPV) immunisation programme for girls aged 12-13 for prevention of cervical cancer, which is most often caused by two HPV types. An important question, yet to be addressed, is whether boys should also be vaccinated. Men also get HPV and transmit it sexually, not just women. Certain HPV types are associated with genital warts, which have significant morbidity, and with difficult to treat non-cervical malignancies, including vulval, penile, anal and oro-pharyngeal cancer, which are best prevented through vaccination. Moreover, increased persistence of HPV infection is associated with HIV infection. A review of the literature and evidence from modelling suggest that vaccinating boys would increase vaccination impact and may be necessary to achieve herd immunity targets. Excluding boys sends the wrong message that girls and women alone are responsible for sexual health. Although protective efficacy of the vaccine in men has not yet been fully established, the rationale for vaccinating boys as well as girls at an early age is strong, assuming efficacy is established. Meanwhile, provision of the quadrivalent vaccine should become UK policy, in order to include protection against genital warts, the argument for which is strengthened if boys are also vaccinated.