Prevalence of HPV, vaccination rate in men
The recent Han et al study from the National Health and Nutrition Examination Survey (NHANES), which represents a national sample of 76.9 million U.S. men aged 18 to 59 years, found that men have a high burden of overall penile HPV infection at 45.2%. The distribution of genital HPV infection in U.S. men appeared to be widespread among all age groups and followed a bimodal pattern, with a peak among men aged 28 to 32 years (50.8%) and a second higher peak among men aged 58 to 59 years (59.6%). The HPV vaccination coverage in men who were eligible for vaccine was only 10.7%.8 Over 25 million eligible U.S. men did not receive HPV vaccination.
According to estimates, approximately 79 million people are infected with some type of HPV, and approximately 50% of new infections occur before the age of 24 years.1 In addition, more than 11,000 cases of HPV-related cancers occur in men annually and are responsible for 63% of penile cancer, 89% of anal cancer, and 72% of oropharyngeal cancer. It is important to emphasize the indirect causal factor for cervical cancer via men serving as reservoirs for HPV transmission.9
LR HPV infection is not without consequence. HPV 6 and HPV 11 are responsible for 90% of genital warts affecting 160,000 men annually.10 HPV may also lead to recurrent respiratory papillomatosis.11
The prevalence of oral HPV is relatively low compared to that of genital infection, occurring in 10.1% of men, but the distribution pattern of oral HR HPV infection associated with oropharyngeal cancer is similar to penile HPV infection with a bimodal pattern. Although the oral HPV prevalence is lower than genital HPV infection, the number of oropharyngeal cancers associated with HPV has increased significantly over time.12 With this continued trend, the annual incidence of HPV-related oropharyngeal cancers surpassed the annual number of cervical cancers in 2015, despite the availability of a highly efficacious prophylactic vaccine against HPV.9
Using NHANES, Han et al also revealed that the genital oncogenic HR HPV infection prevalence for men was 25.1%, which was widespread among all age groups. The HPV prevalence with at least one of the 4vHPV types in adults aged 18 to 59 was 8.5%, representing over 6.5 million U.S. men. The overall prevalence of infection with at least one of the 9vHPV types was 15.1%. Prevalence of 9vHPV types was similarly elevated in the vaccine non-eligible group (14.6%), questioning the rationale behind the current age cutoff of HPV vaccination in men.
Similarly, overall HPV 16 and 18 infection prevalence was 4.3% and 1.7%, respectively, without showing the difference between vaccine-eligible and vaccine non-eligible men. Prevalence of overall HPV infection was lowest in males aged 18 to 22 years at 28.9%, which may reflect the current practice of providing HPV vaccination to the younger age group in men.8