Letters HPV vaccination

Genitourinary medicine clinics may not see young men who have sex with men before they become infected with human papillomavirus (HPV)

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5215 (Published 19 August 2014) Cite this as: BMJ 2014;349:g5215
  1. Emily Clarke, specialty trainee in genitourinary medicine1,
  2. Courtney Burtenshaw, specialty trainee in general practice1,
  3. Megan Goddard, medical student2,
  4. Raj Patel, consultant in genitourinary medicine1
  1. 1Department of Sexual Health, Royal South Hants Hospital, Solent NHS Trust, Southampton, UK
  2. 2University of Southampton, Southampton, UK
  1. emilyrclarke{at}doctors.org.uk

Stanley and colleagues discuss the need to vaccinate all young people against human papillomavirus (HPV).1 Genitourinary medicine clinics may help in preventing HPV infection by offering vaccination opportunistically to men who have sex with men (MSM), but they may miss many young MSM.

An Australian study of 200 MSM aged 16-20 found that the proportion of men with HPV infection increased with each additional sex partner, and that nearly half had anal HPV by the time they had had anal sex with four partners.2 The median age of first insertive or receptive anal intercourse was 17.3

We reviewed all MSM attending this UK level 3 sexual health service from 1 August 2013 to 1 February 2014. Data on MSM who attended on multiple occasions were analysed once, giving a final sample of 134. The median age at attendance was 32 and the median age at first attendance at our clinic 28. Our data suggest that most MSM would have had multiple sexual partners with increased risk of HPV acquisition before they attend any clinic.

The economic cost of warts treatment, as well as the psychosexual burden of recurrent genital warts, has been largely ignored.4 An Australian study found that in MSM the incidence of genital and anal warts was 0.94 and 1.92 per 100 person years respectively.5 In our clinic sample, 22% of MSM (29/134) presented with warts during 793 years of follow-up, giving an incidence of 3.66 per 100 years of follow-up.

Although opportunistic vaccination of MSM at genitourinary clinics has a role in preventing HPV infection, especially in providing catch up vaccination for older MSM, it will not adequately access young MSM before they have become infected with HPV. We therefore strongly recommend the roll out of HPV vaccination to all teenage boys in the UK.


Cite this as: BMJ 2014;349e:g5215



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