Quadrivalent Human Papillomavirus Vaccine (4vHPV, GARDASIL®) Fails to Protect Men who Have Anal Sex
High Risk Gay and Transgender Groups Provide Stress Test to Widely Used Vaccine
By Peter A. McCullough, MD, MPH
The quadrivalent human papillomavirus vaccine 4vHPV, GARDASIL® was approved in the US in 2009 for use in males aged 9 to 26 for the prevention of HPV-related genital warts, and in 2010 for the prevention of certain HPV-related anogenital diseases. It is widely used in normal boys and girls who are at low risk for serious HPV disease. However, a stress test for the real protective effect if any, would be men who have anal sex with men in high frequency and promiscuous sexual lifestyles. If the vaccine really stopped these four variants of HPV, we should see it in real world data.
Morgan et al, studied 666 age 18 to 26, gay or transgender men who are living as as women who agreed to perform rectal swabs. A total of 45% had been fully vaccinated and 22% were carrying one of the four strains of HPV that should have been covered by the vaccine. Among vaccinated participants, 18, 36, and 177 reported exclusively insertive, exclusively receptive, or both sexual positioning practices, respectively. Compared to participants reporting exclusively insertive anal sex, odds of any HPV were significantly higher among participants engaging exclusively in receptive anal sex (aOR=5.90, 95% CI: 2.52–13.78) as well as those engaging in both (aOR=3.32; 95% CI: 1.71–6.44). Vaccinated participants, compared with unvaccinated participants, had lower odds of 4vHPV-type HPV regardless of sexual positioning practices (aOR=0.56; 95% CI: 0.34–0.92).
These data are very disappointing. A 44% risk reduction in HPV carriage is modest at best for such a large effort with this vaccine. These data suggest public health efforts would be better spent on this high risk population rather than a one-size-fits-all blanket vaccination strategy for lower risk groups.
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"Morgan et al, studied 666 age 18 to 26, gay or transgender men who are living as as women who agreed to perform rectal swabs."
Curious number 666 no? 🙄
The big question is did any vaccine ever work? I can only find a handful which may potentially have worked a bit in the short term but not in the long term. It really does seem to be 'Turtles all the way down'