HPV infections pose serious risks for both men and women, experts say
The common infection can lead to anal, oral and head and neck cancers
Gilles Charette first noticed something was going on with his body when he found an anal wart during a shower.
Charette confirmed with a nurse practitioner that he had acquired a human papillomavirus (HPV) infection, and quickly received topical ointment for treatment.
As a gay man in an open marriage, Charette also decided to get the HPV vaccine, choosing to pay out of pocket to be immunized rather than risk another HPV infection or HPV-associated cancer.
"The recommendation was to [get vaccinated]," said Charette, who is the director of the Gay Men's Sexual Health Alliance in Toronto.
"And so I did."
HPV is one of the most common sexually transmitted infections in Canada and the world, and is estimated to be responsible for five per cent of all cancer cases globally.
HPV infection is most commonly associated with cervical cancer, since roughly 99 per cent of all cervical cancer cases are connected to HPV. But experts warn that HPV is a virus that affects all sexually active people and can lead to a variety of cancers — regardless of gender.
"We tend to focus on women because of the concern with cervix cancer … but in fact men also carry and can be infected and affected by HPV," University of British Columbia (UBC) professor Dr. Deborah Money, told Dr. Brian Goldman, host of CBC's The Dose.
How common is HPV?
The Public Health Agency of Canada (PHAC) estimates that roughly three quarters of sexually active men and women will have at least one HPV infection in their lifetime.
"The good news is that, in fact for most people, it's a transient infection and it's cleared and it just goes away," said Money, who heads the UBC faculty of medicine's department of obstetrics and gynaecology (OBGYN).
While HPV infection is dangerous for women because of the risk of cervical cancer, HPV is dangerous for gay, bisexual and other men who have sex with men because of concerns over genital and anal cancer.
Of the more than 100 strains of HPV that exist in nature, two strains cause the majority of cancer cases associated with HPV, including cancers of the cervix, vagina, vulva, penis and anus.
However, HPV infections can also lead to cancers of the throat, tongue and tonsils.
Gilla Shapiro, a psychologist at the Princess Margaret Cancer Centre and faculty member of the Centre for Vaccine Preventable Diseases at the Dalla Lana School of Public Health, says rates of mouth and throat cancers are on the rise for men and women in Canada, but at a faster rate for men.
According to numbers from the Canadian Cancer Statistics Dashboard, male head and neck cancer rates were 2.7 times higher than female head and neck cancer rates in 2019, with 2024 rates projected to be 2.8 times higher for men versus women.
In communities of men who have sex with men, HIV/AIDS status is more openly discussed than whether someone has had HPV, according to Charette. bBut he notes that an HPV infection can be especially detrimental for people who are HIV positive.
A 2020 review looking at the relationship between HIV status and HPV-related cancers in sub-Saharan Africa found that HIV positivity is associated with an increased prevalence of HPV infection, "which will result in increased burden of HPV-related cancers among [people living with HIV]," according to the authors.
"So certainly people living with HIV should be considering HPV vaccination," said Charette.
PHAC recommends that immunocompromised individuals — including people living with HIV — receive three-dose schedule of the Gardasil-9 vaccine.
It estimates that 25 to 35 per cent of mouth and throat cancers are associated with oral HPV infection.
The Canadian Cancer Society estimates that 90 per cent of people with anal cancer also have an HPV infection.
HPV vaccines lead to reduced cancer rates, research shows
Experts agree the easiest way to prevent HPV infection is through one of the two approved HPV vaccines: Gardasil-9 and Cervarix.
Gardasil-9, which protects against nine types of HPV, is available for men and women, between the ages of nine and 45.
Cervarix, approved for women aged nine to 45, protects against the two high-risk HPV types that cause approximately 70 per cent of all cervical cancer cases.
A 2022 U.S. review found that an earlier version of Gardasil, which protected against four strains of HPV, was 90 per cent effective at reducing genital warts in males, and 77.5 per cent effective in reducing anal intraepithelial neoplasia in males, a precancerous condition that causes abnormal changes to the lining of the anal canal.
According to research published by the Canadian Partnership Against Cancer, HPV immunization before the age of 17 leads to a 90 per cent reduction in invasive cervical cancer risk, while HPV immunization before the age of 30 leads to a 50 per cent reduction in cervical cancer risk.
"They're much more effective than many of the vaccines we use," said Money.
HPV vaccines are usually offered to school-aged boys and girls, ideally before the average age that they begin engaging in sexual activity.
Nonetheless, even people who are already sexually active can benefit from the HPV vaccine, because the likelihood that someone has been exposed to every type of HPV that the vaccine protects against is low, according to B.C. Cancer.
A Health Canada spokesperson confirmed that the National Advisory Committee on Immunization (NACI) recommends HPV vaccines for people between nine and 26 years of age.
"[NACI] also recommends vaccination of individuals 27 years of age and older following a consultation with a health-care provider, in consideration of risk factors which may lead to infection with the human papilloma viruses," wrote Health Canada via email.
NACI estimates that vaccine uptake for at least one dose is higher among females than males. Roughly 77 per cent of females have at least one HPV vaccine dose according to 2023 numbers, compared to 75 per cent of males.
The vaccine is free for males and females under the age of 26, typically through school-based and catch-up programs in every province and territory, according to the Canadian Partnership Against Cancer.
If you're older than 26 in most parts of Canada, however, you will have to pay out of pocket, like Charette.
He says the price of the HPV vaccine for those not eligible for free programs — $215 per dose in Toronto, for example — can be prohibitive for some.
Shapiro says there are programs developed to support the vaccination of gay, bisexual and other men who have sex with men, "because of the higher risk of developing certain types of HPV associated cancers."
Ultimately, Charette says that even though most people clear this common STI with little issue, the elevated risk for oral and anal cancer should motivate men to consider HPV vaccination.
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