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Gay men using cervical cancer vaccine

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  1. Sean Cummings 24 Feb 2007, 3:53pm

    Dear Editor I was very interested to read Professor Fraser’s comments about the use of the vaccine Gardasil in adult gay males. I would support the suggestion that blindly immunizing all gay males would be both likely to be expensive and ineffective. The reality though is that there are highly effective methods of detecting the cancer forming variants of HPV – especially subtypes 16 and 18 by simple, painless swab techniques. Where we identify individuals who test positive for type 16 and 18 then there is no particular point in immunizing at that point and anal pap smearing may be more appropriate. In addition, HPV infection does not maintain a constant prevalence in the community and there are several good studies showing marked reduction in HPV contamination with the simple passage of time. HPV 16 is the most persistent and also currently one of the one most implicated in ano-genital malignancies. Given that the rate of anal cancers in the gay population as a whole at 35/100,000 is the same as that of cervical cancer which originally triggered the cervical smear programmes in the Western world and that the rate in HIV+ people is of the order of 100/100,000 we all need to take an energetic look at combination strategies to reduce mortality and morbidity. HPV testing, vaccination and anal smears are all part of that. Yours sincerely, Séan Cummings