My doc doesn't think I need gardasil

[rocket]

 Hi everyone,it's been a while as Iv'e had all sorts of computer problems,and my gallbladder removed.
              My doc doesnt think i need the vaccine because of my age,over 50.My numbers are good,over 600,on atripla. I disagree with him,as I still have sex and I think there's no harm in getting it.
                Im not happy with my doc for other reasons,always seems to be rushed etc. If anyone knows a good doc that doesn't have a problem with recommending gardasil,please pm me.
                 Im in Connecticut near New York,so a Ny city area doc would be helpfull.Thanks.

[edfu]

Gardasil is not going to do much good for someone like yourself who has been sexually active for at least thirty years.  Indeed, you already know you have been infected with HPV, since you've revealed in an earlier post that you have been treated for warts, which are considered low-grade dysplasia.  If you "still have sex," are condoms used?  What you really need, first of all, is an anal Pap test to find out  if the HPV has caused any cell abnormalities.  If so, then biopsies would be recommended. 

[Miss Philicia]

Yes, I agree with both your doctor and my dear friend edfu -- gardasil is only approved by the FDA for men ages 9-26, and even then it's only useful with a 77% efficacy for HPV types 6, 11, 16, and 18.

http://www.medscape.com/viewarticle/718152

[wtfimpoz]

I was 28 and hpv neg when I got tested, and couldn't get it

[Hellraiser]

The HPV he may have been exposed to may not have been the types listed.  My curiosity is piqued why he would not be allowed to get that vaccine if he wanted it.  What gives yo?

[rocket]

Gardasil is not going to do much good for someone like yourself who has been sexually active for at least thirty years.  Indeed, you already know you have been infected with HPV, since you've revealed in an earlier post that you have been treated for warts, which are considered low-grade dysplasia.  If you "still have sex," are condoms used?  What you really need, first of all, is an anal Pap test to find out  if the HPV has caused any cell abnormalities.  If so, then biopsies would be recommended. 

yes,I use condoms,hpv is easily contracted,unlike hiv though.And you are saying what  my doc told me,it wouldn't do much good.

Yes, I agree with both your doctor and my dear friend edfu -- gardasil is only approved by the FDA for men ages 9-26, and even then it's only useful with a 77% efficacy for HPV types 6, 11, 16, and 18.

http://www.medscape.com/viewarticle/718152

77% isn't bad.

I was 28 and hpv neg when I got tested, and couldn't get it

I wonder if this is for insurance companies,as they would have to pay for it,where do they draw the line? But at age 27 as a cut off,it's like they are saying,you shoudn't be having sex with more than one partner.

The HPV he may have been exposed to may not have been the types listed.  My curiosity is piqued why he would not be allowed to get that vaccine if he wanted it.  What gives yo?

Yes,this confuses me.I offer to pay cash,maybe they are worried it won't be paid for.If one has not been exposed to these cancerous strains,why not try it?

[Miss Philicia]

Have you had a PAP smear done?  If not, why not?

[edfu]

yes,I use condoms,hpv is easily contracted,unlike hiv though.And you are saying what  my doc told me,it wouldn't do much good.

I'm sorry; I wasn't completely clear when I asked this about condoms.  You're correct.  HPV is very easily contracted:  skin to skin contact is all that is needed--penile-anal (where the condom doesn't completely cover the shaft), oral-anal, digital-anal. 

One of the problems here is that there is currently no FDA-approved test for HPV infection in men, although there is one for HPV infection of the cervix.  One of the reasons for this is that the medical establishment is more concerned with HPV infection of the penis than with HPV infection of the anus.   Some might say this is the result of homophobia, and I would be among them.  Without such a test for men, it is pointless to discuss the multiple types of HPV and which are known to potentially cause cancer and which do not:  There is no way to differentiate among the various types of HPV in gay men when there is no way to test for HPV itself. 

That's one of the reasons why the anal Pap test is so important.  Without any way to determine HPV infectivity in the anus (other than, for example, the appearance of warts there), the next best thing is to test for the possible results of HPV anal infectivity:  anal dysplasia (cell abnormalities). 

You already know you have HPV, because of the warts.  There is no way to find out which variants of HPV you have (outside of a research setting).  So you need to get an anal Pap test, which may also be difficult, because many M.D.'s do not know how to administer it (see homophobia referred to above) or do not believe in its efficacy (there are issues of specificity and sensitivity).  However, it's all we have at the moment.       

If you're willing to pay for the Gardasil vaccinations yourself, I'm not at all sure why your doctor refuses to administer them on the basis of off-label usage, unless it's because of issues of liability.  My own personal opinion, for what it's worth (and it's only worth very little in spite of my intensive study of anal-cancer issues amongst gay men), is that it would be pointless and not worth the expense.  I find it extremely difficult to believe, from what I've read, that a 50-year-old gay man has managed to escape being infected with the many varieties of HPV, non-cancerous and potentially cancerous, because, as you've pointed out, how easily they can be contracted.     

[YaKaMein]

hope this helps

http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

some HPV like a few other STI's can be spread via direct skin-to-skin contact ... so condoms first ....
but seeking treatment for any skin outbreaks after close physical or sexual contact should be considered

[wtfimpoz]

Have you had a PAP smear done?  If not, why not?

If this was directed at me, I apologize.  I don't know what the exact procedure was.  I had the inside of my rectum scraped and was told that I didn't have HPV. 

[Miss Philicia]

No, it was asked of the OP

[red_Dragon888]

funny my NP gave it to me as part of a study for men.

[rocket]

No, it was asked of the OP

               Yes,I should get a pap smear,as I must have been exposed to one of the four cancerous types.

I'm sorry; I wasn't completely clear when I asked this about condoms.  You're correct.  HPV is very easily contracted:  skin to skin contact is all that is needed--penile-anal (where the condom doesn't completely cover the shaft), oral-anal, digital-anal. 

One of the problems here is that there is currently no FDA-approved test for HPV infection in men, although there is one for HPV infection of the cervix.  One of the reasons for this is that the medical establishment is more concerned with HPV infection of the penis than with HPV infection of the anus.   Some might say this is the result of homophobia, and I would be among them.  Without such a test for men, it is pointless to discuss the multiple types of HPV and which are known to potentially cause cancer and which do not:  There is no way to differentiate among the various types of HPV in gay men when there is no way to test for HPV itself. 

That's one of the reasons why the anal Pap test is so important.  Without any way to determine HPV infectivity in the anus (other than, for example, the appearance of warts there), the next best thing is to test for the possible results of HPV anal infectivity:  anal dysplasia (cell abnormalities). 

You already know you have HPV, because of the warts.  There is no way to find out which variants of HPV you have (outside of a research setting).  So you need to get an anal Pap test, which may also be difficult, because many M.D.'s do not know how to administer it (see homophobia referred to above) or do not believe in its efficacy (there are issues of specificity and sensitivity).  However, it's all we have at the moment.       

If you're willing to pay for the Gardasil vaccinations yourself, I'm not at all sure why your doctor refuses to administer them on the basis of off-label usage, unless it's because of issues of liability.  My own personal opinion, for what it's worth (and it's only worth very little in spite of my intensive study of anal-cancer issues amongst gay men), is that it would be pointless and not worth the expense.  I find it extremely difficult to believe, from what I've read, that a 50-year-old gay man has managed to escape being infected with the many varieties of HPV, non-cancerous and potentially cancerous, because, as you've pointed out, how easily they can be contracted.     




The thing I still don't understand is this:  If one hasn't been exposed to the four cancerous strains,why would'nt the vaccine provide protection? If exposed to many different strains,does this ruin protection against the four cancerous strains.
           And 9 out of 10 people clear the virus on thier own,does this mean if one has cleared the bad strain on their own,you now have immunity against it?

[lmdo]

This thread is very interesting to me - I wrote to the scientist who invented "Gardasil" Prof Ian Frazer and received a very brief reply today.
The reason for me writing to him was to find out some answers regarding HPV as my partner who has been HIV + for 10 years has recently been through throat cancer treatment - the tumour was of HPV 16 origin.
I wanted to know the reason for the high rates of HPV cancers in HIV patients - is it simply due to being immune deficient (my partner's CD4 count was over 500 shortly after cancer diagnosis) or might it be possible that some HAART drugs reduce HIV replication but allow other viruses to replicate easier.
I also wanted to know whether monogamous partners are best to use condoms to protect against anal cancer - I recalled reading a study that reported that this was found to reduce rates of cancer, but I think that study was for cervical cancer, not anal.
I also asked whether someone who is entirely receptive (passive) is at higher risk of anal cancer than someone who is entirely active.
- his response was :

"The interaction between cancer causing viruses and the immune system is complex. The short answer to your question is that these viruses are common, and immune suppression is a major determinant of whether they cause cancer. This is also true in transplant recipients, so it's not the anti HIV drugs. Because the viruses are so common, it's not worthwhile trying to prevent their spread. Condoms are not very effective and in any case the virus is highly infectious and therefore, generally caught in early adult life."

My question about active vs passive risk for anal cancer was not answered - maybe it was too icky for him to contemplate....
btw he has vaccinated his sons even though guidelines here provide for health cover ONLY for girls to receive the vaccine.

[Grasshopper]

As I understand this vaccine is for prophylactic purposes only ; to be administered prior to being sexually active. Hence only administered to pre-teens.

At least this is how it was presented to us here in the Netherlands.

[Grasshopper]

The reason for me writing to him was to find out some answers regarding HPV as my partner who has been HIV + for 10 years has recently been through throat cancer treatment - the tumour was of HPV 16 origin.

I am glad you brought this up. A friend of mine got diagnosed with throat cancer last week, caused by HPV.
So do we now need to have beside our rectums also our throats swabbed ?

Ran across this article recently :

http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068

[lmdo]

Well I am struggling to get any information AT ALL from doctors about HPV and risks etc.

I am under a colo-rectal surgeon for ongoing anal problems and will discuss anal pap smears with him. Last time I saw him, he checked me out visually with a scope. I know anal pap smears are not sensitive or specific for cancer and are a work in progress but can they get their act together quickly please?! Sometimes women's health seems to get all the attention!

Re oral swabs - haven't heard anything about it - I think it is purely based on getting mouth visually checked by doctors / dentists. Which sounds pretty primitive to me - surely with the cervix, the doctors don't wait til they can see the tumour til they do something right?

It's all very very frightening, especially when you don't have a fully functioning immune system to fight off these bastard viruses!

[lmdo]

Just read that abc news story. Not much that I hadn't already found out, apart from the comment at the end about HPV screening in the mouth:
"Dentists do have tests available, such as ViziLite, that screen for pre-cancerous and cancerous cells. This is what we use in my Boston dental office."
I have no idea what that is or if it is a reliable screening test...

[northernguy]

lmdo, ask for a biopsy.  It hurts just a bit, honestly, I find the having the scope put up my butt the most painful part.   

[lmdo]

thanks 4 that - seeing him in Dec 4 just a check up - just to keep an eye on my dodgey anus..
 
he's pretty gay friendly and trust his opinion - if he's worried he'll get a biopsy.

still, i reckon it might be better getting an anal smear test accurately diagnosing cancer (ala cervical) woulkd be better than waiting til a lump / suspicious part grows to biopsy...

anyway - I haaaave heard that there is a HPV therapeutic vaccine treatment study happening - will try and find more out - it is not in a poz population though...
 

[Miss Philicia]

I find the having the scope put up my butt the most painful part.   

Oh come on girl, it's not that large.  I'm sure you've handled larger at M2M Playspace on Granville.

[northernguy]

Oh come on girl, it's not that large.  I'm sure you've handled larger at M2M Playspace on Granville.

Ouch, bitch 

What would a Main Line gal know about M2M?  I recall its a bit of a dingy hole, but I did have an intense experience with a BDSM top there in my pre-HIV days.  Quite the eye-opener for a good little catholic boy like myself.  Back to topic, my delicate rosebud must actually be tightening as I age, as even the slightest medical intrusion now causes a vise-like clenching.

[fearless]

My question about active vs passive risk for anal cancer was not answered - maybe it was too icky for him to contemplate....
btw he has vaccinated his sons even though guidelines here provide for health cover ONLY for girls to receive the vaccine.

I saw an item on ABC24 last night and they are currently considering whether to extend the free vaccination program to boys here (Aus, that is).

[lmdo]

hi fearless,
that is great news for boys who are still young enough to be vaccinated.
i am holding out for a therapeutic vaccine which is OK for poz people to take.
I understand there is research in this area happening now - but on adults with HPV, not poz people.
I think it is obvious how important it is to eliminate the risk of developing certain cancers, not only in people whose immune systems are suprressed but also the general population!!

[Hellraiser]

hi fearless,
that is great news for boys who are still young enough to be vaccinated.
i am holding out for a therapeutic vaccine which is OK for poz people to take.
I understand there is research in this area happening now - but on adults with HPV, not poz people.
I think it is obvious how important it is to eliminate the risk of developing certain cancers, not only in people whose immune systems are suprressed but also the general population!!

I was actually reading an article about the pros and cons of this vaccine and potentially giving it to boys.  The big con is that this vaccine is not cheap, and it really mostly prevents cancer amongst gay/bi men/boys as straight men wouldn't have HPV exposure inside of the anus or throat.  The issue is for it to be effective it needs to be given young, so a targeted campaign for young gay men before they become sexually active would seem to be appropriate.  The problem there is sexuality is so personal and sometimes even undeveloped that it wouldn't really be possible.  The cost versus effectiveness would be prohibitive if you tried to vaccinate universally.  So now they're debating exactly what to do.  By the way the vaccine is 100 bucks a shot and there are three shots.  Even amongst girls most of them don't finish the three cycles rendering it useless.

[rocket]

I was actually reading an article about the pros and cons of this vaccine and potentially giving it to boys.  The big con is that this vaccine is not cheap, and it really mostly prevents cancer amongst gay/bi men/boys as straight men wouldn't have HPV exposure inside of the anus or throat.  The issue is for it to be effective it needs to be given young, so a targeted campaign for young gay men before they become sexually active would seem to be appropriate.  The problem there is sexuality is so personal and sometimes even undeveloped that it wouldn't really be possible.  The cost versus effectiveness would be prohibitive if you tried to vaccinate universally.  So now they're debating exactly what to do.  By the way the vaccine is 100 bucks a shot and there are three shots.  Even amongst girls most of them don't finish the three cycles rendering it useless.

        If the girls don't finish the shots,they would still get some immunity from hpv with the first or first and second shot?

[Hellraiser]

        If the girls don't finish the shots,they would still get some immunity from hpv with the first or first and second shot?

Don't think so no, but you'd have to ask someone who's more versed in the science.

[lmdo]

Hi Hellraiser,

The people funding these vaccination programs need to be aware that if you eliminate HPV from boys / males then not only are you eliminating mouth, throat, anal cancers from gay men but also stopping the tranmission of the virus to girls who have NOT been vaccinated - i.e. moved from overseas, not had their shots, too poor to have their shots etc.

If I were a parent of a boy it would be a no brainer, and most parents I have spoken to agree.

The cost of $300 per boy is much cheaper than cancer treatment / disability down the line.

[Hellraiser]

Hi Hellraiser,

The people funding these vaccination programs need to be aware that if you eliminate HPV from boys / males then not only are you eliminating mouth, throat, anal cancers from gay men but also stopping the tranmission of the virus to girls who have NOT been vaccinated - i.e. moved from overseas, not had their shots, too poor to have their shots etc.

If I were a parent of a boy it would be a no brainer, and most parents I have spoken to agree.

The cost of $300 per boy is much cheaper than cancer treatment / disability down the line.

300 dollars is expensive compared to most vaccines out there.  In fact I'm curious to know which vaccines are more expensive than this one.  The drug company wants this vaccine to become universally applied because of the cash cow it's prospectively looking at.