In this issue, Dunne et al1 report on the seroprevalence of 4 types of human papillomavirus (HPV) in a study of 499 men from Tucson, AZ and Tampa, FL. They observed increasing seropositivity with age for HPV6/11, the major causes of genital warts and respiratory papillomatosis, and for HPV 16 and HPV 18, the major causes of anogenital cancers and some oropharyngeal cancers. Men who smoked were more likely to be seropositive to at least one of the types, as were those who had a current sexual partner in the past 3 months. Interestingly, in contrast to findings from studies in women, the association of seropositivity with lifetime sexual partners was weak. Overall, seroprevalence to HPV 16 was 12.1%, to HPV 6/11 combined was 9.7%, and to HPV 18 was 5.4%; only 1% of men were positive on all 3 type-specific assays. HPV 6, HPV 11, HPV 16, and HPV 18 are the 4 types prevented by the currently licensed HPV prophylactic vaccine (Merck’s Gardasil). The results suggest that benefit from quadrivalent vaccination would decrease with age due to increasing previous exposure resulting in immunity to reinfection. Viewed uncritically, the data also would suggest that considerable benefit in men might remain well into adulthood because seroprevalence did not increase substantially until the 35+ year old age group.

Any tool to guide the planning of vaccine programs is welcome, and this study represented a fruitful collaboration of excellent epidemiology and serology. As the authors state, vaccine recommendations in men are both topical and important. Policies must weigh the high cost of male vaccination programs that would cost billions of dollars against possible benefits that include prevention of genital warts and a fraction of anogenital and oral cancers in men and their sexual partners. Adding male vaccination to female vaccination programs would also help prevent, to a still unknown amount, the great burden of cervical cancer/precancer in women.