You can get HPV without sex too.

https://www.cdc.gov/sti/about/about-genital-hpv-infection.ht...

"HPV is most commonly spread during vaginal or anal sex. It also spreads through close skin-to-skin touching during sex"

This focuses on sex, but any virus that can be found on skin, also has a chance to be transmitted without sex just as well. Admittedly the chance here for HPV infection is much higher with regard to sex, but not non-zero otherwise. The HeLa cells also contain a HPV virus in the genome, though this was probably transmitted via sex:

"The cells are characterized to contain human papillomavirus 18 (HPV-18)"

HPV-18. I think HPV-18 may in general be more prevalent than HPV-16.

Uh, monogamy of both partners is also an option, not just celibacy. Not common in these times, I know, but you don't have to completely abstain from sex to be safe.

The study you've quoted here is not definitive evidence of the claim you're making, and that claim is...let's just say that it's controversial. Conventional wisdom is that you're unlikely to benefit from HPV vaccination unless you have not already seroconverted for at least one of the 9 strains (6, 11, 16, 18, 31, 33, 45, 52, 58) in the current vaccine.

There's not much hard evidence to suggest that vaccination for HPV has strong ability to protect you from a strain after you've already been infected with that strain [1], as the best available data shows a substantial decline in efficacy for women over age 26 and for women of any age who had prior documented infection [2]. This study is small, unrandomized, and the measured primary outcome (anti-HPV IgG) doesn't really tell you anything about relative effectiveness at clearing an infection. The only real evidence they advance for this claim is:

> Persistent HPV infection after vaccination was significantly less frequent in the nine-valent vaccinated group (23.5%) compared to the control group (88.9%; p < 0.001).

...but again, this is a small, unrandomized trial. We don't know how these 60 people differ from the typical HPV-positive case. You can't rely on this kind of observational data to claim causality.

Vaccination is great, but let's not exaggerate or spread inaccurate claims in a fit of pro-vaccine exuberance. The HPV vaccine has age range recommendations [3] for a reason.

[1] For the somewhat obvious reason that your immune system has already seen the virus.

[2] See tables 2 and 3 here: https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/

It's also worth calling out table 4, which shows the (IMO bad) efficacy data for biological men, which is why I only talk about women, above, and why anyone who recommends vaccination without mentioning this factor is not being entirely forthright. Few people are rushing to give older men the HPV vaccine because it's not really supported by data!

[3] I believe the current guideline is under age 45 in the USA.

This statistic seems to be used by some people to avoid the vaccine - they figure they've already had it at some point. The biggest problem with that logic is that not all strains are as dangerous and they probably have not contracted 16 or 18 specifically. The other problem is there's still a good number of people who have never had it and shouldn't assume they have because its common.

I wish more people would get vaccinated.

However, the vaccination is expensive (~1k) and it is difficult to find doctors who will do non-recommended vaccinations for self-payers.

YCMV

Hmm. Compared to what measurement? Most viruses are actually not oncogenic.

From cancer causes, oncogenic viruses are thought to be responsible for about 12% of human cancers worldwide:

https://www.mdpi.com/2079-7737/14/7/797

From what I remember, most viruses are not oncogenic in nature, so I am unsure whether the statement made is correct.

I'm a proponent of EHRs, but the key value is at patient-level, not population level where other approaches perform equally well.

For the HPV section specifically, there were at least two major omissions.

First, in his table showing autoimmune adverse effects, he has chosen to crop out the next column in the table containing the control conditions - which show very similar rates of adverse effects to the vaccine condition.

Secondly, when discussing negative efficacy in the case of existing persistent infection, he only quotes the data from one of three studies that the linked report covers. The linked report indeed covers the negative efficacy in study 013 as an area of concern. However, study 015 (which had roughly twice the number of total participants as study 013) showed no real evidence of negative efficacy. When all 3 studies are pooled together, the point estimate still says negative efficacy, (at ~-12%), however the error bars are quite wide.

Why this is tragic, is because these two omissions do actually point to failures in public communication about the vaccine. For example, the control condition in the Merck trials were a mix of saline injections (this is the traditional placebo), as well as injections with just the adjuvant (AAHS). This is less standard, and raises legitimate questions about why Merck used an adjuvant as the control, instead of just saline. There a cynical/conspiratorial angle to this question, which I think would be directionally correct.

The second omission is because I think there is a reasonable question of "are there extra risks associated with getting the HPV vaccine while having an active persistence infection", even when taking into account the different and larger study populations within the original trial data. Once again, I think the idea that both companies and public health agencies don't want to deal with a vaccine that requires testing before hand is true. I also believe that on a population level, even if there was a modest increase in risk in that specific subgroup, it makes sense to implement broad vaccination campaigns.

That said, I think the unwillingness of public health agencies to engage with this tricky area of communication and education creates these types of opening for anti-vaccine messaging. If you want a sense of "conspiracy" - here's a random review study - https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/

Notice that when reporting results, the groupings for HPV status at enrollment time are "naive" and "irrespective" - the "test positive" grouping isn't broken out.

So I'm fine with it being flagged and decline to vouch for it.

The FDA itself restricted access to the vaccine on the basis of age. Given that virions aren't even involved in the production process, its safety should have been deemed good enough for the entire population early on.

As people cite these statistics, it would be useful to distinguish exposure to HPV causing foot warts, etc from the much more dangerous variants. I rarely see any statistics do this sort of segmentation.

Second, the body normally clears HPV naturally after 1-2 years. However, natural infection often does not provide immunity, so reinfection can easily occur (even from the same partner or a different part of your own body).

People often assume that HPV is either a lifetime infection or that recovery guarantees immunity - neither is the case!

They say the prevalence of virus is down. They don't say that the cancer rate is down (granted too early to tell), nor do they talk about any adverse events or all cause mortality differences (again, probably too early to tell)

The only thing they can conclude is that the treatment given to stop the virus, stops the virus. But they don't mention any tradeoffs.

Not trying to be an anti-vaxxer conspiracy theorist, but good science needs to talk about the whole picture.

Why is this different? Why is pestering a doctor to give me a medicine they don't recommend a good idea?

1) if you've ever been exposed to HPV already, then the vaccine is useless

2) there is no test to determine if a male has been exposed, although there is one for females

so they just push the ages up by probability, over time. As the probability of a man being with an older and therefore unvaccinated woman decreases - since with women is the most probable - the age can rise

Depends entirely on where you are and what your healthcare situation is. Mine cost me ~100eur.

I am currently getting the HPV series and I only had to pay my copay for the first appointment have nothing for the second one (I am assuming it will be the same for the third)

What makes it work is the public registers.

e-boks is like gmail (and others) in that it keeps your old mail. So you can easily find old stuff, a great improvement on paper mail.

I don't even check my physical mailbox once a week.

Denmark is one of the very most digital countries. Physical mail is very much on the way out. We no longer has mailboxes to send mail, you have to go to a shop to send letters, which now cost at last $6 per letter due to the low amount of mail sent.

It is only a matter of less than 10 years before letters will be fully gone.

Which is bad, we definitely should have them. Referral data appears to be managed through Healthlink, which may just be a privatised not always used medical record system.

There are multiple publications. THe easiest way to find is Gemini 3 Pro or ChatGPT Thinking + find for publications (go to link, not just rely on summary).

They differ by population and methodology. For example, here is "Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden: results of a cross-sectional study in Estonia", 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10255022/

It is DEFINITELY not too early to tell. Cervical cancer rates in Australia, which adopted the vaccine widely and early have decreased, and it has been widely reported ( https://www.canceraustralia.gov.au/cancer-types/cervical-can... )

In the case of public health, there are a bunch of organizations that keep on top of the research and maintain a more comprehensive view of their perception of the current consensus.

For day to day guidance, individuals should be referring to either those sources, or healthcare professionals.

If people are looking at individual studies like this to make decisions, something has gone very wrong.

The first thing on your list of complaints is something that by your own admission cannot yet be determined. If you’re not trying to be an anti-vaxxer, you’re doing a bad job of it.

Doctors are not all knowing, infallible oracles. They are human beings you can have a conversation with about your health. If you think something makes sense for you, you can run it past them. No one is suggesting randomly asking doctors to prescribe random shit.

Doctors/medical associations don't agree with each other on much, even at the very highest levels. For example, the USA and EU have totally different recommendations related to digital rectal exams for aging men. One believes that finding cancer in old men is important, the other claims it's bad because most of those cancers are benign and sticking a finger up an old mans butt often causes its own complications.

This is patently incorrect. The vaccine protects against 9 variants. Having been exposed to all 9 before vaccination sounds like really bad luck.

> 2) there is no test to determine if a male has been exposed, although there is one for females

The female HPV tests, as I understand, only test for the presence of HPV in the cervix. It can be present in many other areas. No one is testing women for the presence of HPV on their hands or in their throats.

Most places now offer HPV vaccines to young boys as well. People over 40 more or less missed the boat, but they can still get vaccinated. How useful it is depends entirely on their personal circumstances and risk profiles.

(even for rest-of-the-world topics)

My reading of the following is that the cost of each additional quality adjusted life year would be over $100,000, rather than that each vaccination prompts $100k in economic value

> Including preadolescent boys in a routine vaccination programme for preadolescent girls resulted in higher costs and benefits and generally had cost effectiveness ratios that exceeded $100 000 per QALY across a range of HPV related outcomes, scenarios for cervical cancer screening, and assumptions of vaccine efficacy and duration

The justification for 27-45 year olds heavily references a meeting. Based on time, author and title, I think either https://stacks.cdc.gov/view/cdc/78082/cdc_78082_DS1.pdf or https://pmc.ncbi.nlm.nih.gov/articles/PMC10395540/ should be a fair summary of the meeting (I hope...).

I don't really have time to read it all, but the basic idea is as you said - the cost-benefit ratio is off. Basically expanding from something like the current case, to vaccinating up to 45 year old will avert an extra 21k cases of cancer (compared to the base case of 1.4 million) - so about an extra 1.5% cases averted, while the direct vaccination costs are estimated to increase from 44 billion to 57 billion (+29%).

The current guidance says "do not recommend" plus "consult your doctor". You should read that as "blanket vaccination as public policy is cost inefficient in that age range" not "you as a 45 year old should not get the vaccine categorically".

HealthLink is a messaging system and stores no EHRs at all. eHealth is the National EHR programme aiming to roll out EHRs by 2030 nationwide.

It will be a no-opt-out centralised EHR and combined social care record.

My medical insurance will pay for several literally fake/quack treatments because of this crap. If you want to wage war against Quackery I better see you going after "big Chiropractor" first.

Same reason you can't get Shingrix under a certain age.

Deregulating medical systems regarding patient choice and access to drugs is good, but you'll eventually get some bootlicker claiming that "we can't do that because SOMEONE WITH A VIRUS MIGHT USE AN ANTIBIOTIC INCORRECTLY" while ignoring the mass consumption of antibiotics by farm animals as a vector for super bugs.

It is incorrect. I had it tested multiple times. It is done less routinely, usually under assumption that since it is women who are mostly at risk, why bother testing men. Which is horrible mindset in anything related to epidemiology.

See:

- https://www.droracle.ai/articles/607248/what-methods-are-use...

- https://pmc.ncbi.nlm.nih.gov/articles/PMC12256477/

- https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2...

> 1) if you've ever been exposed to HPV already, then the vaccine is useless

Also no. See other comments.

Over a decade ago I tried getting the HPV vaccine in my early 20s, but the doctor told me it wasn't recommended for men and that insurance won't cover it. I was young and didn't have the money to pay out of pocket.

I went to Planned Parenthood and got the vaccine last year. At some point they changed the recommendation to men under 45 now and I got all 3 shots free.

Honestly, though I'm glad to have finally got the vaccine it's been a pretty frustrating experience.

"Since HPV vaccination was implemented in the Danish childhood vaccination programme in 2009, we have received 2,320 reports of suspected adverse reactions from HPV vaccines up to and including 2016. 1,023 of the reported adverse reactions have been categorised as serious. In the same period, 1,724,916 vaccine doses were sold. The reports related to HPV vaccination that we have classified as serious include reports of the condition Postural Orthostatic Tachycardi Syndrome (POTS), fainting, neurological symptoms and a number of diffuse symptoms, such as long-term headache, fatigue and stomach ache."

"The risk of cervical changes at an early stage was reduced by 73% among women born in 1993 and 1994, who had been vaccinated with the HPV vaccine compared with those who had not been vaccinated."

"The Danish Health Authority recommends that all girls are vaccinated against HPV at the age of 12. The Danish Health Authori- ty still estimates that the benefits of vaccination by far outweigh any possible adverse reactions from the vaccine."

https://laegemiddelstyrelsen.dk/en/sideeffects/side-effects-...

Got a source?

I didn't say it wasn't a significant source of cancer. I said that nobody knows a guy who knows a guy who's dick fell off or some other extreme outcome. Without enough of that to back up your messaging it just won't work. You need to be honest with people, not try and scare them like you're trying to keep school kids from smoking weed in 1990.

The public messaging you're trying to engage in could perhaps have skated by in a less critical time but in the current environment it will be counterproductive.

I don't want my kid or my grandkid to get measles or some other "of immediate consequence" disease because they go to school with a bunch of unvaccinated kids because you people sullied the reputation of public health via "just push the truth a little, it'll make them take the vaccine" type endeavors.

This has nothing to do with vaccines. There is a very good reason that misinformation is, and should remain legal. This simply allows the person or group who gets to define what is or is not misinformation to arbitrarily imprison anyone doing publishing they don’t like.

You really need to think through the implications and consequences of censorship laws before advocating for them.

Insurance companies used to only pay for the vaccine at 60. They've reduced it to 50 now because people (like me) were getting it in their 50's. I got it in my left eye and because my immune system is kinda shit, I still have it, though it doesn't give me too much grief now. But it did trash my cornea in that eye, so it's messed my vision up pretty good. And since there's still an active infection (after 8 years), I can't get a cornea transplant.

https://www.health.harvard.edu/staying-healthy/two-dose-shin...

1) you probably haven't had all N strains yet.

2a) you likely haven't been infected with the ones that cause cancer, because they're relatively rare.

2b) ...that is especially true if you're young and not sexually active.

2) being infected with one strain does not provide sterilizing cross-immunity against the other strains.

3) even if you've been infected with a strain, some of the vaccines have been shown to prevent reinfection and reactivation better than natural infection alone.

4) in general, the vaccination-mediated immunity might last longer or be "stronger" than the natural version, since the vaccines are pretty immunogenic, and the viruses are not.

But for point 4, it's well-known that vaccine efficacy is lower for people who have already seroconverted (cf [1]), so there's clearly some amount of practical immunity provided by infection.

[1] The vaccines are roughly 90% effective for the major cancer-causing strains, but it's not a simple answer, and varies a lot by how you frame the question. See table 2 here: https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/

Also be sure to see table 4 if you're a man. The data for biological men and women are surprisingly different!

The benefits may be statistically lower, since you may have been infected by some of the variants already, older males may have fewer sexual partners in the future, and cancer takes a while to develop.

In the USA, it is recommended by default for adults up to 26 and kinda for 27-45.

No. The general reason that people don't do the test for men is that DNA testing is extremely sensitive, and produces a lot of false positives for a virus that is widespread.

It's also not actionable. You can't treat an asymptomatic infection, and a positive leads to the same outcome they would give anyway: use physical barriers and abstinence.

(Edit: hilariously, your first link says exactly what I just wrote, at the very top of the page. Did you read it?)

https://pmc.ncbi.nlm.nih.gov/articles/PMC6288961/

So maybe 70% of throat cancer victims have HPV, and like 70% smoked - and if those were independent facts you'd expect that about 49% both smoked and had HPV, but it's actually more than half 'cos it turns out that if you have HPV then smoking is even worse. So that's nice.

[0] https://www.asha.org/practice-portal/clinical-topics/head-an...

JFC. I'm checking out of this conversation.

Maybe I did?

It is possible that we just disagree on this. Clearly misinformation about medical stuff is so damaging that many places have found it necessary to have laws on the books. I'm just elevating this from a misdemeanor to an actual crime based on the outcomes.

If you want to read more: https://wiki.roshangeorge.dev/w/IVF

Now maybe that changes if you get divorced and get a new sexual partner.

Those are basic bits of knowledge that apply to most vaccinations.

The problem is that the quacks diminish the positive effects, exaggerate the negatives and engage in a campaign of fear mongering that costs some people (and in some cases lots of people, see COVID) their lives. They are not only clueless, they are malicious.

From Gwyneth Paltrow, JFK Jr, all the way to Donald Trump and a whole raft of others the damage is immense. I have a close family member who now is fully convinced of the healing power of crystals and there isn't a thing you can do to reason with people that have fallen into a trap like that.

I'm not being avoidant here -- medical decisions are always subjective and multi-factor, and I can't begin to tell you what you should do. (But I also sincerely believe that propagandists try to reduce nuanced data to talking points, which is equally wrong.)

Please note the caveat about gender that I just added. The data for biological men and women are very different. Also, I haven't discussed risks at all, which is the other side of the ledger -- these vaccines are pretty darned safe, but everything comes with risk, and only you can decide what level of risk is appropriate for your life.

People don't want to hear this obviously. But it is a fact STI transmission has skyrocketed since the so called sexual revolution of the late sixties. Within fifteen years, we has an AIDS epidemic.

and even if it is reliable, its utility is limited

all leads to focusing solely on probability of exposure(s)

It’s the opposite of a fact. Gonorrhoea rates as an example rose significantly in the 1960s, but are now lower than in the 1940s and 1950s. This is thanks to good public health measures.

Start by making sure you’re accurately informed.

For more context, I have Anthem Blue Cross health insurance. The cost might depend on your insurance.

HPV spreads through oral sex as well by the way.

It is a simple fact that unprotected sex with large numbers of people is very risky. We should have learnt that lesson in the eighties.

The biggest barrier to disease transmission reduction, at least here in the US, is uncritical abstinence promoters like yourself. It works, at best, for a small fraction of the population, and leaves the rest woefully unprepared for the biological realities. The best solution to STDs is education. Which, yes, should emphasize that not having sex is an option, but cannot stop there.