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Necessity and dose of HPV vaccination in males.

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Hello Doctor, my 18 y/o son received his 1st HPV vaccination (Gardasil) in December 2013. His 2nd vaccination was done 8 months later, in August 2014. Considering the time past between two immunizations, would receiving one last HPV vaccination be sufficient to protect him against the virus or he needs to restart the series? We are trying to avoid the unnecessary immunization, if possible. Please share with me your opinion about this vaccine, its safety and necessity for males. Thank you!


Category: Family Physician-GP

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
To start with, Gardasil, the vaccine against HPV, is highy effective in preventing HPV infections in the future. In women it is extremely important because HPV infection is common and the primary cause of cervical cancer. In males also it can lead to genital warts, or anal warts, mostly the source being the infected partner, however the chances are much lower.
Especially in US, Gardasil is recommended to both the sexes, to reduce the viral pool in the community.
It is a very safe vaccine, and till now apart from allergies in some rare cases, there has been no other reported side effects.
The only issue in your case, is that the schedule has not been proper.
HPV vaccine is supposed to be taken 0,2nd month and 6th month dose, ( last dose being 6 months from the first dose ). If this is not strictly adhered too, the vaccination won't be helpful. Any particular reason why there was such a delay between first and second dose?
If safe sex practices are employed then HPV can be prevented and hence it is not the most important vaccine that a male needs. But it is highly recommended in homosexuals, since they have more chances of anal warts.
Even though the schedule has not been followed properly, i will advise you to take the last dose to atleast complete the vaccination. A gap of 3 months can be maintained between the 2nd and the 3rd dose.
Regards.


Patient replied :

Thank you Dr. Sebastian! The reason he didn’t get the 2nd dose in the timely manner is completely my fault. I did the online research and saw that some people had a bad reaction to the vaccine, like paralysis, infertility etc. and, as a worried mom, I got very concerned and wanted to stop the vaccination all together. After a while, I decided to resume anyway but the schedule was already off. I am on the conservative side and try to avoid unnecessary injections and meds for the fear that it may cause more harm rather than good on the long run. If my son will have his 3rd dose done in November, it will be 3 months after the 2nd dose and 11 months after the 1st one. You mentioned that if the schedule is not proper and strictly adhered to, the vaccination won't be helpful. What do you think? My son is smart and careful (as much as he can be) but he falls into the homosexual group.


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,
I totally understand your concern and fears.
It does happen for a very small percentage of people, so you should not worry.
Moreover he has tolerated the first two doses well. So again it proves he won't have any side effects to it.
I will recommend you give him the 3rd shot by november. I didn't mean to imply it won't be effective at all, it is supposed to be given in 6 months time, but at times due to circumstances it can be missed. So there is nothing to worry, just go ahead and finish the 3 shots by november.
The effectiveness of the vaccine can come down a bit, but it is still better than not getting the last shot at all. And again there is no need to restart the vaccine altogether.
Especially since he is in the homosexual group, it will be good for him to be vaccinated as HPV can cause anal warts. But with the vaccin and protected sex, there is no further cause of concern.
Hope this was helpful,
Regards.


Patient replied :

My son will be back home from college at the end of November and he will definitely get the shot then. It will put him at exactly 3 months after his 2nd shot from the end of August. It is great to hear that he doesn’t need to restart the series, but I am just curious, is there any benefit in receiving another, the 4th shot in a few months, considering his schedule being off and him being a homosexual male? Thank you so much!


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello.

Another, extra shot is not required. Let him take his last shot and that should be sufficient.
In a study on vaccine efficacy of the quadrivalent vaccine (Gardasil), its efficacy remained high in persons who did not adhere to the recommended immunization schedule, including those who got fewer than three doses. This suggests that some flexibility in the spacing of doses is allowed and that restarting the series or giving extra shots is not required.

The Advisory Committee on Immunization Practices (ACIP) also recommends that if the vaccination series is interrupted for any length of time, it can be resumed without restarting the series, or needing extra doses.
I hope this clears your doubt.

Regards.


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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