HPV Vaccine for Adolescent Males: Attitudes and Practices of Primary Care Physicians

Background:  The quadrivalent HPV vaccine (HPV4) was approved for use in males age 9 to 26 years in 2009; the Advisory Committee on Immunization Practices stated that HPV4 can be used for males, but HPV4 was not included in the routine immunization schedule. 

Objectives:  Describe attitudes and current practices related to HPV4 for adolescent males among a sample of pediatricians and family medicine physicians. 

Methods:  Survey of nationally representative sample of physicians conducted by mail and internet between 6/2010 and 9/2010. 

Results: The response rate was 72% (609/842).  Among respondents, 53% strongly and 36% somewhat agree that HPV-related disease is severe enough in females to warrant routine immunization of males; 31% strongly and 42% somewhat agree that HPV-related disease is severe enough in males to warrant routine immunization.  When discussing HPV4, 63% would strongly emphasize prevention of genital warts in the patient and 62% would strongly emphasize prevention of cervical cancer in partners.  While 20% strongly and 33% somewhat agree that it is necessary to discuss sexual health issues prior to recommending HPV4, only 27% report routinely discussing these issues with11-12 year olds. While 81% would strongly recommend HPV4 for males known to be homo/bisexual, only 11%, 35%, and 51% routinely discuss sexual orientation with 11-12, 13-15, and 16-18 year olds, respectively.  Currently, 31% report administering HPV4 to males; 14% strongly recommend HPV4 for 11-12 year old males, 21% for 13-15 year olds, and 22% for 16-18 year olds. 

Conclusions:   Most physicians agree that HPV-related disease is severe enough to warrant routine use of HPV4 in males and would emphasize both the prevention of cervical cancer in partners and prevention of warts in males when discussing the vaccine.  Most physicians recognize that men who have sex with men are a group that would benefit from vaccination, but are not routinely asking questions that might identify this group.