For an excellent and thorough review of HPV in the United States, please see this article by Sharon Phillips, MD., originally published by Rewire.  Please also see this excellent article on HPV in men and boys by Pamela Merritt.

This post has been updated, Thursday, September 16, 2010, 2:30pm EST

I took my 11-year-old son (we’ll call him “E” out of protection for his future teen self who may or may not read this) for a back-to-school check-up recently. He’s in need of a Tdap vaccine, apparently (clearly, I’m less than on-point about keeping up with the vaccine schedule – and somewhat cautious about which vaccines are necessary and which aren’t). After undergoing his first official “pre-teen” health exam while I was in the room with him, E. turned to me slightly red-faced and sighed, obviously thrilled at its completion. It was at that moment his pediatrician addressed me, “Okay, Mom (why are we all the monolithically named, Stepford wife-esque “Mom?”),  he looks great.”

“Just one more thing…”

He glances sidelong, ever so briefly, at E. and looks back to me.

“Have you thought at all about the HPV vaccine?”

Now, as a reproductive and sexual health advocate and writer I’m always quick to jump in ever-so-proudly when conversation turns to these issues – like a fourth-grade know-it-all who can’t wait to show off her knowledge: oooh! oooh! I know this! I know this!

But, I admit that his question caught me off guard. I’d read very little, to be honest, about the pros and cons of the HPV vaccine for boys and young men.

There are currently two HPV vaccines on the market: Cervarix and Gardasil. Both prevent against the most prevalent strains of HPV known to cause cervical cancer, but Gardasil also protects against the strains that cause genital warts. The price tags for both are hefty – anywhere between $120 – $260 per dose. And you need three shots over a period of nine months. Most private insurers cover it, however, and it’s also covered by the federal government’s Vaccines for Children program. Still, for those without private insurance it can certainly be prohibitively expensive.

In 2006, amidst growing concern over the prevalence of HPV – it’s the most common sexually transmitted infection in the United States – Gardasil was approved by the U.S. Food and Drug Administration (FDA) for girls and women ages 9 to 26 years old. But, as with everything else related to female sexuality, it wasn’t without its share of controversy. Anti-sex ed, anti-choice Conservatives screamed that vaccinating girls and young women would give them license to become sexually active sooner – even “promiscuous.”

In October 2009, the use of Gardasil was approved for males in the same age range, to protect against the two strains of HPV which cause genital warts. Strangely, this approval process did not engender the heated debate over a potential sexuality “apocalypse” it did for females. But the reality of its importance still stands – at least half of all sexually active adults in the United States will become infected with HPV at some point in their lives; over twenty million Americans are currently infected.

It’s no surprise that the vaccine is now suggested for males as well. Gardasil is extremely effective in protecting against genital warts in males. In a study of males betwen the ages of 16 and 26, who were not infected with the strains of HPV which cause genital warts, the vaccine was 90 percent effective at preventing infection.

Dr. Doug Lowry is the co-creator of Gardasil. In a story on NPR, he argues that vaccinating boys against HPV provides “herd immunity”, since boys can reduce the number of people transmitting the HPV infection,

He says that since just 11 percent of girls now get all three doses of the vaccine and less than half get even one dose, rates of HPV in the U.S. are unlikely to come down very much.

So, he says, let’s offer the vaccine to boys as well.

“When the percentage of girls getting vaccinated are in the 30 to 40 percent range, vaccinating boys is suggested to have a substantial enhancing impact on trying to protect those girls who are not vaccinated,” Lowy says.

Some are not convinced, however, citing the fact that it will take a much longer time for the vaccine to “catch on” for girls. Vaccinating boys is not the answer.

Dr. Diane Solomon, with the National Cancer Institute says it’s also about cost effectiveness.

“The greatest benefit in terms of health care costs is with decreasing cervical cancer and cervical abnormalities,” Solomon says. “Men don’t have a cervix.”

Even though the HPV vaccine protects against anal cancer and genital warts in men as well, she says vaccinating boys still doesn’t bring down the cost of health care enough.

For me and my son?

He’s certainly not at the age, yet, where this is an issue. His doctor told me he was planting the seed since he believes if it can help prevent genital warts in males and help stem the spread of HPV in both males and females, it’s worth it. As with all issues surrounding the health of my children, I include them in the discussion process. This is about my son’s body, health and life. When he becomes sexually active or he reaches an age where I think we need to realistically address sexual activity and talk more in-depth about it, we’ll do so. We’ve already talked about birth control, sexuality, and pregnancy and infection protection. To me, this is one more area of discussion he has a right to be a part of. Until then, I have time to consider whether another vaccine is the right way to go.