Antiviral chewing gum to reduce influenza and herpes simplex virus transmission

Every source I see says the vaccine is approved only up to age 45, but are you saying my doctor will give it upon request?

The old tried and true Pap test is still the best screening tool we have for cervical cancer.

This sounds like the words of someone who has tried others.

That said, I feel like any thread about viral transmission is probably a good place for an HPV vaccine reminder too

Second part of the PSA, one should keep prophylactic antiviral medication on hand incase you get exposed to someone with HSV. With 60% of the population positive for HSV, everyone should have an antiviral on hand. acyclovir, famciclovir and valaciclovir

https://www.ncbi.nlm.nih.gov/books/NBK525787/

I am not sure why all the replies are indicating you are anti-science or anti-vax.

It is annoying to be told something from your doctor, internalize it, have your doctor suggest flu and covid vaccine for years but never HPV, and then be told on HackerNews "you should have the HPV" and now I am supposed to tell my doctor I can do his job better than him because I read something on the internet even though most doctors specifically grimace when you do that?

I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.

Medical ethics focus on the benefit to a specific individual - your patient.

This defuses the "Should I kill one to save ten?" moral dilemma - the individual is your patient, even if the other ten are also your patients, you must not harm the one. But for vaccines it also means that the wider societal implications are not ethically relevant

So, medics won't recommend that you give patient A an intervention which is of no benefit to A but is really helpful for everybody else. For example, that you vaccinate teenage boys in the expectation that this way they won't infect teenage girls (with whom statistically many of them will have sex) with an STI that harms those girls.

As a result, the guidance cared about proven benefits to you even though taken neutrally you might have been enthusiastic about a vaccine that might or might not protect you but is definitely a good idea for the wider population. The initial studies understandably focused on the numerically larger problem: If we vaccine young female patients does that prevent relevant HPV infections, and then, as a proxy we might assume they also won't get cancer. Such studies can't tell you whether it prevents men getting cancer because that wasn't measured.

So the recommendation to vaccinate boys was delayed because first somebody has to study what might seem obvious - does the vaccine also prevent HPV related cancers in males? It is, after all, possible that some subtle mechanism means the vaccine isn't effective for this purpose, and it would not be ethical to give schools full of boys a vaccine that they personally do not benefit from having - even if societally maybe that's a good choice.

Beyond the female/ male differential, for adults and older, it's basically a stats game. Most adults have sex. Having sex means you're likely to contract HPV, more sex, more exposure. Is it worth getting vaccinated when there's a 50% chance it's useless? How about 95%? 99.5%? Do you always wait for the crossing lights? Did you ever drink beer or eat bacon ?

US citizens used to value the adults managing such science oriented endeavors actually doing their homework before making broad proclamations of efficacy. Lately, not so much.

This is how science works. Our understanding of a medication's efficacy evolves over time.

> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.

Because approval involves evaluating a risk-benefit tradeoff, and the benefits for those groups are wildly different, as are the risk profiles, due to the way HPV strains[0] work. If they tested against a wide and heterogenous population from the start, it would risk demonstrating insufficient effect, which would eliminate the possibility of the vaccine for everyone. Instead, by testing against the group most likely to benefit from it (women, and specifically women of the age to have no prior exposure to HPV) they can see whether the vaccine has any potential at all, and expand from there.

As it turns out, the vaccine was incredibly effective for them, and as we studied it further, it turned out that other groups which had potentially lower benefits (men, older women) or higher potential risks (teenage girls) had a risk-benefit tradeoff that still overwhelmingly supported approval for those groups.

[0] yes, plural, because there are hundrends, and the vaccines (again, plural, because there are more than one) protect against a handful of them (although that fortunately includes the strains that account for 80-90% of HPV-caused cancers

With regards to HPV, when they tried recommmending (and even making it mandatory) for young print the Christian-right cried foul pretty hard. The Texas Governor got a heap of shit over it at the time because abstinence is the only thing teenagers should know about.

> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.

Multiple reasons.

The first one is basic ethics. Similar on how you should do rolling upgrades of your SaaS software to catch errors before everything goes down, you got to do the same with vaccines. For there, go for the target group with the highest risk and highest potential of averting damage - and for the HPV vaccine, mid-20 women are the best such group: young enough that they might be lucky and not exposed yet, old enough to fall out of the scope of the usual ethics bureaucracy that (rightfully) comes with doing experimental research involving minors, and not so old that they definitely got exposed and making the effort moot. Then it got rolled out to teenage girls as it was proven safe, and eventually to men as well because we can be asymptomatic carriers (as we are for a lot of STDs).

Obviously if you got the speed of Covid vaccines in mind as a comparison, the HSV vaccine appears slow in rollout speed - but please do not forget, the Covid vaccines went through very speedy trials. We were extremely lucky it worked out the way it did.

The second one is availability. Again, unless it's Covid where everything went into full production power in a matter of months, production has to be ramped up carefully, matching rollout strategies - it doesn't make sense to have a mismatch into either direction.

And the third one is time. With Covid, it was easy to prove effectiveness: the people that got the shot got Covid at waaaay lower rates than the control population (and the risks of side effect were way less than the risk of severe Covid). But with something like HPV that can have years if not decades worth of time between exposure and symptoms, it becomes harder to reasonably judge effectiveness and safety.

My guess is it's cost driven? IIRC insurance would not pay for mine when i was out of the recommendation pool but they did (were legally required to afaik) when the pool expanded to include my age group.

Either the vaccine has notable safety issues or it should be at least fine to get the vaccine at an older age.

The reason many people don't trust the CDC's advice is they don't really tell you why or why not.

If you're over 26 you're pretty likely to already be exposed to HPV but not necessarily every strain which would be protected by the vaccine (as it says in the article).

So this pushes the question: why shouldn't I get it even if there's only a small chance it will be beneficial at my age? Is there really a risk they're not telling me about or are they giving bullshit answers? There isn't a third direction.

Thats nonsense. Their "recommendation" is based on supply and epidemiological trends, not actual need of the drug. If supply gets constrained, its up to the CDC and drug makers to make more, not to tell the population to limit uptake.

This is why I don't trust CDC guidelines, nor doctors who blindly parrot them without explanation or context.

Sure, check with "your doctor" about the vaccine. If they give you no good reason not to take it, then take it.

CDC guidelines are nonsense here and I fail to see why they would give them. Is there a vaccine shortage?

The claim is that you're more likely to catch the virus early in your life and thus "lifetime efficacy" is reduced as you grow older. Duh, this is true of any vaccine. There are various strains of HPV and you can catch them one after the other. Having HPV at 50 is just as painful as when you're 18, if not more since your immune system is less effective.

The second part of I don't understand this advice is that they say there's no HPV test for men because the result is non-actionable. What? HIV is also nearly "non-actionable" but knowing one has it definitely reduces the chances of spreading it, does it not?

I don't get it.

I got the vaccine in my thirties against doctor's advice.

Please get the vaccine if you're sexually active with more than one person, regardless of your age.

Yeah, and masks don't work. If it is recommended for adults aged 45, when you turn 46, it kills you.

The CDC is just a government organization. Don’t put too much stock in appeals to authority.

https://www.goodrx.com/gardasil-9

"All". Even if that's true, some time you might travel and be around women who aren't vaccinated, and you get an infection with something bearing the lovely name "genital warts". It has the long-term complications of "cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat". And you can give it to any other women you get with for the next few years, potentially giving them any of those relevant cancers.

So yes. It absolutely makes sense for a man to get it. For selfish reasons, you probably don't want penis cancer. For non-selfish ones, you don't want give other partners cervical cancer.

I guess I am a weirdo, but vaccines are the closest thing we have to space magic. Generally, they are very safe and prevent some of the most devastating diseases. All for the most minor discomfort. I want everything I can get, even if I am unlikely to be exposed to the real infectious agent.

Vaccines aren't 100% effective.

I'm not sure what the effectiveness of the hpv vaccine is, but if it was 95% effective (totally made up number, i dont know what the real one is), then there is a 1 in 20 chance it wont work for someone. If both of you have the vaccine then the chance of both failing would go down to 1 in 400.

That seems worthwhile to me, given there is basically no downside.

(I guess this doesn't account for the affects of herd immunity)

yes. many different strains and even if your body clears infection with one doesn’t protect against other strains

Anecdotal evidence of curative effects even for long term symptomatic infection exists.