A 16-year-old boy is brought to the office by his mother for a routine well visit. The patient has been doing well in school and has not been in the office over the past year for any sick visits. His mother says, "My son has had a girlfriend for the last few months, and I wonder if boys can receive the human papillomavirus vaccine. I am friends with his girlfriend's mother and heard that she received the vaccine a few years ago." The patient takes no daily medications and has no known drug allergies. The mother leaves the room for the examination, and the patient says that he is considering vaginal intercourse with his girlfriend. His parents have talked with him about abstinence and the importance of using a condom if having sex. The patient was sexually active with a previous girlfriend and used condoms every time. He is not sexually active with males and has never been tested for sexually transmitted infections. There is no family history of cancer. Physical examination shows no skin lesions, including in the genital area. The penis is circumcised with no visible discharge. The testes are descended bilaterally with no erythema or masses. Counseling about the prevention of pregnancy and sexually transmitted infections is provided. Which of the following is the most appropriate recommendation about the human papillomavirus vaccine in this patient?

Question

A 16-year-old boy is brought to the office by his mother for a routine well visit.  The patient has been doing well in school and has not been in the office over the past year for any sick visits.  His mother says, "My son has had a girlfriend for the last few months, and I wonder if boys can receive the human papillomavirus vaccine.  I am friends with his girlfriend's mother and heard that she received the vaccine a few years ago."  The patient takes no daily medications and has no known drug allergies.  The mother leaves the room for the examination, and the patient says that he is considering vaginal intercourse with his girlfriend.  His parents have talked with him about abstinence and the importance of using a condom if having sex.  The patient was sexually active with a previous girlfriend and used condoms every time.  He is not sexually active with males and has never been tested for sexually transmitted infections.  There is no family history of cancer.  Physical examination shows no skin lesions, including in the genital area.  The penis is circumcised with no visible discharge.  The testes are descended bilaterally with no erythema or masses.  Counseling about the prevention of pregnancy and sexually transmitted infections is provided.  Which of the following is the most appropriate recommendation about the human papillomavirus vaccine in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bddc_fee5_8f63_a55eeacbcaa0_MD0005_00 Human papillomavirus (HPV) is a common sexually transmitted infection responsible for nearly all cases of cervical cancer and many cases of other anogenital cancers (eg, vulvar, vaginal, anal, penile), oropharyngeal cancer, and genital warts. The HPV vaccine series targets 9 serotypes that cause either genital warts (eg, types 6 and 11) or cancer (eg, types 16 and 18), and routine vaccination has resulted in the decline of HPV infection and HPV-related cancers. The primary indication for vaccination in girls is reducing the risk for cervical cancer, and all boys should be vaccinated to decrease the risk for anogenital and oropharyngeal cancers. Vaccine administration in boys also contributes to herd immunity against cervical cancer in women. Genital warts are prevented in both sexes. The recommended time for the first dose is age 11-12 (as early as age 9) because it is most effective in those who are HPV-naive (ie, prior to sexual debut). Younger adolescents also produce a more robust immune response to the vaccine than older patients. However, all patients age <26 should be offered the vaccine to decrease the risk for HPV transmission and related cancers (Choice A). Patients from age 26 to 45 can also receive the vaccine, but its effectiveness may be decreased due to an increased likelihood of prior HPV exposure from previous sexual partners. (Choices B and C) HPV is spread by skin-to-skin contact. Condoms offer partial protection but do not cover the entire genital area, so HPV can still be transmitted. Although the vaccine may be less effective in sexually active patients due to the possibility of prior exposure to HPV, it can confer protection against other HPV strains. Therefore, HPV vaccination should be offered to patients age <26 regardless of sexual history or method of contraception. (Choice E) Most male patients with HPV are asymptomatic. Clinically significant HPV infections manifest as genital warts or anogenital/oropharyngeal cancer. Although some cervical cancer treatments in women can reduce fertility, HPV does not cause male infertility. Educational objective: The human papillomavirus vaccine series should be offered to all patients age 11-26. The vaccine reduces the risk of genital warts and anogenital and oropharyngeal cancers in both sexes. References: Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. (http://www.ncbi.nlm.nih.gov/pubmed/32639044) Efficacy, effectiveness and safety of vaccination against human papillomavirus in males: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/30016957)

A 16-Year-Old Boy Is Brought to the Office by His