I'm male and read about this exposure vector back in 2012 when it was only rolled out to 12 year old girls, with a further guideline that nobody over 26 should take it.

this was pre- antivaxxer anxiety, and just run of the mill 'is the government condoning sex' anxiety, and it was controversial for that reason alone

the issue was that if you've been exposed already then the vaccine doesn't work. they had a test for women that can prove they've been exposed or not, and most adults have. they don't have a test for men that can prove they've been exposed or not, and most adults have. At the time, they had also only considered males to be carriers, with no cancers themselves.

so for the US government to recommend a limited stock and get insurers on board, it was all based on probabilities of exposure and utility.

I was younger at the time, naturally, I paid $600 out of pocket to get it across 3 doses because I figured it was worse than that, or I could get some 'male ally' brownie points from women. I wasn't wealthy then but figured this experience couldn't be taken from me even if I went bankrupt.

Since then, they've further linked it to throat cancers in males, because of our mouth's contact with genitals, and insurers are told to cover it across all genders and up to mid 40s. that's not really much of a difference now though, since the checkpoint is basically the same group of people, 13 years later.

They're still assuming older people are not worth bothering with, due to likely exposure.

There is an amusing side of this if you are male and not vaccinated yet, since nobody can tell if you've been exposed still: keep your sexual relationships with younger women. lol. in case you needed an excuse - higher probability they're vaccinated.

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Fomite 4 days ago | parent | next [-]

"this was pre- antivaxxer anxiety" - It was really, really not.

Another thing to keep in mind was that the initial trials were only using cervical cancer endpoints - the association between HOV infection and cervical cancer is really strong. At that time, vaccinating boys provided only indirect protection (you couldn't infect a female partner), rather than direct protection (you won't be infected) in the context of cervical cancer.

Women prior to sexual debut were the biggest "bang for the buck" and the obvious first recommendation target.

Researchers both at universities and in private industry then started working on other populations based on alternative endpoints.

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elric 4 days ago | parent [-]

> Women prior to sexual debut were the biggest "bang for the buck" and the obvious first recommendation target.

It was a stupid decision to leave out the boys. I mean hindsight is 20/20, but if heterosexual women were getting cervical cancer from HPV, and HPV is spread by sexual activity, then vaccinating the boys along with the girls would have been the logical thing to do in order to stop the spread.

I assume this wasn't done because they didn't do any studies on boys at first, because they were looking for cervical abnormalities to gauge vaccine effectiveness, and maybe it would have been hard to recruit a bunch of boys for a vaccine study that would probably not benefit them.

With that same hindsight we now know that HPV vaccination also prevents some oral cancers, and that leaving out the boys was a very stupid decision indeed.

These days most places do seem to also vaccinate boys. I got an HPV vaccine at some point in my 30s, and I pretty much had to wrestle my doctor into submission in order to get a prescription.

	▲	yieldcrv 4 days ago \| parent [-]
		They had and still have no test for males. So this is more about the inflexibility of our recommendation process and how insurers are tied to the regulatory agencies. The logic makes sense but its about who is paying for administering to the carriers. Or what was initially seen as just carriers.

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mgiampapa 4 days ago | parent | prev [-]

The current recommended cutoff is 45 (well, pre the current US administration). So I think it was a question of we tested this at the time in these high risk age groups and we were still waiting on the results for other cohorts that were less important.