A new trial finds that the Gardasil vaccine protects men against human papillomavirus (HPV) as effectively as it does women. the question is: is widespread vaccination necessary?

Gardasil became available in 2006 and is now recommended by the Centers for Disease Control and Prevention (CDC) for all girls and young women between the ages of 9 and 26. it protects against four strains of HPV: 6 and 11, which cause 90% of genital warts cases, and 16 and 18, which cause 75% of all cervical cancers. Cervical cancer affects some 12,000 women per year.

However, vaccination rates remain low: according to a study presented in 2010 by researchers at the University of Maryland, only about one-third of teen girls and young women who start the three-dose series actually finish, and nearly three-quarters don’t start it at all. Part of the problem may be the drug’s cost, which approaches $400 for all three doses.

In 2009, Gardasil was approved for use among boys and men aged 9 to 26, but, lacking key data on the effectiveness of the vaccine in boys, official CDC guidelines don’t recommend routine vaccination in this group.

The new study, funded by Gardasil’s maker, Merck, involved 4,065 sexually active young men ages 16 to 26, from 18 countries, who were HPV-free at the time of trial. the participants were followed for two to three years. Overall, the study found that those in the Gardasil group was 65.5% less likely to develop genital warts caused by the four HPV strains that Gardasil inoculates against, compared with the placebo group. among study participants who completed the entire three-dose regimen, the vaccine was 90.4% effective at preventing genital warts (and 85.6% effective at preventing persistent HPV infection), compared with the placebo group — similar to its effectiveness in the female population.

Preventing persistent HPV infection and genital warts in men may also protect them from related cancers of the anus and penis. But given that rates of both genital warts and anal and penile cancers are so low in men, experts question whether the costs of vaccination are worth its benefits. Still, last week, the American Academy of Pediatrics included HPV vaccines for the first time in its list of recommended vaccines for children and teens. In December, Merck received permission from the FDA to market Gardasil as prevention for anal cancer.

Some advocates of routine HPV vaccination say that inoculating men contributes to herd immunity, and helps protect women. CNN reports:

“Men are such a vital component of the whole prevention cycle when looking at HPV or any sexually transmitted infection,” says Demetrius Porche, a professor of nursing research and evaluation at the Louisiana State University School of Public Health in new Orleans.

Vaccinating men provides a “double benefit” in that fewer men with HPV will also mean that fewer women are exposed, adds Porche, who was not involved in the current study but has researched HPV in men.

HPV is the most common sexually transmitted infection and affects 50% of sexually active adults over their lifetimes. the CDC estimates that 20 million Americans currently have a strain of HPV, with 6 million new cases each year. the virus has 40 different strains and is unusual in that its symptoms and outcomes can vary wildly; most people who have the virus have no symptoms and no lasting health problems. About 90% of HPV cases clear up on their own, though it can take up to two years for that to happen, which affords plenty of time to spread the disease.

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Other traumatic events such as a road accident or sexual abuse can also trigger the condition. NO two people experience PTSD in the same way and while in some cases symptoms can occur weeks after the event, in others it doesn?t happen for months or years. ?It?s not inevitable,? says Lincoln University psychologist  Roderick Orner. ?Major incidents happen in the lives of around three-quarters of people in their lifetime and very few actually develop PTSD.? However for those who do, it can be overwhelming. ?I felt a real need to defend my home and family in an obsessive way,? says 31-year-old Ram, who carried out security checks on his house three times every night. ?I even took it to the extent of cutting the grass outside the front door very low to the ground to enable me to identify footprints of anyone attempting to get near the house.? often underestimated is the impact of PTSD on loved ones says Nigel Hunt, associate professor in health psychology at Nottingham University. ?You can imagine how it affects families,? he says. ?One man leaves the house to go to war, a different man comes back. sometimes he is unrecognisable. In some cases there is aggression, violence and drinking.? Candice recalls the struggle of having to remain calm throughout. ?I knew it wasn?t his fault but his extreme stress affected every aspect of our lives,? she admits. Patricia Campbell-Hughes is a psychologist who has worked with many ex-servicemen suffering from PTSD and says: ?One of the most difficult things for families is that sufferers often have extremely frightening flashbacks as if they are actually reliving the situation.? Treatment has historically been hard to come by particularly within a military context. It is difficult enough for anyone to recognise they have a mental health problem, let alone in an environment where resilience is key. ?Prior to 15 years ago it was difficult to get the military to even recognise PTSD as that might lead to soldiers claiming compensation in terms of their duty of care as an employer,? says Professor Hunt. Today it?s a different story Largely thanks to the MoD and NHS working closely with the Royal British Legion and other armed forces charities, treatment is becoming increasingly available and innovative. Treatments range from cognitive behavioural therapy which works on identifying and challenging thoughts and behaviour that may be maintaining symptoms and eye-movement desensitisation and reprocessing where the  patient tracks and follows a moving object while recalling a stressful memory or event. Newer narrative techniques focus on people telling their stories. ?As soon as it became apparent that I needed help, it happened really quickly,? says Ram who reports that in his nine months of therapy he was able to work through the causes of the problem, not least his difficulty in coming to terms with the lives Afghan children had to endure. ?Having a young daughter exacerbated this especially because my daughter was fortunate enough to have both parents who loved her and had the means to provide for her. there was a mental and emotional turmoil within me  which often left me guilty, frustrated, angry and helpless.? ROYAL British Legion head of welfare Sue Freeth says: ?People with PTSD can feel very isolated and they may be a risk to themselves and others. People who have served their country should not have to feel lost.? keen to give something back to those who helped him Ram has organised the March for Honour (marchforhonour.com). Four teams consisting of former and serving members of the armed forces left from separate points in the UK last Thursday on a 250-mile march, culminating in them delivering the Book of Remembrance to the Royal Albert Hall on November 11 for Saturday?s Festival of Remembrance there. The march will also raise money for the Poppy Appeal and symbolises the struggle faced by everyone at some point in life, says Ram. we all hit a wall at some time, he adds, and the support of those around us and the realisation  others have overcome obstacles help us through. Candice has also managed to salvage something positive from their ordeal. ?I actually think it?s made our family closer,? she says. ?I knew when I met Ram that he was a strong person but seeing him overcome what he has still amazes me. I never take anything for granted now. ?I often stop and thank my  lucky stars for the normality of daily life that I longed for during that time.”