What vaccines should gay and bi men get?

Condoms, PrEP and doxyPEP all need you to do something every time. A vaccine you do once and forget about. A few arm shots now and some of the nastier things that go around our community just don’t happen to you.

The vaccines to ask for

There’s also a combined hepatitis A and B shot (Twinrix) if you’d rather do both at once.

How well do these vaccines work?

Really well. Here’s the best study for each one and how much it cut the risk of getting the infection (or, for HPV, the precancer that leads to anal cancer).

A few things worth knowing about those numbers:

• HPV and mpox were studied in guys like you. The HPV trial enrolled 602 gay and bi men. Among the men who got all 3 doses before catching the HPV types in the vaccine, it cut anal precancer by 78% and lasting anal HPV infection by 95%.
• Hepatitis A and B were mostly studied in kids and the general public, but they work the same way in adults. Fun bit of history: more than 1,000 gay men in New York volunteered for the trial that proved the first hepatitis B vaccine worked, back in the late 1970s.
• Mpox results vary by study. Another big US study found 66% for 2 doses and 36% for 1. Every study agrees on the main point: the second dose matters.
• Meningococcal protection fades. It drops from 79% in the first year to about 61% after 3 years, which is why people who need it get boosters.

Hepatitis A and B

The CDC recommends hepatitis A vaccine for all men who have sex with men, and hepatitis B vaccine for every adult aged 19 to 59. Hepatitis A outbreaks among gay and bi men have hit several US cities, often spread by rimming. Hepatitis B can turn into a lifelong infection that damages your liver.

Not sure if you had these as a kid? A blood test can check, or you can just get vaccinated. An extra dose won’t hurt you.

HPV: the one to chase down first

If there’s one shot on this list worth making a point of, it’s this one. Almost everyone who has sex gets HPV at some point, usually with no symptoms. Most of the time your body clears it. When it doesn’t, some types cause warts and others can turn into cancer years later.

The numbers are why this vaccine matters so much for us. The CDC estimates that HPV causes 91% of anal cancers and 70% of throat cancers.

And gay and bi men get anal cancer far more often than other men. A 2020 analysis in the International Journal of Cancer found about 19 cases a year per 100,000 HIV-negative gay and bi men, and 85 per 100,000 among those living with HIV. For men overall, the rate is 0 to 4 per 100,000, depending on age.

Here’s the good news: the CDC says HPV vaccination can prevent more than 90% of cancers caused by HPV. And there’s no standard screening test for anal or throat cancer for most people, so the vaccine is the best tool you’ve got. If you’re at higher risk, ask your doctor about an anal Pap test too.

The CDC recommends the vaccine for everyone through age 26: 3 doses over 6 months if you start at 15 or older. If you’re 27 to 45, it’s a conversation with your doctor. It works best before you’ve met a type, but even if you’ve had plenty of sex, it can still protect you from the types you haven’t caught yet.

Mpox

The 2022 mpox outbreak spread mostly among gay and bi men, and cases still turn up. ACIP, the CDC’s vaccine panel, now recommends 2 doses of JYNNEOS for gay and bi men with new or multiple partners, or who have sex at saunas, sex parties or big events. Two doses give you much better protection than one (86% versus 75% in the CDC’s biggest study), so come back for the second.

Where to get vaccinated for free

• Health department or sexual health clinic: most give hepatitis A, hepatitis B, HPV and mpox shots for free.
• Pharmacy: many pharmacies give these vaccines without an appointment, and insurance covers them.
• Your doctor or PrEP clinic: ask at your next visit, since you’re already getting blood drawn.

Under the Affordable Care Act, most insurance plans must cover recommended vaccines with no copay.

Frequently asked questions

Should gay men get the hepatitis A vaccine?
Yes. The CDC recommends it for all men who have sex with men. It’s 2 shots, 6 months apart.

Am I too old for the HPV vaccine?
It’s routinely recommended through age 26. From 27 to 45, it may still help, especially if you have new partners, so ask your doctor.

Do I need the mpox vaccine if I had mpox?
Usually not. Having had mpox gives you some protection. Ask a clinic if you’re unsure.

Are these vaccines free?
Usually. Health departments often give them for free, and most insurance plans cover them with no copay.

Sources: CDC on HPV vaccination, CDC on cancers caused by HPV, Clifford et al., International Journal of Cancer (2020), CDC adult immunization schedule, CDC universal hepatitis B vaccination for adults (2022), ACIP mpox vaccine recommendation, Palefsky et al., New England Journal of Medicine (2011), Dalton et al., MMWR (2023), Cohn et al., Pediatrics (2017), CDC Pink Book on hepatitis A, CDC Pink Book on hepatitis B.