A few weekends ago Jerry and I were driving back to Phoenix after our weekend road trip to Los Angeles. As usual Jerry fell asleep after a few hours in the car, so I started flipping around the satellite to find something to entertain me. I eventually landed on “Doctor Radio” where there was a special edition in progress covering various infectious disease topics. Jackpot!
One of the topics that was discussed over the course of the next hour or two was information about various STDs and the vaccines that are available to prevent them. Specifically, the doctors were talking about Hepatitis A and B, and HPV (Human Papillomavirus, or genital warts). Although the show wasn’t focused on gay patients, it was mentioned that gay men are many times more likely to contract these viruses and experience complications from them. I made a mental note to follow up on this after I got settled back in at home.
After some online research was completed, I called my doctor’s office a few days later to make an appointment to come in and get some vaccinations. The voice on the other end of the line sounded a little skeptical and confused why I was calling about this. As it turned out, they did not have the HPV vaccine available, but could offer me a Hepatitis A and/or B vaccine. They would “have to figure out which ones I needed.” I made the appointment and prepared myself to pay cash for this.
Hepatitis A is quite easy to contract whenever anal sex is involved. Aside from that, it can also be contracted anywhere feces are present, such as in a public bathroom. You’re completely over it in a couple months, and you’ll probably develop immunity against future infection. Hepatitis B can be contracted from blood or bodily fluid (even saliva) contact. You can get it from kissing, it doesn’t have to be sex or drug use. It’s a lot more severe, although it’s usually self-limiting and 95% of patients will fully recover and develop immunity on their own against future infection (the other 5% develop a chronic infection that doesn’t go away and they might get liver cancer and/or cirrhosis). Chronic infection doesn’t always show symptoms, and you might not know about it until later in life when you actually get liver cancer.
So I saw the doctor this last Wednesday. He also seemed a little skeptical as to why I was there, but after I explained that I was listening to the radio show about STDs and vaccines and so “here I am,” he suddenly understood and started looking at my chart. It seemed that he had already noticed from my last liver test results that I had partial Hepatitis antibodies, but not enough to actually protect me…I had a “4 out of 10″ on whatever scale this was. So I explained that I had two out of the three required jabs about 20 years ago when I volunteered at a hospital, and did not get the third because I had stopped working there a few months later. This made sense to him and he recommended that I start over with the three jab course, and get the Hepatitis A and B combination vaccines.
I asked him if I was going to have to pay cash for this, and he said that most insurance plans will cover it and I probably didn’t need to worry about it. This was really interesting to me, because I wondered why they didn’t offer me the vaccine when I was here a few months ago for my last physical? I have a gay-friendly doctor, and so it seemed like they really ought to know the importance if this.
Anyway, he also gave me the phone number for the only clinic in the area that he knew offered the HPV vaccine. I asked him if he recommended that I get it, and he said that if he had a son he would definitely make sure he got it. I already knew from my research that it was recommended for all gay men to get it, although it has to be given “off-label” since the FDA only recommends it for women at this point in time. I made another mental note to call this other clinic when I got home.
I asked him if there were any other vaccines I could get, and added that I make no apologies for being a bit of a crazy germophobe. He replied that I could get a tetanus booster that was recommended every 10 years, although it wasn’t really necessary unless I get cut a lot as part of my job or something. Great! I told him that I never get cut, but will take what I can get and I accepted in ernest.
The doctor left, probably while writing something about my craziness in my chart, and then while later a nurse came in with two syringes. She cleaned my right shoulder and then she slowly injected the tetanus vaccine as something stirred. Wait…huh?
I awkwardly pulled up my shirt from my left shoulder as she cleaned it with a cold alcohol pad and then started to inject the Hepatitis vaccine. I confirmed that it was a combination of A and B vaccine. After she jabbed the needle in, I looked at the wrapper and saw the medical labeling. This time there was more to inject, and it burned a little. After she was done I slowly exhaled and felt a little shaky and light headed. I was hooked!
……
This afternoon I was at the Fit Health clinic to get my HPV vaccine. I waited for the admin at the desk to ask me what I was doing there getting a women’s vaccine, but she didn’t. Instead, she sheepishly asked me if I wanted to read some pages of information she had printed out for me regarding the effectiveness of the Gardasil vaccine. Didn’t she know that this was basically porn for germophobes? Of course I wanted to read it, and I scanned it as she asked me to pay my $150 for the first of what would be three doses required for full immunity.
There was of course no way that my insurance was going to cover this one. Just as the HPV virus causes almost all cases of cervical cancer in women, it causes almost all cases of anal cancer in men. Being gay and having anal sex increases your risk of anal cancer significantly. In fact you’ve probably heard this mentioned from some of the religious nutjobs as proof that homosexual sex is unhealthy - this is somewhat true, although it’s funny that they don’t mention cervical cancer as proof that heterosexual sex is unhealthy! Both involve the likelihood of the eventual transmission of one or more HPV virus strains, which cannot be prevented through condom use.
There are over 100 different strains of HPV virus out there. The Gardasil vaccine gives you immunity to four strains of the HPV virus. This doesn’t seem like much, but two of those strains (16 and 1 
were selected because they are the strains that cause nearly all of the cancer, and two were selected (6 and 11) because they cause nearly all of the actual cases of genital warts. Most people have at least one strain after they have been sexually active for awhile, but the vaccine is still recommended so that immunity can be achieved against the other remaining strains. It is rare for someone to be infected with all four of those strains.
So, back to the clinic as I’m called back for my injection. Clean the shoulder, unwrap the syringe, push the needle, and…
I’m imagining recombinant viral proteins beings sprayed into my muscle tissue, proteins assembled maybe months after they were stripped from the shells of virus particles (the technology!). Before that, a process invented somewhere by lab coated medical God warriors in the bowels of the R&D department of Merck.
It burns as I visualize lymphocytes from my immune system swarming around the proteins and destroying them. Killer T cells are searching (searching!) to make sure that no cells were infected. They weren’t, this time. B cells start dividing to make millions of new antibodies and spread them through my whole body. B cells and T cells now remember the virus and will overwhelm it the next time it’s encountered.
I feel like Neo in The Matrix. “I know Kung Fu.”
The nurse discards the syringe and asks me if I want a call in two months to help me remember to come in for my second injection.
“Sure,” I manage to say to her. But I don’t need it.
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