Nonavalent human papillomavirus vaccination as alternative treatment for genital warts

HPV-16-Induced Squamous Cell Carcinoma in Hidradenitis Suppurativa: HPV Vaccination May Be Useful

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with significant morbidity. Although cutaneous squamous cell carcinoma (cSCC) is a rare complication, it has serious consequences, particularly when associated with high-risk human papillomavirus (HPV) infections. This study examines two cases of HPV-16-induced cSCC in patients with long-standing HS and explores the potential role of HPV vaccination in preventing such malignancies.

METHODS AND RESULTS

We report on two male patients with severe HS (Hurley stage III) and cutaneous squamous cell carcinoma with positive detection of HPV DNA in the tumour tissue.

CONCLUSIONS

HPV vaccination may offer a preventive approach to cSCC in HS patients by reducing high-risk HPV infections. Incorporating vaccination into the management of HS, particularly in high-risk individuals, could potentially reduce the incidence of malignant transformation and improve long-term outcomes. Further research is warranted to validate these findings and refine prevention strategies.

The relationship between the recurrence rate of genital warts and administration of quadrivalent human papilloma virus vaccine in women

In this cohort study a total of 203 women with genital warts, who were referred to gynecology clinic of Shahid Muftah in Yasuj city between 2019 and 2022, were examined and treated by a gynecologist and trained for injection of three doses of Gardasil vaccine after treatment. Of these, 138 women completed the study. Half of them who received three doses of the Gardasil vaccine, aligned in vaccinated group and the other half served as the unvaccinated group. In the vaccinated group, 8 individuals (11.6 %) experienced recurrence, compared to 15 individuals (21.7 %) in the unvaccinated group (p = 0.11). The overall number of recurrence among all participants was 23 (16.7 %). The average duration of treatment until recurrence was 43.6 ± 24.7 weeks in the vaccinated group and 16.4 ± 16.5 weeks in the unvaccinated group (P ≤ 0.017), underscoring the vaccine's preventive role in the recurrence of genital warts.

Treatment and Prevention of HPV-Associated Skin Tumors by HPV Vaccination

HPV-associated dermatological diseases include benign lesions like cutaneous warts and external genital warts. In addition, HPV infection is associated with the development of epithelial skin cancers, in particular cutaneous squamous cell carcinoma (cSCC). In contrast to anogenital and oropharyngeal cancers caused by mucosal HPV types of genus alpha papillomavirus, cSCC-associated HPV types belong to the genus beta papillomavirus. Currently available HPV vaccines that target mucosal HPV types associated with anogenital cancer and genital warts are type-specific and provide no cross-protection against beta HPV. When implementing vaccination to beta HPV to prevent skin tumors, it must be considered that acquisition of these HPV types occurs early in childhood and that the risk for cSCC increases with growing age and decreasing immune surveillance. Thus, individuals considered for beta HPV vaccination usually have pre-existing infection and are largely immunocompromised. On the other hand, worldwide increasing incidence rates of epithelial skin cancer reflect an urgent need for skin cancer prevention measures. Based on the pathogenic involvement of beta HPV, vaccination may represent a promising prevention strategy. Indeed, various procedures of prophylactic and therapeutic vaccination have been developed, and some of them have shown efficiency in animal models. Thus far, however, none of these vaccine candidates has been approved for application in humans.

Knowledge and Attitude of Turkish Male Health Care Workers Regarding Human Papillomavirus and Vaccination

This descriptive, cross-sectional survey study aimed to evaluate the knowledge of human papillomavirus (HPV) infection and vaccination, related diseases, vaccination status, and attitudes toward vaccination among Turkish male health care workers (HCWs). The study was planned between June 20 and 30, 2023. A questionnaire was developed by reviewing similar studies to assess the sociodemographic characteristics, knowledge about HPV, vaccination, and attitudes toward vaccination. A total of 322 volunteers (doctors, male nurses, and other allied health personnel such as cleaning staff, patient carers, and technicians) completed the questionnaire. Participants generally provided accurate answers to questions about HPV but often provided incorrect answers regarding vaccination. In addition, the overall HPV knowledge score was significantly higher among vaccinated participants or those willing to be vaccinated than those who were unvaccinated participants and those who were unwilling to be vaccinated (p < .05). There was a significant and moderately strong relationship between HPV vaccine knowledge level and willingness to be vaccinated. In addition, the relationship between vaccination status and knowledge level was substantial. Factors such as medical position, age, alcohol use, and regular physical activity were more likely to affect the HPV knowledge levels of assistant HCWs negatively. Vaccine hesitancy was also higher in the 27 to 40 age group. Knowledge about HPV, medical position, number of sexual partners, social habits, views on vaccination, cost, and religious and cultural values directly affect the rate of HPV vaccination and willingness to be vaccinated.

Knowledge and acceptability of the human papillomavirus vaccine and associated factors among adolescent girls in public primary schools in Dessie Town, South Wollo, Northeast Ethiopia, 2020: A cross-sectional study

OBJECTIVE

To assess the knowledge and acceptability of the human papillomavirus (HPV) vaccine and the associated factors among adolescent girls in public primary schools in Dessie Town, South Wollo, Northeast Ethiopia in 2020.

DESIGN, PARTICIPANTS AND METHODS

This was an institutional cross-sectional study conducted from 1 November to 30 November 2020 among 844 adolescent girls. A systematic random sampling method was used to select participants, who completed a pretested, self-administered questionnaire. Data were entered into EpiData V.4.6 and exported to SPSS V.25 for analysis. A binary logistic regression model identified the contributing factors to HPV vaccine knowledge and acceptance. Adjusted OR (AOR) and 95% CI computed at p<0.05 were used to assess significance levels.

MAIN OUTCOME MEASURES

The primary outcomes of interest were knowledge and acceptability of the HPV vaccine.

RESULTS

The HPV vaccine is known and acceptable to 47% and approximately 43% of the respondents, respectively. Age (AOR=3.51, 95% CI 1.62 to 7.6), father's educational level (AOR=2.62, 95% CI 1.57 to 4.38) and parent-child communication about sex and reproductive health (AOR=1.94, 95% CI 1.36 to 2.76) were associated with knowledge of the HPV vaccine. Acceptance of the HPV vaccine was significantly influenced by fathers' educational level (AOR=1.88, 95% CI:1.02 to 3.29), knowledge of Pap smear tests (AOR=2.54, 95% CI 1.79 to 3.62) and knowledge of the HPV vaccine (AOR=5.30, 95% CI 3.77 to 7.73).

CONCLUSION

In this study, there was generally good and high acceptance of the HPV vaccine, respectively, compared with a study conducted in Southwest Ethiopia. The study, however, had limitations in terms of recall bias, assessment of coverage/effectiveness over time and generalisability due to the institutional sample used.

Therapeutic Role of HPV Vaccination on Benign HPV-induced Epithelial Proliferations in Immunocompetent and Immunocompromised Patients: Case Study and Review of the Literature

Human papillomavirus (HPV) vaccination represents a milestone in primary prevention of sexually transmitted infections. However, little is known about its possible effects on already established HPV infections. We report the case of a 9-year-old immunosuppressed girl with refractory warts, successfully treated with the nonavalent-HPV vaccine and review the literature about the therapeutic effects of HPV vaccination on benign HPV-induced epithelial proliferations in immunocompetent and immunosuppressed patients. In the literature, promising results were shown on cutaneous warts after HPV vaccination, especially in children and young adults, also in immunosuppressed patients, whereas controverse results were found on anogenital warts. These findings suggest a critical need for randomized clinical trials to assess the efficacy of HPV vaccination in the treatment of benign HPV-induced epithelial proliferations.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases-A Comprehensive Review

Human papillomavirus (HPV) encompasses a diverse array of viruses, comprising approximately 200 serotypes that affect humans. While the majority of HPV strains are associated with benign skin or mucous membrane growths, a subset is implicated in severe health conditions, such as cervical, anal, vulvar, and vaginal cancers. Despite the established effectiveness of HPV vaccines in preventing cervical and anal carcinomas in particular, their therapeutic potential in addressing cutaneous diseases linked to diverse HPV strains remains an intriguing area of investigation. This narrative review critically examines the existing literature to assess the viability of HPV immunization as a therapeutic intervention for prevalent cutaneous conditions. These include genital and extragenital cutaneous warts, epidermodysplasia verruciformis, and keratinocyte carcinomas. The findings suggest a promising dual role for HPV vaccines in preventing and treating dermatologic conditions while emphasizing future research directions, including the immunization perspective against β-HPVs. Moreover, the presence of conflicting study outcomes underscores the imperative for larger-scale, randomized trials with well-matched control groups to validate the efficacy of HPV immunization in the dermatologic context. This review contributes valuable insights into the evolving landscape of HPV-vaccine applications in the field of dermatology.

A systematic review of the treatment of active anogenital warts with human papillomavirus vaccines

BACKGROUND

Anogenital warts (AGWs) caused by the human papillomavirus (HPV) are a common manifestation of HPV infection. Treatment strategies generally include topical therapies to promote wart regression or removal through surgical or other means. These strategies are effective but are associated with high rates of recurrence. HPV vaccines are known to be effective for prevention of AGWs yet preliminary data suggest they may offer therapeutic benefit for regression of active AGWs.

OBJECTIVES

This study aimed to determine the efficacy of HPV vaccines for treatment of active AGWs.

METHODS

A systematic search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted in July 2023 with no limits on date of publication. The search was supplemented with a manual review of references from identified articles and pertinent review articles. Articles were included if they reported at least one patient with active AGWs who received at least one dose of any HPV vaccine. The primary outcome of interest was complete or partial regression of AGWs over any time period. Risk of bias was assessed for each study meeting inclusion criteria.

RESULTS

Seven articles were included. These included 1 randomized controlled trial (RCT), 1 non-RCT, 3 case series, and 2 case reports. All were deemed to have a high risk of bias. Study results showed evidence that HPV vaccines may offer therapeutic benefits to those with active AGWs. Studies reported outcomes for both intralesional and systemically administered vaccines. Outcomes reported improvement according to both partial and complete regression of AGWs.

CONCLUSION

This review found that there is evidence that HPV vaccines may have a role in the treatment of active AGWs. Findings support the notion that the vaccine should be offered to previously unvaccinated patients but the role of intralesional administration of the vaccine to vaccinated patients is still unclear.

Recent Developments in Human Papillomavirus (HPV) Vaccinology

Human papillomavirus (HPV) is causally associated with 5% of cancers, including cancers of the cervix, penis, vulva, vagina, anus and oropharynx. The most carcinogenic HPV is HPV-16, which dominates the types causing cancer. There is also sufficient evidence that HPV types 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 cause cervical cancer. The L1 protein, which, when assembled into virus-like particles, induces HPV-type-specific neutralising antibodies, forms the basis of all commercial HPV vaccines. There are six licensed prophylactic HPV vaccines: three bivalent, two quadrivalent and one nonavalent vaccine. The bivalent vaccines protect from HPV types 16 and 18, which are associated with more than 70% of cervical cancers. Prophylactic vaccination targets children before sexual debut, but there are now catch-up campaigns, which have also been shown to be beneficial in reducing HPV infection and disease. HPV vaccination of adults after treatment for cervical lesions or recurrent respiratory papillomatosis has impacted recurrence. Gender-neutral vaccination will improve herd immunity and prevent infection in men and women. HPV vaccines are immunogenic in people living with HIV, but more research is needed on the long-term impact of vaccination and to determine whether further boosters are required.

Treatment of Pediatric Anogenital Warts in the Era of HPV-Vaccine: A Literature Review

Anogenital warts (AWs) represent a therapeutic challenge, especially in infants, due to sensitive skin and frequent disease recurrence. Though the initial wait-and-see approach is often adopted in asymptomatic immunocompetent children, with spontaneous clearing in almost 90% of cases within two years, persistent or symptomatic lesions can be reasonably treated. However, few studies have been conducted on children. Consequently, most treatments on patients under age 12 are not approved by the Food and Drug Administration. Herein, we review possible therapies for pediatric use in AW and report an illustrative case of a two-year-old boy with atopic skin and symptomatic, persistent AWs who was successfully treated with topical podophyllotoxin, without adverse effects or recurrence. Among available therapies for AWs, topical therapies, such as immunomodulating-agents (topical imiquimod 5% and 3.75% cream, sinecatechins 15% ointment) and cytotoxic agents (podophyllotoxin and cidofovir) are considered manageable in children because of their low aggressiveness. In particular, podofillotoxin gel 5% and imiquimod 5% cream have been reported to be safe and efficacious in children. Currently, HPV vaccination is not recommended as a treatment for established HPV infection and AWs, yet a possible therapeutic role of HPV vaccination was recently suggested in the literature and deserves mention.

Anterior segment optical coherence tomography characteristics of conjunctival papilloma as compared to papilliform ocular surface squamous neoplasia

PURPOSE

To describe the anterior segment optical coherence tomography (AS-OCT) appearance of conjunctival papilloma and identify differentiating features from papilliform ocular surface squamous neoplasia (OSSN).

METHOD

A retrospective chart review of individuals clinically diagnosed with conjunctival papilloma (n = 10) or papilliform OSSN (n = 10) based on slit lamp features. Data on demographics, tumour characteristics, and primary treatment were collected. AS-OCT features were assessed including epithelial thickness and reflectivity, a corrugated epithelial surface, presence of an overhanging edge, presence of intrinsic spaces and posterior shadowing. Histopathology was available in 5 papilloma and 3 OSSN specimens.

RESULT

Overall, the majority of individuals in both groups were white males. OSSN lesions were more likely to involve the limbus (80% vs.10%, p = 0.005) and the bulbar conjunctiva (100% vs. 20%, p < 0.001) compared to papillomas. On AS-OCT, maximum epithelial thickness was thicker in papilloma compared to OSSN (936 ± 533 vs. 637 ± 207 µm, p = 0.009). The feature that best differentiated papilloma from OSSN was an overhanging edge (100% vs. 0%, p < 0.001), where the epithelial lesion was seen on top of underlying normal epithelium. Other features more common in papilloma compared to OSSN included a corrugated epithelial surface (70% vs.10%, p = 0.02), the presence of intrinsic spaces (100% vs. 50%, p = 0.03), and posterior shadowing (100% vs. 40%, p = 0.01).

CONCLUSION

AS-OCT shows differentiating features between papilloma and OSSN with an overhanging edge as a distinctive AS-OCT feature of papilloma.