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Malheiro R, Magalhães C, Dias CC, Rodrigues AG, Lisboa C. Genital Warts in Women Vaccinated against HPV in Childhood: A Systematic Review. Vaccines (Basel) 2024; 12:548. [PMID: 38793799 PMCID: PMC11126080 DOI: 10.3390/vaccines12050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Human papillomavirus (HPV) is the most prevalent sexually transmitted infection among young women. Notably, more than ten years after the introduction of HPV vaccination programs in Europe, it is essential to review the real-world evidence of the incidence of anogenital warts (GWs) among women vaccinated during childhood. In this systematic review, three databases were searched for studies published between January 2008 and September 2023. Nine cohort studies were included. A total of 890,320 HPV-vaccinated women and 1,922,033 unvaccinated women were evaluated. All the studies but one investigated the 4vHPV vaccine. The incidence rate of GWs in vaccinated women ranged from 0.0 to 1650 per 100,000 person-years. The highest incidence rates were found in women vaccinated with one dose at the age of 17-19 years old and in fully vaccinated women only after 19 years of age. Similar incidence values were reported among unvaccinated women. The incidence of GWs was lower when the age at first dose was 9-11 years old. This systematic review reveals that the incidence of GWs among HPV-vaccinated women is related to the age of vaccination and the number of vaccine doses received. In the post-vaccination era, epidemiological surveillance of the incidence of GWs and their genotypes is crucial.
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Affiliation(s)
- Renata Malheiro
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.M.); (A.G.R.)
| | - César Magalhães
- Department of Dermatology and Venereology, Gaia and Espinho Local Health Unit, 4434-502 Porto, Portugal;
| | - Cláudia Camila Dias
- Centre for Health Technology and Services Research/Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Knowledge Management Unit, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.M.); (A.G.R.)
- Centre for Health Technology and Services Research/Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Carmen Lisboa
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.M.); (A.G.R.)
- Centre for Health Technology and Services Research/Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Dermatology and Venereology, University Hospital Center of São João, 4200-319 Porto, Portugal
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Pešut E, Šimić I, Fureš R, Milutin Gašperov N, Lež C, Feratović F, Kukina Žvigač T, Grce M, Erceg Ivkošić I, Sabol I. Monitoring HPV Prevalence and Risk Cofactors for Abnormal Cytology in the Post-Vaccination Period among Croatian Women. Viruses 2024; 16:642. [PMID: 38675981 PMCID: PMC11054414 DOI: 10.3390/v16040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The incidence and mortality rate of cervical cancer in Croatia remains a health challenge despite screening efforts. Besides the persistent infection with HPV, the development of cancer is also associated with some cofactors. The goal of this study was to assess circulating HPV genotypes and risk factors for the development of cervical precancer after almost 16 years from the onset of HPV vaccination in Croatia. In this study, a total of 321 women attending gynecological care were evaluated. Relevant medical and demographic information, including cytology, were collected. HPV genotyping was performed by PCR. Comparing the HPV types found in circulation in the pre-vaccination (1999-2015) and post-vaccination periods (2020-2023), a statistically significant reduction in HPV 31 was noted, while the overall prevalence increased in the post-vaccination period. Besides the expected HPV positivity as a risk factor, the history of smoking was associated with LSIL or worse cytology at enrollment. For the first time, this population study revealed a statistically significant shift in the HPV genotype in the post-vaccination period, as well as the confirmation of risk factors for the development of abnormal cytology among Croatian women.
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Affiliation(s)
- Ena Pešut
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia; (E.P.); (I.Š.); (N.M.G.); (M.G.)
| | - Ivana Šimić
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia; (E.P.); (I.Š.); (N.M.G.); (M.G.)
| | - Rajko Fureš
- General Hospital Zabok, Bračak 8, 49210 Zabok, Croatia; (R.F.); (C.L.); (F.F.); (T.K.Ž.)
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University Osijek, Crkvena 21, 31000 Osijek, Croatia
- Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Nina Milutin Gašperov
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia; (E.P.); (I.Š.); (N.M.G.); (M.G.)
| | - Cvjetko Lež
- General Hospital Zabok, Bračak 8, 49210 Zabok, Croatia; (R.F.); (C.L.); (F.F.); (T.K.Ž.)
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University Osijek, Crkvena 21, 31000 Osijek, Croatia
| | - Fabijan Feratović
- General Hospital Zabok, Bračak 8, 49210 Zabok, Croatia; (R.F.); (C.L.); (F.F.); (T.K.Ž.)
| | - Tomica Kukina Žvigač
- General Hospital Zabok, Bračak 8, 49210 Zabok, Croatia; (R.F.); (C.L.); (F.F.); (T.K.Ž.)
| | - Magdalena Grce
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia; (E.P.); (I.Š.); (N.M.G.); (M.G.)
| | - Ivana Erceg Ivkošić
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University Osijek, Crkvena 21, 31000 Osijek, Croatia
- Special Hospital Sveta Katarina, Branimirova 71 E, 10000 Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia; (E.P.); (I.Š.); (N.M.G.); (M.G.)
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Williamson AL. Recent Developments in Human Papillomavirus (HPV) Vaccinology. Viruses 2023; 15:1440. [PMID: 37515128 PMCID: PMC10384715 DOI: 10.3390/v15071440] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
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.
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Affiliation(s)
- Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine/SAMRC Gynaecological Cancer Research Centre/Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town 7925, South Africa
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Wu M, Ma X, Li H, Li B, Wang C, Fan X, Fan A, Xue F. Which is the best management for women with normal cervical cytologic findings despite positivity for non-16/18 high risk human papillomaviruses? Front Public Health 2022; 10:950610. [PMID: 36438260 PMCID: PMC9682294 DOI: 10.3389/fpubh.2022.950610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
Women who test positive for the human papillomavirus (HPV) but have normal cytology constitute the predominant subgroup of patients in the screening population in the post-vaccination era. The distribution of HPV genotypes changed dramatically, which was attributable to an increase in HPV vaccination coverage. These changes have created uncertainty about how to properly manage women with normal cytology, non-HPV16/18 infections, or persistent infections. Current recommendations include retesting and continued surveillance in the absence of HPV16/18 infection. However, these are not always applicable. The ability to implement genotyping or incorporate HPV16/18 with some additional high-risk HPV (HR-HPV) types for triage and management with the aim of identifying type-specific risks in this population could be acceptable. When the next set of guidelines is updated, generating potential triage strategies for detecting high-grade cervical lesions, such as the p16/Ki67 cytology assay and other alternatives that incorporate genotyping with newer tests, should be considered. Current clinical management is shifting to risk-based strategies; however, no specific risk threshold has been established in this population. Importantly, innovative triage testing should be evaluated in combination with primary screening and management. Furthermore, there is an untapped opportunity to coordinate HPV genotyping in combination with colposcopic characteristics to modify risk in this group. Hence, providing a more personalized schedule through the efficient application of risk stratification and improving the detection of pre-cancer and cancer is an option worth exploring.
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Affiliation(s)
- Ming Wu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Bijun Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangqin Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China,*Correspondence: Fengxia Xue
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Zhang H, Zhang S. Prevalence and genotype distribution of human papillomavirus infection among female outpatients in Northeast China: a population-based survey of 110,927 women. Arch Gynecol Obstet 2022; 308:35-41. [PMID: 35904609 DOI: 10.1007/s00404-022-06653-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Human papillomavirus (HPV) infection, especially high-risk HPV, is a major etiological factor for cervical cancer. This study aimed to investigate the distribution of human papillomavirus infection among female outpatients in Northeast China. METHODS A total of 110,927 women aged between 18 and 80 years from Shengjing Hospital of China Medical University, tested with the HPV Geno-Array Test Kit (HybriBio), were enrolled in this study. RESULTS The overall prevalence of HPV infection in the study population was 16.95% (18,802/110,927). A total of 21 HPV genotypes were identified and the six most prevalent ones were HPV16 (5.78%), HPV58 (2.62%), HPV52 (1.91%), HPV33 (1.55%), HPV53 (1.45%), and HPV18 (1.16%). The prevalence of single HPV was 83.58% (15,714/18802) and that of multiple HPV was 16.42% (3088/18802). HPV16, HPV58, and HPV52 were the most common types of HR-HPV infections, while CP8304, HPV11, and HPV6 were the most common types of LR-HPV infections. Among the multiple infection groups, HPV16 was the most common type of co-infection. Furthermore, the prevalence of HPV infections varied among different age groups. Age-specific prevalence of HPV exhibited two peaks in the youngest age group and in the group aged 50-60 years. CONCLUSION HPV16, 58, 52, 33, 53, and 18 were the most common types in the general female population. The prevalence of HPV infection varied among different age groups. This study provides guidance for future HPV-based cervical cancer screening tests and prophylactic HPV vaccinations in China.
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Affiliation(s)
- Huijie Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shulan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
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Morris BJ, Katelaris A, Blumenthal NJ, Hajoona M, Sheen AC, Schrieber L, Lumbers ER, Wodak AD, Katelaris P. Evidence-based circumcision policy for Australia. JOURNAL OF MEN'S HEALTH 2022; 18:132. [PMID: 36034719 PMCID: PMC9409339 DOI: 10.31083/j.jomh1806132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using "circumcision" with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Athos Katelaris
- Department of Urology, St George Hospital, Sydney, NSW 2217, Australia
| | - Norman J. Blumenthal
- Department of Obstetrics and Gynaecology, SAN Clinic, Wahroonga, NSW 2076, Australia
| | - Mohamed Hajoona
- Victoria Circumcision Clinic, The Regent Medical Group, Preston, VIC 3072, Australia
| | | | - Leslie Schrieber
- Department of Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights; Priority Research Centre for Reproductive Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex D. Wodak
- St Vincent’s Hospital, Australian Tobacco Harm Reduction Association and Australia21, Darlinghurst, NSW 2010, Australia
| | - Phillip Katelaris
- Katelaris Urology, North Shore Private Hospital, St Leonards, NSW 2065, Australia
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Hampson IN. Effects of the Prophylactic HPV Vaccines on HPV Type Prevalence and Cervical Pathology. Viruses 2022; 14:v14040757. [PMID: 35458487 PMCID: PMC9029410 DOI: 10.3390/v14040757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
Vaccination programs with the current prophylactic HPV vaccines started in most countries around 2008 with introduction of the bivalent Cervarix HPV16/18 vaccine, rapidly followed by Gardasil (HPV6/11/16/18) and, finally, Gardasil 9 (HPV6/11/16/18/31/33/45/52/58), from 2015. Many studies have now confirmed their ability to prevent infection with vaccine-covered HPV types, and the subsequent development of either genital warts and/or cervical neoplasia, although this is clearly more effective in younger women vaccinated prior to sexual debut. Most notably, reductions in the prevalence of vaccine-covered HPV types were also observed in unvaccinated women at the same geographical location, presumably by sexual dissemination of these changes, between vaccinated and unvaccinated women. Furthermore, there are several studies that have demonstrated vaccine-associated HPV type-replacement, where vaccine-covered, high-risk HPV types are replaced by high-risk HPV types not covered by the vaccines, and these changes were also observed in vaccinated and unvaccinated women in the same study population. In light of these observations, it is not entirely clear what effects vaccine-associated HPV type-replacement will have, particularly in older, unvaccinated women.
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Affiliation(s)
- Ian N Hampson
- Division of Cancer Sciences, University of Manchester, Oxford Rd, Manchester M13 9WL, UK
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