engleski

HPV AND MALES IN THE CONTEXT OF THE HPV VACCINE –WHERE ARE WE NOW?

Anogenital warts (condylomata acuminata) are the most common lesions presented in men, however, during the last decade the other HPV-associated exaggerated lesions such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias, as well as the penile, urine bladder and prostate cancer have been studied a little bit more extensively. Consistent studies are still lacking for male population. According to our results, HPV 16 and 18 have been isolated (PCR) from “benign" HPV-associated genital lesions (anogenital warts) in 20% of patients, i.e. more than it is usually expected. Therefore, the diagnostic, therapeutic and prophylactic approach to HPV genital infections in men needs to be complex including HPV DNA typing whenever it seems appropriate. In general, it can be postulated that, over the last decade significant progress has been achieved in the investigation of the HPV prevention. More than 35 types of HPV infect the genital tract ; types 16 and 18 inducing about 70% of cervical cancer and high-grade cervical (and not only cervical) intraepithelial neoplasia (CIN), and HPV 6 and 11 causing 90% of anogenital warts. A prophylactic vaccine that targets these types should thus substantially reduce the burden of HPV-associated clinical diseases. The results of the most recent studies have clearly shown that a quadrivalent HPV vaccine (6, 11, 16, and 18) was generally well tolerated, induced high-titres of serum antibodies to HPV types, and effectively prevented acquisition of infection and clinical disease caused by common HPV types. Since HPV is transmitted by sexual intercourse, managing both partners is necessary in order to eliminate the virus in the population. Approaches to this include prophylactic vaccines such as quadrivalent HPV vaccine for both men and women. This should be the only way to significantly decrease the numbers of infected persons. The recent approval of vaccines against HPV has raised great hopes. Ultimately, within the spectrum of therapeutic options for condylomata, no method is really superior to others ; recurrences occurred in 30-70% of cases. We definitely need the HPV vaccination programme to get rid of one of the oldest and up to now unsolved problems of mankind. The recent introduction of a HPV vaccine (especially the quadrivalent one considering the prevention of the anogenital warts in men, as well) has ushered in new hope of substantially reducing global prevalence of HPV disease. Vaccine-induced immunogenicity in men is equal (if not even greater?) to that in women, and there are indirect benefits to women with male vaccination. Clinical efficacy studies in men are ongoing. It can be concluded that, in this very moment, there is a need for a coordinated effort of patients, parents, health professionals, hospitals, and policymakers to ensure successful implementation of vaccination programs for both women and men. Thus, the role of quadrivalent HPV vaccine in preventing genital warts in men will definitely need to be (re)emphasized.

HPV; males; clinical spectrum; HPV vaccine

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