PL9 The HPV‐genital (and oral?) infections – how are we standing now?

Abstract

Human papillomavirus (HPV)‐associated genital pathology represents one of the major problems among STIs mostly due to the high recurrence rate, difficult eradication and oncogenic potential. Besides, the young, sexually active population in the generative period is mostly affected. Anogenital HPV infections are the most frequently diagnosed STIs of viral origin. However, oral affections caused (or induced?) by the HPV‐‘genital’ types seem to be rather rare and could be very sporadically associated with the genital lesions in the immunocompetent individuals in spite of the clear involvement of the oral mucosa in the (sexual) mode of transmission. HPV genital infections are also one of the most frequent diagnoses in the Sexually Transmitted Diseases (STD) Outpatient Clinic of the Department of Dermatology and Venereology of the Zagreb University Medical School. As the very careful and friendly‐orientated manner of taking the medical history and clinical examination is rather important in order to obtain the exact data (especially regarding the oro‐genital mode of transmission), the clinical variations are presented ranging from clinically invisible or poorly visible, ’asymptomatic’ lesions to the bizarre forms of giant condyloma of Buschke‐Löwenstein type. In spite of the fundamental importance of the clinical examination itself, we wanted to identify the HPV DNA type in these lesions. We wanted to evaluate the significance of viral tests (PCR, hybridization) for HPV‐induced, clinically visible lesions (condylomata acuminata, condylomata plana, Buschke‐Löwenstein) in men. According to our results, HPV 16 and 18 have been isolated from ’benign’ HPV‐associated genital lesions in 20% of patients, i.e. more than it is usually expected. Therefore, the diagnostic approach to HPV genital infections needs to be complex including HPV DNA typing whenever it seems appropriate. Different methods are presented for the treatment of genital warts, such as cryotherapy, podophyllotoxin, curettage, podophyllin, and imiquimod (in the smaller group, as compared to other treatment modalities). It can be concluded that no definite treatment method has been clearly found superior so far. Thus, treatment should be guided by the available resources, the experience of the provider and the preference of the patient. In general, it can be postulated that, over the last decade, the oncogenic properties of HPVs have been intensively studied. 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 candidate 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.