Papillomavirus Vaccination in Dermatology
Anogenital infection by human papillomavirus (HPV) is the most common sexually transmitted infection (STI). It bears oncogenic potential, causing most cases of cervical, vulvar, vaginal and anal cancer. There is no specific antiviral therapy and the treatment of HPV-associated neoplasms does not prevent transmission. Thus, prevention of infection is particularly important, and the Venereology consultation is a privileged opportunity to identify people who benefit from preventive measures. The most recent nonavalent HPV vaccine provides coverage for types 6, 11, 16, 18, 31, 33, 45, 52 and 58, which together account for 90% of cancers of the cervix and genital warts. The vaccine is recommended by the WHO for women and men up to 26 years old. In most countries, the vaccine is provided freely to ensure universal immunization of female adolescents prior to the commencement of sexual activity. In addition to the target population, the vaccine may benefit other individuals often treated by dermatologists: men who have sex with men, immunocompromised hosts such as organ-transplant and HIV-seropositive patients, and candidates for immunosuppressive treatments. The decision to vaccinate should consider the individual risk of prior exposure to HPV and the potential benefit of vaccination, which is prophylactic and not therapeutic. We review published data on the immunogenicity, safety and efficacy of the HPV vaccine in different clinical contexts, and international recommendations that may guide individual counseling by the dermatologist.
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