You are currently viewing a new version of our website. To view the old version click .
MDPIMDPI
Search all articles
Pathogens
Download PDF
  • Article
  • Open Access

11 December 2025

Study of the Knowledge, Attitudes and Practices of Students from Medical Majors Regarding HPV Infections and HPV Vaccines

,
,
,
and
1
Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
2
Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
*
Author to whom correspondence should be addressed.
Pathogens2025, 14(12), 1270;https://doi.org/10.3390/pathogens14121270
This article belongs to the Special Issue Human Papillomavirus Vaccination: Progress and Challenges in Global Immunization Strategies
Version Notes
Order Reprints

Abstract

Background: Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection that can lead to cervical and other anogenital and oropharyngeal cancers. Despite available vaccines, vaccination coverage remains low in Bulgaria. This study aimes to assess the knowledge, attitudes, and practices of Medical University students in HPV prevention. Materials: A cross-sectional anonymous survey was conducted at the Medical University-Plovdiv, Bulgaria. Results: A total of 1485 students, primarily women (60.1%) with a median age of 22.78 years, participated. Four hundred fifty-two (30.4%) reported having received the HPV vaccine. Of the unvaccinated, 800 (77.8%) expressed willingness to receive the vaccine. Vaccinated respondents were more likely to report having had five or more sexual partners (37.1%) compared to unvaccinated respondents (21.1%) (χ2 = 77.136, p < 0.001). Approximately one-third (36.4%) mistakenly believe condoms provide complete protection and that antibiotics effectively treat HPV. Students who opposed the assertion that vaccinating minors suggests early sexual activity is permissible were 1.89 times more likely to be vaccinated. Conclusions: Medical University students possess insufficient understanding of HPV transmission, health outcomes, and prevention. Their attitudes and practices require improvement. Enhancing the curriculum with comprehensive HPV information will better equip future healthcare providers and improve public health outcomes.

1. Introduction

Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection (STI) with significant implications for public health, since 85–90% of sexually active people will acquire it at some point throughout their life [1,2]. HPV is a DNA virus with over 200 identified types, categorised into low-risk (lr-HPV) and high-risk (hr-HPV) HPV types based on their potential to cause disease [1], and is primarily transmitted through sexual contact, although some non-sexual routes have also been suggested [3,4].
Among the 14 classified hr-HPVs (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), types 16 and 18 are the most oncogenic, responsible for approximately 70% of cervical cancers, while other hr-HPVs, such as types 31, 33, 45, 52, and 58, contribute to an additional 15–20% of cases [4,5]. Low-risk HPV types, including HPV-6 and HPV-11, do not cause cancer but are linked to benign conditions such as genital warts and recurrent respiratory papillomatosis (RRP), which affects the respiratory tract [4]. Vaginal, vulvar, penile, and some head and neck cancers are associated with hr-HPV types [6]. Furthermore, oropharyngeal cancer, increasingly prevalent in men, is strongly associated with HPV-16 [7], and approximately 90% of anal cancers are also linked to hr-HPVs [8]. High-risk HPV types mediate oncogenesis primarily through E6 and E7 oncoproteins, which inactivate tumour suppressors p53 and Rb, respectively, promoting genomic instability, cell cycle deregulation, and malignant transformation across anogenital and oropharyngeal sites. These oncoproteins disrupt normal cellular checkpoints, enabling persistent viral replication in differentiated keratinocytes and accumulation of secondary genetic alterations essential for cancer progression [8].
In 2022, HPV-associated cancers accounted for 1,505,394 new cases worldwide (922,728 in females and 582,666 in males), with an age-standardised incidence rate (ASIR) of 20.9 per 100,000 people, and 755,303 deaths (ASMR of 10.2 per 100,000). Cervical cancer remains the predominant HPV-related malignancy, comprising over 90% of cases in women, though head and neck cancers represent the largest absolute number of cases (685,204) [9]. These figures underscore the persistent global challenge despite vaccination efforts. In asymptomatic women, the prevalence of cervical HPV infection globally is approximately 11%, with rural women and those attending cervical cancer screening clinics having higher prevalence rates compared to urban populations [10]. The global pooled prevalence of genital HPV infection among men is 31% for any HPV type and 21% for hr-HPVs, and prevalence peaks are observed in young adults aged 25–29 years [11]. Although the majority of HPV-related malignancies are cervical, there is an escalating epidemic of HPV-driven oropharyngeal squamous cell carcinoma in specific regions globally, especially low- and middle-income countries (LMICs) [1].
Bulgaria, a country located in Eastern Europe, has a population of 6.4 million, of whom 3.06 million are women aged 15 years and older who are at risk of developing cervical cancer. Estimates from 2023 show that 1009 women receive a cervical cancer diagnosis each year, and 503 of them succumb to the disease. Approximately 9.7% of women in the general population are expected to be infected with cervical HPV-16/18 at any given time, and 84.7% of invasive cervical malignancies are linked to HPVs 16 or 18 [12].
On a global scale, six HPV vaccines are officially licenced for use: three bivalent, two quadrivalent, and one nonavalent. The most frequently employed are bivalent, which targets HPV-16 and 18, with some cross-protection against types 31 and 45; quadrivalent, which provides protection against HPV types 6, 11, 16, and 18; and nonavalent, which expands coverage to five additional types—31, 33, 45, 52, and 58—offering nearly complete protection against HPV-related infections and precancers [13,14].
Widespread vaccination could potentially eliminate cervical cancer, as demonstrated by countries with high vaccination rates like the UK and Australia [15,16,17]. The WHO emphasises the importance of HPV vaccination for both genders, focusing especially on regions with low female coverage, aiming to vaccinate 90% of girls by age 15 and promoting the inclusion of boys in immunisation efforts [18]. Several models have indicated that vaccinating both males and females is more effective at reducing HPV infections and related diseases than focusing vaccination efforts solely on girls [19].
Despite the effectiveness of vaccines, many regions face challenges linked to misconceptions about vaccination and low general HPV knowledge and therefore have low vaccination rates [15]. As of 2023, fewer than 15% of females globally have completed the full course of HPV vaccination, while vaccination coverage among males lags even further behind, with only around 4% of men worldwide having received full HPV immunisation as of 2019 [20,21]. Bulgaria expanded its immunisation coverage by providing the HPV vaccine free of charge for boys aged 10–13 years in response to the very low immunisation coverage of 2% and following international recommendations in April 2025 [22].
Raising HPV vaccination rates is a public health priority that requires a multifaceted approach, including awareness campaigns, educational initiatives, and proper training for healthcare professionals [23]. Enhancing the knowledge, attitudes and practices of university students from medical majors is especially important, as they play a vital role in promoting HPV prevention, raising public awareness, and increasing vaccine acceptance in the future.

2. Materials and Methods

2.1. Study Design and Settings

A cross-sectional anonymous survey was conducted in the period May–October 2023 among students at the Medical University of Plovdiv, Bulgaria. The survey sought to assess knowledge, attitudes, and practices about HPV infection and vaccination. The survey was disseminated electronically through Google Forms via the university’s email and correspondence system. No personal information was gathered. Before commencing the questionnaire, all participants provided informed consent, affirming their readiness to participate.

2.2. Questionnaire

The questionnaire was designed in both Bulgarian and English, considering that university studies are undertaken in these languages. The study had four panels: demographics, knowledge of HPV infections and the HPV vaccine, attitudes towards the HPV vaccine, and practices concerning the HPV vaccine. The enquiries assessing student attitudes utilised a 5-point Likert scale, ranging from 0 (strongly disagree) to 5 (strongly agree).

2.3. Statistical Analysis

Descriptive analyses were applied to both quantitative and qualitative data. For continuous variables, results were expressed as means with standard deviations or, in cases of non-normal distribution, as medians accompanied by interquartile ranges (25th and 75th percentiles). Categorical variables were summarised using counts and percentages (n, %). The Kolmogorov–Smirnov test was used to examine whether continuous data followed a normal distribution.
Group comparisons for non-normally distributed continuous variables were performed using the Mann–Whitney U test, while differences in proportions between two groups were evaluated using the z-test. Variables demonstrating a p-value below 0.10 in univariate analyses were included in a binary logistic regression model to assess the likelihood of a given observation falling into one of two outcome categories—specifically, HPV vaccination—based on several predictor variables. The model yielded odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each predictor.
All data management, statistical processing, and analysis were carried out using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, USA; released 2017).

3. Results

A total of 1485 students, predominantly women (60.1%) with a median age of 22.78 years, took part in the survey. Bulgarian nationals represented 58.6% of respondents (n = 870), while 41.4% (n = 615) were international students. A detailed breakdown of socio-demographic characteristics is presented in Table 1.
Table 1. Socio-demographic characteristics of the study respondents.
Of all surveyed students, 452 (30.4%) reported having received the HPV vaccine. Among those unvaccinated, 800 (77.8%) expressed willingness to receive the vaccine if provided the opportunity.
A statistically significant difference in vaccination rates was noted by nationality: 50.6% of international students (n = 311) were vaccinated, in contrast to 16.2% of Bulgarian students (n = 141) (χ2 = 201.787, p < 0.001). Significant gender disparities were observed, with a greater percentage of women (n = 319, 70.6%) vaccinated in contrast to men (n = 129, 22.3%) (χ2 = 29.978, p < 0.001).
Individuals vaccinated against HPV were more likely to report having had five or more sexual partners (n = 127, 37.1%) compared to unvaccinated individuals (n = 215, 21.1%) (χ2 = 77.136, p < 0.001). Furthermore, approximately 43.8% of vaccinated students (n = 67) had both parents employed in healthcare, in contrast to 26.1% (n = 86) of the unvaccinated cohort (χ2 = 26.944, p < 0.001).
Vaccination rates correlated positively with the year of study: 42.3% (n = 107) of students in their third year or higher were vaccinated, while students in previous years were largely unvaccinated (χ2 = 69.443, p < 0.001). Age (p = 0.062) and sexual preferences (p = 0.110) were not substantially correlated with HPV vaccination status, indicating these factors had minimal impact within this group.
The participants demonstrate adequate understanding of HPV infections in some commonly recognised aspects, yet they exhibit gaps in other areas. Table 2 provides a comprehensive breakdown of knowledge regarding HPV infection.
Table 2. Knowledge regarding HPV infection.
Nearly all participants, regardless of their vaccination status, acknowledge that HPV is transmitted through sexual contact and that infection with the virus increases the risk of cervical cancer. The awareness of vulvar and penile cancer risk stands at 84.9% (n = 1261), showing a slight decline. This trend continues with anal cancer awareness at 71.2% (n = 1058) and oropharyngeal cancer awareness at 74.5% (n = 1106).
A minority of students from medical majors, specifically 46.9% (n = 697), hold the belief in complete recovery from HPV infection. Additionally, approximately one-third of these students, 36.4% (n = 541), mistakenly think that condoms provide complete protection against HPV and that antibiotics can effectively treat viral infections.
It is noteworthy that a higher number of the vaccinated participants inaccurately claim that HPV infection typically presents with visible symptoms (n = 165, 36.5%) (χ2 = 9.287, p = 0.02).
When assessing the knowledge of the respondents regarding the HPV vaccine, we discovered some intriguing results (Table 3). A notably greater percentage of vaccinated participants indicate that a family member has been diagnosed with cervical cancer or other HPV-related oncological diseases (n = 77, 17.0%) in contrast to non-vaccinated respondents (n = 89, 8.6%) (χ2 = 22.450, p < 0.001).
Table 3. Knowledge regarding HPV vaccines.
Approximately 47.1% of vaccinated respondents (n = 213) are aware that the vaccine can be administered to individuals with an existing HPV infection, in contrast to 35.7% of non-vaccinated respondents (n = 369), indicating a statistically significant association (χ2 = 17.154, p < 0.001). This finding is supported by a higher proportion of non-vaccinated students who believe that screening is necessary prior to vaccination (72.9%, n = 753 non-vaccinated vs. 55.3%, n = 250 vaccinated students) (χ2 = 44.350, p < 0.001).
We further studied the attitudes of the students regarding HPV vaccines (Table 4). A significant majority of students agree that vaccines are important in general (n = 1280, 86.2%) and that HPV vaccines are particularly necessary/beneficial (n = 1194, 80.4%). The level of agreement on this matter is notably greater among vaccinated respondents (χ2 = 201.787, p < 0.001). Conversely, unvaccinated participants (n = 667, 64.6%) more frequently agree with the claim that a rise in HPV-related diseases might occur in the near future if vaccination rates remain low compared with vaccinated students (n = 262, 58%) (χ2 = 10.806, p = 0.029).
Table 4. Attitudes towards HPV vaccines.
Approximately 21.5% (n = 319) indicate that vaccine price may influence their decision, and a comparable proportion would only receive vaccination if it were provided at no cost. A significantly higher majority of vaccinated respondents (n = 397, 87.8%) would recommend vaccination to family members, friends, or future patients, compared to non-vaccinated students (n = 696, 69.3%) (χ2 = 117.928, p < 0.001). A majority of respondents (n = 1200, 80.8%) acknowledge the necessity for enhanced awareness regarding HPV infections and vaccines, with a desire for increased knowledge (n = 1142, 76.9%), indicating significant recognition of educational deficiencies.
We conducted a logistic regression analysis to assess the impact on the probability of receiving the HPV vaccine (Table 5). The logistic regression model demonstrated statistical significance, χ2(3) = 708.414, p < 0.001. The model correctly identified 53.8% of the cases. Regarding demographic parameters, respondents in their sixth year of study were 0.385 times less likely to have received the HPV vaccine, while female students were 5.1 times more likely to have been vaccinated. Respondents who expressed fear of potential adverse outcomes following HPV vaccination were less likely to have received the vaccine. Conversely, students who disagreed with the claim that offering the HPV vaccine to minors implies that early sexual activity is acceptable were 1.89 times more likely to have had the vaccination.
Table 5. Binominal logistic regression model for HPV vaccine uptake.

4. Discussion

Concerning understanding of HPV infection, we discovered that sexual transmission and cervical cancer are the most often recognised facts concerning HPV. Further research among health sciences students also confirms a significant awareness of these factors [24,25,26,27]. A diminished awareness of the relationship between HPV and non-cervical malignancies, particularly oropharyngeal and anal cancers, leads to an underappreciation of the virus’s extensive carcinogenic potential. In the United States, merely one-third of participants acknowledged the association between HPV and oropharyngeal cancer, while in Saudi Arabia, dental students exhibited an average knowledge score of 0.9 ± 1.2 out of 5 regarding oropharyngeal cancer, indicating a significantly lower level of awareness compared to our study [28,29]. Furthermore, hardly 50% of medical students in a separate study were aware of the range of HPV-associated malignancies [30]. In a similar study, nursing students in Italy exhibited a limited understanding of different cancers associated with the virus [31].
Concerning the transmission of HPVs, researchers report similar findings, identifying vaginal contact as the predominant known route, while observing decreased awareness of anal, oral, and vertical transmission [23,32]. A cross-sectional survey of medical and paramedical students in India revealed that only approximately 35% accurately recognised vertical transmission (from mother to foetus) as a potential route of HPV infection, whereas many erroneously believed in transmission through blood or contaminated food [33]. Medical students typically have a better overall understanding of HPV transmission pathways compared to dental and nursing students, presumably due to enhanced clinical exposure. Although vaginal intercourse is widely acknowledged as a transmission route, some students underestimate the risks associated with oral and anal sex, which are significant for HPV-related head and neck cancers as well as anal cancers. This disparity may influence their future clinical counselling and vaccination promotion [34,35].
Only fifty percent of the surveyed students believe in total recovery from HPV infection; one-third erroneously assume that condoms provide complete protection, and others believe that antibiotics can treat HPV [36]. Additional studies indicate misunderstandings regarding HPV infection and prevention, such as a survey conducted among medical students in China, where only one-third are aware that HPV infection can be cured or resolved spontaneously. Approximately one-third of college students in a separate Chinese survey falsely believe that antibiotics may eradicate HPV, indicating a notable misperception [37]. This misperception presumably arises from a misunderstanding of viral and bacterial illnesses. This misperception presumably arises from a misunderstanding of viral and bacterial illnesses. A Hungarian nationwide poll targeting college students and their parents revealed that 38% believe condoms offer complete protection against HPV, which aligns with our findings [38].
Approximately one-third of participants were vaccinated, and among those who were unvaccinated, the majority expressed a willingness to receive the vaccine if possible. Daniel et al. [39] similarly report that 32.1% of medical students have completed the full HPV vaccine series, while in Brazil, the vaccination rate is lower at 21.1%, with most students already being sexually active [40]. Mulenga et al. reported that only 6.5% of pharmacy students had received the vaccine [41]. Comparable vaccination rates were noted among medical and paramedical Indian students (6.8%) [42], while only 3.6% of female university students were in health schools in Jordan [43].
The present study reveals a higher vaccination rate among females, consistent with the existing literature indicating that females are more likely to receive HPV vaccinations than males. This trend is likely attributable to the established link between HPV and cervical cancer, along with regional vaccination guidelines that consider gender. Numerous studies indicate notable gender disparities in knowledge and uptake of HPV vaccination [44,45].
We observed that vaccinated participants are significantly more likely to have a family member diagnosed with cervical cancer or HPV-related cancer and have a family member who is also vaccinated, suggesting a particularly strong familial influence in our sample. Furthermore, the interconnectedness of parents’ willingness to vaccinate themselves and their children suggests that vaccination often clusters within families [40,46].
Over 70% of our overall participants, along with the majority of vaccinated medical students in India, exhibit comparable findings, with 68.3% expressing a willingness to recommend the vaccine to others [24]. Vaccinated medical students typically achieve higher scores on knowledge assessments and report greater comfort with patient counselling [47]. Furthermore, dental students consider the endorsement of HPV vaccination to be part of their professional obligations [35].
Our study did not find embarrassment to be a significant barrier to HPV vaccination; however, existing research highlights that feelings of stigma or shame may hinder individuals from disclosing their vaccination status and receiving the vaccine, indicating that this factor can adversely affect vaccine uptake [48,49,50]. A 2023 study examining university students identified embarrassment associated with HPV vaccination as a notable psychosocial barrier. This issue was particularly linked to the vaccine’s connection to sexual activity, with a greater impact observed among female students and those possessing limited knowledge about HPV [51].
The majority of participants in our study acknowledged the necessity for enhanced awareness and information about HPV and the available vaccines, indicating a desire to broaden their knowledge of the subject. A cross-sectional survey conducted in India revealed that a considerable percentage of health sciences students expressed a desire for increased education and training regarding HPV infection and vaccination [24]. Similarly, in Jordan, more than 70% of participants indicated a need for additional information and formal education about HPV and its vaccine to feel confident in recommending it [43]. A study in China highlights the considerable influence of HPV knowledge on students’ vaccination decisions [52]. Evidence from an educational intervention aimed at female healthcare students indicates that structured health education programmes enhance knowledge and awareness of HPV, subsequently increasing the likelihood of vaccination [53].
The findings from the study underscore the importance of implementing educational interventions to improve HPV knowledge and reduce vaccine hesitancy among undergraduate students in medical universities. HPV content should be integrated into preclinical subjects such as microbiology, virology, and infectious diseases curricula to build foundational knowledge of transmission, oncogenesis, and prevention among medical students. Additionally, clinical rotations in gynaecology, oncology, and primary care should incorporate team-based modules with case vignettes on vaccination counselling to improve attitudes and practices. It would be beneficial to explore the application of technological advancements, including mobile applications and virtual reality, to improve HPV education and engagement among students and the broader population [54,55,56,57,58].

5. Conclusions

This study reveals that university students in medical specialities possess insufficient knowledge of HPV in various clinical domains, specifically its transmission routes, related health complications, and preventive strategies, including vaccination. Their attitudes and practices regarding HPV immunisation require improvement. Given that healthcare professionals are essential for patient education and public health advocacy, it is imperative to rectify these deficiencies through comprehensive and systematically organised medical education, thereby enhancing their understanding of the issue and fostering improved attitudes and practices regarding HPV vaccines. Enhancing the curriculum with comprehensive information on HPV, its epidemiology, and preventive measures will better equip future healthcare providers to promote awareness and preventive initiatives for improved public health outcomes.

Author Contributions

Conceptualisation, M.H. (Meri Hristamyan); methodology, M.H. (Meri Hristamyan); software, V.R.; validation, M.H. (Meri Hristamyan) and V.R.; formal analysis, V.R.; investigation, M.H. (Meri Hristamyan); resources, M.H. (Meri Hristamyan); data curation, M.H. (Meri Hristamyan), T.L. and M.H. (Meysam Homadi); writing—original draft preparation, M.H. (Meri Hristamyan) and V.R.; writing—review and editing, M.H. (Meri Hristamyan), V.R. and A.K.; visualisation, V.R.; supervision, A.K.; project administration, M.H. (Meri Hristamyan). All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of the Medical University of Plovdiv (Protocol No. 7/25 June 2025). All participants provided written informed consent.

Data Availability Statement

Data will be provided on request.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Scott-Wittenborn, N.; Fakhry, C. Epidemiology of HPV Related Malignancies. Semin. Radiat. Oncol. 2021, 31, 286–296. [Google Scholar] [CrossRef]
  2. Wang, R.; Huang, H.; Yu, C.; Li, X.; Wang, Y.; Xie, L. Current Status and Future Directions for the Development of Human Papillomavirus Vaccines. Front. Immunol. 2024, 15, 1362770. [Google Scholar] [CrossRef]
  3. Sendekie, A.K.; Abate, B.B.; Adamu, B.A.; Tefera, A.M.; Mekonnen, K.T.; Ashagrie, M.A.; Tadesse, Y.B.; Dagnaw, A.D.; Melaku, M.S.; Bizuneh, G.K. Human Papillomavirus Vaccination Hesitancy among Young Girls in Ethiopia: Factors and Barriers to Uptake. Front. Public Health 2025, 13, 1507832. [Google Scholar] [CrossRef]
  4. Chen, Y.; Li, Q.; Du, L.; Du, Z.; Zhou, Y.; Huang, Y.; Zhang, J.; Wang, W.; Zhang, L.; Xie, J.; et al. Epidemiologic Evaluation of Human Papillomavirus Type Competition in Unvaccinated Women from Xiamen, China. Front. Microbiol. 2025, 16, 1546166. [Google Scholar] [CrossRef]
  5. Cenci, M.; Rossi, F.; Pisani, T. Detection of 14 High-risk Human Papillomavirus (HPV) Genotypes Within the Italian Cervical Cancer Screening. In Vivo 2023, 37, 2161–2165. [Google Scholar] [CrossRef]
  6. Oyouni, A.A.A. Human Papillomavirus in Cancer: Infection, Disease Transmission, and Progress in Vaccines. J. Infect. Public Health 2023, 16, 626–631. [Google Scholar] [CrossRef]
  7. The Impact of HPV. Available online: https://www.europeancancer.org/content/the-impact-of-hpv.html (accessed on 25 July 2025).
  8. Zhang, Y.; Qiu, K.; Ren, J.; Zhao, Y.; Cheng, P. Roles of Human Papillomavirus in Cancers: Oncogenic Mechanisms and Clinical Use. Signal Transduct. Target. Ther. 2025, 10, 44. [Google Scholar] [CrossRef]
  9. Meng, X.; Yang, B.; Yin, H.; Chen, J.; Ma, W.; Xu, Z.; Shen, Y. Global Burden and Incidence Trens in Cancers Associated with Human Papillomavirus Infection: A Population-Based Systematic Study. Pathogens 2025, 14, 880. [Google Scholar] [CrossRef]
  10. Sabeena, S.; Bhat, P.V.; Kamath, V.; Bhat, S.K.; Nair, S.; Chandrabharani, K.; Arunkumar, G. Community-Based Prevalence of Genital Human Papilloma Virus (HPV) Infection: A Systematic Review and Meta-Analysis. Asian Pac. J. Cancer Prev. 2017, 18, 145–154. [Google Scholar] [CrossRef]
  11. Bruni, L.; Albero, G.; Rowley, J.; Alemany, L.; Arbyn, M.; Giuliano, A.R.; Markowitz, L.E.; Broutet, N.; Taylor, M. Global and Regional Estimates of Genital Human Papillomavirus Prevalence among Men: A Systematic Review and Meta-Analysis. Lancet Glob. Health 2023, 11, e1345–e1362. [Google Scholar] [CrossRef]
  12. HPV Centre. Country-Specific HPV Statistics Report: Bulgaria. Available online: https://hpvcentre.net/statistics/reports/BGR_FS.pdf (accessed on 25 July 2025).
  13. Williamson, A.L. Recent Developments in Human Papillomavirus (HPV) Vaccinology. Viruses 2023, 15, 1440. [Google Scholar] [CrossRef]
  14. WHO Human Papillomavirus Vaccines (HPV). Available online: https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV) (accessed on 25 July 2025).
  15. Dattani, S.; Samborska, V. HPV Vaccination: How the World Can Eliminate Cervical Cancer. OurWorldinData.org. Available online: https://ourworldindata.org/hpv-vaccination-world-can-eliminate-cervical-cancer (accessed on 25 July 2025).
  16. Falcaro, M.; Soldan, K.; Ndlela, B.; Sasieni, P. Effect of the HPV Vaccination Programme on Incidence of Cervical Cancer and Grade 3 Cervical Intraepithelial Neoplasia by Socioeconomic Deprivation in England: Population Based Observational Study. BMJ 2024, 385, e077341. [Google Scholar] [CrossRef]
  17. Hall, M.T.; Simms, K.T.; Lew, J.B.; Smith, M.A.; Brotherton, J.M.; Saville, M.; Frazer, I.H.; Canfell, K. The Projected Timeframe Until Cervical Cancer Elimination in Australia: A Modelling Study. Lancet Public Health 2019, 4, e19–e27. [Google Scholar] [CrossRef]
  18. Dykens, J.A.; Peterson, C.E.; Holt, H.K.; Harper, D.M. Gender Neutral HPV Vaccination Programs: Reconsidering Policies to Expand Cancer Prevention Globally. Front. Public Health 2023, 11, 1067299. [Google Scholar] [CrossRef] [PubMed]
  19. Cheng, L.; Wang, Y.; Du, J. Human Papillomavirus Vaccines: An Updated Review. Vaccines 2020, 8, 391. [Google Scholar] [CrossRef]
  20. Ewongwo, A.; Sahor, A.F.; Ngwa, W.; Nwachukwu, C. A Guide to Global Access to HPV Vaccination to All Women in Low- and Middle-Income Countries; a Minireview of Innovation and Equity. Front. Oncol. 2024, 14, 1380663. [Google Scholar] [CrossRef]
  21. Rosado, C.; Fernandes, Â.; Rodrigues, A.G.; Lisboa, C. Impact of Human Papillomavirus Vaccination on Male Disease: A Systematic Review. Vaccines 2023, 11, 1083. [Google Scholar] [CrossRef]
  22. Bulgaria Expands National HPV Vaccination. Available online: https://www.europeancancer.org/resources/news/bulgaria-expands-national-hpv-vaccination.html (accessed on 25 July 2025).
  23. Milecki, T.; Michalak, M.; Milecki, J.; Michalak, M.; Kadziszewski, R.; Kuncman, Ł.; Jarzemski, P.; Milecki, P.; Antczak, A. Polish Medical Students’ Knowledge Regarding Human Papillomavirus’s Ways of Transmission, Risk of Cancer Development and Vaccination, and Their Intention to Recommend Vaccination. Vaccines 2021, 9, 776. [Google Scholar] [CrossRef] [PubMed]
  24. Shetty, S.; Prabhu, S.; Shetty, V.; Shetty, A.K. Knowledge, Attitudes and Factors Associated with Acceptability of Human Papillomavirus Vaccination among Undergraduate Medical, Dental and Nursing Students in South India. Hum. Vaccines Immunother. 2019, 15, 1656–1665. [Google Scholar] [CrossRef] [PubMed]
  25. Abdelaliem, S.M.F.; Kuaia, A.M.; Hadadi, A.A.; Alhujayri, A.K.; Al Anazi, A.A.; Hajar, A.A.; AlShareda, R.S.; Amri, S.M. Knowledge and Attitudes toward Human Papillomavirus and Vaccination: A Survey among Nursing Students in Saudi Arabia. Healthcare 2023, 11, 1766. [Google Scholar] [CrossRef]
  26. Mon, A.A.; Lugova, H.; Maw, M.M.; Haque, M. Medical Students’ Awareness, Knowledge and Acceptance of Human Papilloma Virus Vaccination in the National Defence University of Malaysia. Int. J. Pharm. Res. Allied Sci. 2018, 7, 152–158. [Google Scholar]
  27. Mahdi, A.G.M. Knowledge and Attitude of Medical Students about Role of Human Papilloma Virus, and Vaccine in Head and Neck Cancer. Oral Oncol. 2024, 156, 106939. [Google Scholar] [CrossRef] [PubMed]
  28. Evans, L.; Matley, E.; Oberbillig, M.; Margetts, E.; Darrow, L. HPV Knowledge and Attitudes Among Medical and Professional Students at a Nevada University: A Focus on Oropharyngeal Cancer and Mandating the Vaccine. J. Cancer Educ. 2020, 35, 774–781. [Google Scholar] [CrossRef]
  29. Farsi, N.J.; Al Sharif, S.; Al Qathmi, M.; Merdad, M.; Marzouki, H.; Merdad, L. Knowledge of Human Papillomavirus (HPV) and Oropharyngeal Cancer and Acceptability of the HPV Vaccine among Dental Students. Asian Pac. J. Cancer Prev. 2020, 21, 3595–3603. [Google Scholar] [CrossRef]
  30. Malavika, J.C.; Hegde, R. Knowledge and Awareness of HPV Virus and HPV Vaccine among Medical Students. Int. J. Reprod. Contracept. Obstet. Gynecol. 2022, 11, 2754–2759. [Google Scholar] [CrossRef]
  31. Pelullo, C.P.; Esposito, M.R.; Di Giuseppe, G. Human Papillomavirus Infection and Vaccination: Knowledge and Attitudes among Nursing Students in Italy. Int. J. Environ. Res. Public Health 2019, 16, 1770. [Google Scholar] [CrossRef] [PubMed]
  32. Qaqish, A.; Abdo, N.; Abbas, M.M.; Saadeh, N.; Alkhateeb, M.; Msameh, R.; Tarawneh, S.; Al-Masri, M. Awareness and Knowledge of Physicians and Residents on the Non-Sexual Routes of Human Papilloma Virus (HPV) Infection and Their Perspectives on Anti-HPV Vaccination in Jordan. PLoS ONE 2023, 18, e0291643. [Google Scholar] [CrossRef]
  33. Brahme, K.A.; Pawar, S.P.; Damkondwar, O.B.; Gattani, P.L. Human Papilloma Virus Vaccination Practices, Awareness of Cervical Cancer Screening and Its Risk Factors among Medical and Paramedical Students of a City. Int. J. Acad. Med. Pharm. 2023, 5, 865–872. [Google Scholar] [CrossRef]
  34. Solis-Torres, N.; Braverman-Diaz, I.; Rivera-Morales, L.A.; Perez-Sanchez, J.J.; Perez-Bravo, V.S.; Neris-Sanchez, A.J.; Vera, A.; Diaz-Algorri, Y. Medical Students’ Knowledge about Human Papillomavirus (HPV), HPV Vaccine and Head and Neck Cancer. Hum. Vaccines Immunother. 2024, 20, 2344248. [Google Scholar] [CrossRef]
  35. Wright, M.; Pazdernik, V.; Luebbering, C.; Davis, J.M. Dental Students’ Knowledge and Attitudes about Human Papillomavirus Prevention. Vaccines 2021, 9, 888. [Google Scholar] [CrossRef]
  36. Wen, Y.; Pan, X.F.; Zhao, Z.M.; Chen, F.; Fu, C.J.; Li, S.Q.; Zhao, Y.; Chang, H.; Xue, Q.P.; Yang, C.X. Knowledge of Human Papillomavirus (HPV) Infection, Cervical Cancer, and HPV Vaccine and Its Correlates among Medical Students in Southwest China: A Multi-Center Cross-Sectional Survey. Asian Pac. J. Cancer Prev. 2014, 15, 5773–5779. [Google Scholar] [CrossRef]
  37. Chen, X.; Xu, T.; Wu, J.; Sun, C.; Han, X.; Wang, D.; Zhang, Z.; Qiao, C.; Tao, X. Exploring Factors Influencing Awareness and Knowledge of Human Papillomavirus in Chinese College Students: A Cross-Sectional Study. Hum. Vaccines Immunother. 2024, 20, 2388347. [Google Scholar] [CrossRef] [PubMed]
  38. Marek, E.; Dergez, T.; Bozsa, S.; Gocze, K.; Rebek-Nagy, G.; Kricskovics, A.; Kiss, I.; Ember, I.; Gocze, P. Incomplete Knowledge--Unclarified Roles in Sex Education: Results of a National Survey about Human Papillomavirus Infections. Eur. J. Cancer Care 2011, 20, 759–768. [Google Scholar] [CrossRef]
  39. Daniel, C.L.; McLendon, L.; Green, C.L.; Anderson, K.J.; Pierce, J.Y.; Perkins, A.; Beasley, M. HPV and HPV Vaccination Knowledge and Attitudes among Medical Students in Alabama. J. Cancer Educ. 2021, 36, 168–177. [Google Scholar] [CrossRef]
  40. Wanderley, M.S.; Sobral, D.T.; Resende, C.N.; Levino, L.A.; Marques, L.A.; Feijó, M.S.; Aragão, N.R.C. Medical Students’ Knowledge of the Human Papillomavirus (HPV), Cervical Cancer, and HPV Vaccination. Rev. Bras. Educ. Med. 2021, 45, e155. [Google Scholar] [CrossRef]
  41. Mulenga, P.; Mufwambi, W.; Mwaba, M.; Zulu, M.; Tembo, R.; Mwaba, F.; Mutoya, N.; Chimbala, A.M.; Mwanza, B.; Musonda, M.S.; et al. Knowledge, Attitudes, and Uptake of the Human Papilloma Virus Vaccine among Pharmacy Students at the University of Zambia: Opportunities to Improve Vaccine Uptake. Open J. Obstet. Gynecol. 2025, 15, 744–763. [Google Scholar] [CrossRef]
  42. Swarnapriya, K.; Kavitha, D.; Reddy, G.M. Knowledge, Attitude and Practices Regarding HPV Vaccination Among Medical and Para Medical Students, India: A Cross Sectional Study. Asian Pac. J. Cancer Prev. 2015, 16, 8473–8477. [Google Scholar] [CrossRef]
  43. Sallam, M.; Al-Mahzoum, K.; Eid, H.; Assaf, A.M.; Abdaljaleel, M.; Al-Abbadi, M.; Mahafzah, A. Attitude towards HPV Vaccination and the Intention to Get Vaccinated among Female University Students in Health Schools in Jordan. Vaccines 2021, 9, 1432. [Google Scholar] [CrossRef]
  44. Chen, G.; Wu, B.; Dai, X.; Zhang, M.; Liu, Y.; Huang, H.; Mei, K.; Wu, Z. Gender Differences in Knowledge and Attitude towards HPV and HPV Vaccine among College Students in Wenzhou, China. Vaccines 2021, 10, 10. [Google Scholar] [CrossRef]
  45. Kar, A.; Chakraborty, O.; Dash, C.; Mukherjee, S. HPV Awareness and Vaccination: Are Men and Women Equally Aware? A Survey among College Students of Jamshedpur. Students J. Health Res. Afr. 2024, 5, 10. [Google Scholar] [CrossRef]
  46. Gamble, H.L.; Klosky, J.L.; Parra, G.R.; Randolph, M.E. Factors Influencing Familial Decision-Making Regarding Human Papillomavirus Vaccination. J. Pediatr. Psychol. 2010, 35, 704–715. [Google Scholar] [CrossRef]
  47. Afonso, N.M.; Kavanagh, M.J.; Swanberg, S.M.; Schulte, J.M.; Wunderlich, T.; Lucia, V.C. Will They Lead by Example? Assessment of Vaccination Rates and Attitudes to Human Papilloma Virus in Millennial Medical Students. BMC Public Health 2017, 17, 35. [Google Scholar] [CrossRef]
  48. Khatiwada, M.; Kartasasmita, C.; Mediani, H.S.; Delprat, C.; Van Hal, G.; Dochez, C. Knowledge, Attitude and Acceptability of the Human Papilloma Virus Vaccine and Vaccination among University Students in Indonesia. Front. Public Health 2021, 9, 616456. [Google Scholar] [CrossRef] [PubMed]
  49. Yang, J.Z.; Pittman, M.M. The Silver Lining of Shame: Framing HPV to Influence Vaccination Intentions. Health Commun. 2017, 32, 987–994. [Google Scholar] [CrossRef] [PubMed]
  50. Wong, L.P. Knowledge and Attitudes about HPV Infection, HPV Vaccination, and Cervical Cancer among Rural Southeast Asian Women. Int. J. Behav. Med. 2011, 18, 105–111. [Google Scholar] [CrossRef]
  51. Malik, S.; Mock, K.O.; Martillotti, R.; Caravella, G.; Zhou, X.; Mbamelu, M.; Scarbrough, K.H. HPV Vaccines Among University Students: Understanding Barriers and Facilitators of Vaccine Uptake. Vaccines 2024, 12, 1385. [Google Scholar] [CrossRef]
  52. Dai, Z.; Si, M.; Su, X.; Wang, W.; Zhang, X.; Gu, X.; Ma, L.; Li, J.; Zhang, S.; Ren, Z.; et al. Willingness to Human Papillomavirus (HPV) Vaccination and Influencing Factors among Male and Female University Students in China. J. Med. Virol. 2022, 94, 2776–2786. [Google Scholar] [CrossRef]
  53. Verma, I.; Bajpai, R.; Arjaria, V.; Garg, L.; Mungad, A.; Singh, D.; Gavli, J.; Khare, A. A Study to Assess the Impact of Education on the Knowledge and Attitude Toward Cervical Cancer and HPV (Human Papillomavirus) Vaccination Among Female Healthcare Students. Cureus 2024, 16, e59856. [Google Scholar] [CrossRef]
  54. Zhang, C.; Greengold, J.; Tackett, S.; Lentz, C.; Bennett, W.; McGuire, M. Evaluation of online educational curriculum on HPV vaccination practices among adult primary care providers. BMC Med. Educ. 2023, 23, 923. [Google Scholar] [CrossRef]
  55. Wiley, R.; Shelal, Z.; Bernard, C.; Urbauer, D.; Toy, E.; Ramondetta, L. Human Papillomavirus: From Basic Science to Clinical Management for Preclinical Medical Students. MedEdPORTAL 2018, 14, 10787. [Google Scholar] [CrossRef]
  56. Costa, A.S.; Gomes, J.M.; Germani, A.C.C.G.; da Silva, M.R.; Santos, E.F.S.; Soares Júnior, J.M.; Baracat, E.C.; Sorpreso, I.C.E. Knowledge gaps and acquisition about HPV and its vaccine among Brazilian medical students. PLoS ONE 2020, 15, e0230058. [Google Scholar] [CrossRef]
  57. Thanasuwat, B.; Leung, S.O.A.; Welch, K.; Duffey-Lind, E.; Pena, N.; Feldman, S.; Villa, A. Human Papillomavirus (HPV) Education and Knowledge Among Medical and Dental Trainees. J. Cancer Educ. 2023, 38, 971–976, Erratum in J. Cancer Educ. 2024, 39, 213–215. https://doi.org/10.1007/s13187-024-02398-w. [Google Scholar] [CrossRef]
  58. Aldawood, E.; Alzamil, L.; Dabbagh, D.; Hafiz, T.A.; Alharbi, S.; Alfhili, M.A. The Effect of Educational Intervention on Human Papillomavirus Knowledge among Male and Female College Students in Riyadh. Medicina 2024, 60, 1276. [Google Scholar] [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Article Metrics

Citations

Article Access Statistics

Journal Statistics
Multiple requests from the same IP address are counted as one view.
Download PDF
A Begomovirus solanumdelhiense Vector for Virus-Induced Gene Silencing in Melon
Previous
Canine Ticks, Tick-Borne Pathogens and Associated Risk Factors in Nigeria
Next