Search Results (809)

Background/Objectives: Human papillomavirus (HPV) is now responsible for the majority of oropharyngeal squamous cell carcinomas (OPSCCs), an HPV-related cancer of direct relevance to the dental profession; oral-health providers may be well-positioned to perform routine oral examination, recognize suspicious signs, refer appropriately, and educate patients about HPV-related oropharyngeal cancer and HPV vaccination. This study assessed knowledge, attitudes and practices regarding sexually transmitted infections (STIs), HPV, HIV/AIDS and HPV-related oral and oropharyngeal cancer among secondary-school students in Apulia, Italy, with particular attention to the dental setting. Methods: A cross-sectional study was conducted by the University of Foggia among 1224 students from three secondary schools at the end of the 2025/2026 school year) using a self-administered 108-item questionnaire. A 63-item composite knowledge score was computed; “don’t know” answers were scored as incorrect and adequate knowledge defined a priori as ≥60% (Bloom’s cut-off). The minimum required sample (737) was derived using Cochran’s formula adjusted for a cluster-sampling design effect. Results: Overall knowledge was low (mean 28.5%, SD 18.2); only 5% reached the ≥60% threshold (Bloom’s cut-off). Only 14.8% of students were aware that HPV can cause oropharyngeal cancer, the lowest figure among all oncogenic outcomes assessed and significantly lower in boys (11.2%) than girls (17.3%; p = 0.003), despite boys carrying the higher OPSCC risk. Knowledge was independently associated with female sex, age and sexual experience. Despite poor knowledge, 61.2% of students would like to receive the HPV vaccine. Conclusions: The dental visit may represent an under-used opportunity to address this oral-cancer-prevention knowledge gap; the integration of oral-health professionals into school-based and clinical HPV-prevention strategies is a plausible public-health implication. Full article

Background/Objectives: Cervical cancer (CC), mainly caused by human papillomavirus (HPV), is one of the major cancers threatening women’s health in Algeria. However, despite the existence of a cost-effective vaccine, it has not yet been introduced into the national vaccination program. Recent information indicated that its introduction will be imminent. Thus, the current study was conducted to evaluate the level of awareness and knowledge about CC and HPV among the Algerian population as well as its attitudes toward HPV vaccination. Methods: A cross-sectional survey was carried out between 4 November 2022 and 8 May 2023 using a self-administered questionnaire that was diffused through social media platforms. Results: A total of 414 participants were included in our sample, with the dominance of those aged 18 to 30 years old (74.6%), those with university education (75.8%), and those with a medium financial level (77.5%). A high level of awareness was reported (76.3%), especially among healthcare workers (98.4%, OR: 17.099, 95% CI: 2.294–127.476, sig. = 0.06), participants aged more than 30 years (87.6%, OR: 2.78, 95% CI: 1.313–5.883, sig. = 0.008), and females (85.1%, OR: 2.02, 95% CI: 1.15–3.548, sig. = 0.014). However, the level of knowledge did not follow, since less than a third (32.1%) of the participants only were aware of HPV, and multiple gaps were reported regarding its epidemiology and its prevention. Moreover, while 30.8% of the participants were willing to get the HPV vaccine, 40.5% were hesitant, and 27.7% were resistant. The causes of rejection/hesitancy included mainly complacency, vaccine refusal, and the lack of confidence in the vaccine. In addition, hesitant and reluctant participants have shown a low level of knowledge and a high score of conspiracy beliefs. Conclusions: These results provide new insights into knowledge and attitudes towards CC and HPV vaccination. It reported that despite the high level of awareness about CC, gaps of knowledge remain and vaccination hesitancy/reluctance is persistent. These results suggest the need for raising awareness particularly about HPV which will consequently help to increase HPV vaccine acceptance. Full article

Human papillomavirus type 16 (HPV16) is a major etiological agent of cervical and other epithelial cancers, yet the mechanisms underlying host–pathogen interactions remain incompletely understood. In this study, we investigated the responses of human peripheral blood leukocytes to engineered HPV16 L1/L2 chimeric virus-like particles (VLPs), produced in suspension by HEK 293-F cells. These VLPs were designed to mimic native viral structures while incorporating chimeric features that enhance stability and immunogenicity. Through experimental assays, we characterized leukocyte engagement, primarily involving leukocyte phenotyping, VLP internalization, confocal colocalization, and endocytic pathway analyses. We demonstrated that recombinant L1/L2 proteins assembled into structured VLPs capable of interacting with mononuclear cells, including lymphocytes and monocytes, but not with polymorphonuclear cells, such as neutrophils, eosinophils and basophils. Uptake occurred via the CD71 transferrin receptor-mediated pathway, in addition to other endocytic routes analyzed, as confirmed by blockage assays using chlorpromazine, rCTB, filipin, nystatin, liquemine, and sodium azide. Confocal colocalization and endocytic pathway analyses further supported receptor-mediated uptake. These findings demonstrate that HPV16 L1/L2 chimeric VLPs interact with and are internalized by human peripheral blood mononuclear cells through CD71-associated and other endocytic pathways. The study provides new insights into HPV16 VLP–leukocyte interactions and contributes to a better understanding of the cellular mechanisms involved in VLP uptake, which may be relevant for future studies on HPV biology and VLP-based vaccine development. Full article

Background: Healthcare workers play a critical role in parental vaccine decision-making and the uptake of non-routine childhood vaccines. This study aimed to evaluate healthcare workers’ knowledge, attitudes and behaviors regarding non-routine childhood vaccines, including rotavirus, meningococcal, human papillomavirus (HPV) and influenza vaccines. Methods: This cross-sectional study was conducted between October 2025 and March 2026 among healthcare workers in Türkiye. Data were collected using a structured questionnaire and the Attitudes Towards Vaccine Scale (ATVS), distributed through convenience and snowball sampling methods. Results: A total of 345 healthcare workers participated in the study. Recommendation behaviors differed significantly according to vaccine type (p < 0.001). Rotavirus and meningococcal vaccines were more frequently recommended than HPV and influenza vaccines. Although influenza vaccine had the highest awareness rate, it demonstrated the lowest recommendation rate and the lowest support for inclusion in the national immunization schedule. Physicians had significantly higher knowledge levels and vaccination attitude scores than non-physician healthcare workers (p < 0.001). ATVS scores were positively correlated with recommendation behaviors (ρ = 0.35, p < 0.001) and self-vaccination tendency (ρ = 0.34, p < 0.001). In multivariable analyses, higher vaccination attitude scores independently predicted greater self-vaccination tendency (OR = 1.07, 95% CI: 1.04–1.11, p < 0.001). Cost was the most commonly reported barrier to vaccine implementation. Conclusions: Positive attitudes toward non-routine childhood vaccines among healthcare workers do not necessarily translate into consistent recommendation behaviors across all vaccine types. Strategies targeting healthcare worker education, equitable vaccine access and standardized vaccine counseling practices may improve uptake and recommendation of optional childhood vaccines in Türkiye. Full article

Background: Women treated for cervical intraepithelial neoplasia grade 2 (CIN2) face an increased risk of disease recurrence due to persistent or newly acquired human papillomavirus (HPV) infections, suggesting a potential role for adjuvant HPV vaccination. While a growing body of literature evaluates the outcomes of HPV vaccination following a large loop excision of the transformation zone (LLETZ) for high-grade squamous intraepithelial lesions (CIN2–3), data specifically focused on isolated CIN2 remain limited. This study aims to evaluate the clinical efficacy of the nonavalent HPV vaccine (9vHPV) as an adjuvant strategy to reduce CIN2+ recurrence in women undergoing LLETZ for histologically confirmed, isolated CIN2. Methods: Between November 2017 and November 2024, women undergoing LLETZ for histologically confirmed CIN2 received their first dose of adjuvant 9vHPV within one month of surgery. Patients who achieved double-negative co-testing (Pap test and high-risk HPV DNA test) at the 6-month post-LLETZ follow-up were included in the study group. Conversely, patients with at least one positive test result at 6 months were excluded to rule out residual disease. The study group underwent a subsequent Pap smear at 12 months and a full co-test at 18 months post-surgery; upon achieving negative results through the 18th month, patients returned to the organized screening program. The primary outcome was the recurrence rate, defined as histologically confirmed CIN2+ occurring more than 6 months post-treatment. It was compared against an unvaccinated historical control group treated with LLETZ prior to the study period. The secondary outcome evaluated the prevalence of HPV genotypes at baseline and at the time of recurrence. Results: In the vaccinated group, 3 women (2.03%) experienced CIN2+ recurrence compared to 6 women (5.71%) in the unvaccinated control group. This represents an absolute risk difference of 3.69% and a relative risk reduction of 64.6%, though the difference did not reach statistical significance via Fisher’s exact test (p = 0.165). In the study group, two recurrences were detected at 18 months (associated cytologies: ASC-H and LSIL; genotypes: HPV 51/53 and 16, respectively) and one at four years (cytology: HSIL; genotype: HPV 33/58). In the control group, recurrences occurred at 12 months (n = 3), 18 months (n = 2), and four years (n = 1). Associated cytology revealed HSIL in three cases, ASC-H in one case, LSIL in one case, and ASCUS in the final case. The corresponding HPV genotypes were 16 (two cases), 18, 51, 31 and 56 (co-infection), and one case of high-risk HPV, not further genotyped. Conclusions: Adjuvant 9vHPV administration after LLETZ for isolated CIN2 was associated with a clinically substantial lower absolute recurrence rate (2.03% vs. 5.71%, corresponding to a 64.6% relative risk reduction). Although this reduction did not achieve statistical significance ($p=0.165$) due to our small sample size and a low baseline recurrence rate in this isolated cohort, the effect size is highly comparable to broader CIN2+ studies. The study was likely underpowered to prove statistical significance, and larger multi-center studies are required to confirm the statistical value of adjuvant vaccination specifically in isolated CIN2 lesions. Full article

Oncogenic viruses contribute to approximately 20% of human cancers globally, with their impact falling disproportionately on populations in Sub-Saharan Africa. In this region, cervical cancer, hepatocellular carcinoma, endemic Burkitt lymphoma, and Kaposi sarcoma represent major causes of cancer-related morbidity and mortality, driven by persistent infection with human papillomavirus (HPV), hepatitis B and C viruses (HBV/HCV), Epstein–Barr virus (EBV), Kaposi sarcoma-associated herpesvirus (KSHV), and human T-lymphotropic virus-1 (HTLV-1). This review synthesizes current insights into the immunological mechanisms that underpin viral carcinogenesis in Africa, emphasizing how defective viral clearance, chronic immune activation, and immune evasion arise from the convergence of region-specific co-infections, host genetic diversity, and environmental exposures. We examine the mechanistic roles of HIV-associated CD4⁺ T cell depletion, malaria-induced perturbation of antiviral T cell immunity, helminth-driven T helper 2 polarization, and tuberculosis-associated inflammatory signaling in promoting viral persistence and malignant transformation. In addition, the influence of the extensive diversity of African human leukocyte antigens (HLA) and cytokine gene polymorphisms on antiviral immune responses and cancer susceptibility was discussed. We also assessed how virus-associated tumors establish profoundly immunosuppressive microenvironments characterized by impaired antigen presentation and the dominance of immune checkpoint pathways. Finally, we examined how gaps in vaccination, screening, and diagnostic capacity intersect with immunological vulnerability across Africa, contributing to the burden of infection-associated cancers. These challenges position Africa as a critical setting for developing targeted, genotype-inclusive public health interventions and reducing global cancer disparities through advances in immunoprevention and immunotherapy. Full article

Background: Human papillomavirus (HPV) continues to cause an estimated 4000 preventable cancer deaths each year in the United States. Given the prevalence of HPV-related disease and suboptimal vaccination rates, this study explores perceptions of HPV vaccination among HIV-negative females and females living with HIV in Tennessee. Methods: This prospective, observational qualitative study consisted of narrative interviews which were conducted with HIV-negative and HIV-positive participants, focusing on their perceptions of HPV and its vaccine. Interviews were conducted by phone, and the verbatim transcripts were inductively coded by three researchers. The inductive codes were then grouped into categories based on similarities which facilitated the emergence of themes. Results: A total of 40 participants were interviewed between July 2024 and December 2024. Narrative analysis revealed three themes: (1) “I had never heard of it until I saw the flier.” Gaps in Understanding of HPV and Its Health Implications, (2) Navigating Adolescent Health Decisions and Emotional Influence, and (3) Barriers to Uptake—Skepticism, Trust, and the Need for Tailored Information. Two subthemes emerged: Cohort-Specific Skepticism, and Parental Influence and Communication Gaps. Conclusions: This study revealed significant gaps in HPV knowledge and vaccination uptake among HIV-negative women and women living with HIV in Tennessee. Provider communication was key to vaccine decisions, but clear recommendations were often missed in clinical encounters. Full article

Pharyngeal infection with high-risk human papillomavirus (HPV), particularly HPV16, is biologically distinct from cervical infection because it occurs within the specialized lymphoepithelial environment of Waldeyer’s ring. This review evaluates nanoparticle materials for the prevention, detection, and treatment of pharyngeal HPV, with an emphasis on structure–property–function relationships, mucosal performance, and translational feasibility. Lipid nanoparticle platforms, polymeric nanoparticle platforms, inorganic systems, and hybrid platforms are compared with respect to composition, particle size distribution, surface charge, colloidal stability, biodegradability, payload compatibility, release behavior, and manufacturing complexity. Evidence suggests that lipid and polymeric systems are the most credible near-future candidates for mucosal vaccination and localized nucleic acid delivery because they offer the best balance between controllable fabrication, analytical tractability, and biologically plausible performance in mucus-exposed tissue. By contrast, the development of inorganic theranostics and CRISPR-enabled platforms remains at an earlier stage because repeated mucosal dosing, retention in lymphoid tissue, and combined product regulation impose substantial burdens. A translational roadmap is proposed in which material selection is guided by clinically relevant quality attributes, standardized saliva- and mucus-relevant assays, human tonsil organoid testing, and early attention to manufacturability, safety, and regulatory strategy. The field is promising, but direct pharyngeal HPV data remain limited; accordingly, there is an urgent need for comparative studies that connect nanoparticle architecture to measurable outcomes such as tonsillar deposition, epithelial uptake, immune activation, and local tolerability. Full article

Background: India accounts for one-fifth of global cervical cancer deaths, yet Human Papillomavirus (HPV) vaccination coverage remains low despite the World Health Organization (WHO) recommendations to initiate vaccination at age 9. With the national HPV vaccination campaign in 2026 and its approval for integration into India’s Universal Immunization Programme (UIP), strengthening physician knowledge, beliefs, and confidence in recommending the vaccine is critical. Methods: In 2023, the American Cancer Society and Cancer Foundation of India catalyzed two national medical societies, the Federation of Obstetric and Gynaecological Societies of India and the Indian Academy of Pediatrics, to educate physicians on HPV vaccination using a train-the-trainer (ToT) model. A mixed-methods evaluation, using the RE-AIM Framework, included pre- and post-training surveys assessing changes in knowledge, beliefs, confidence, and intent, as well as monthly engagement surveys and project reports analyzed using descriptive and inferential statistics. A fidelity assessment evaluated consistency of training delivery. Twenty in-depth interviews explored physician reactions and implementation of learnings, analyzed using a rapid approach. Results: A total of 18,206 physicians were trained. The post-training respondent group demonstrated higher HPV vaccination knowledge scores and more favorable responses in confidence, beliefs, and intent than the pre-training respondent group. The fidelity assessment demonstrated consistent delivery overall, with some variability in role play facilitation. Interviews highlighted increased physician confidence, peer knowledge sharing, and community engagement following the training. Medical societies reported strong program adoption and plans for continued efforts. Conclusions: A ToT physician training cascaded through medical societies is a feasible strategy to prepare physicians to recommend the HPV vaccine and address parental concerns at scale. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Background: Human papillomavirus (HPV) has traditionally been considered a sexually transmitted infection, yet accumulating evidence demonstrates that HPV can be acquired through multiple non-sexual routes. Understanding these alternative transmission pathways is critical for interpreting HPV detection in non-sexually active populations and for refining public health strategies. Methods: This review synthesizes current evidence on non-sexual HPV transmission routes, including vertical (transplacental, intrapartum), perinatal oropharyngeal colonization, fomite contamination, breast milk transmission, and horizontal non-sexual contact. We examine HPV prevalence data from female virgins, neonates, infants, and children, and evaluate metagenomic evidence positioning HPV as a component of the human virome across multiple body sites. Results: Published studies report that vertical transmission occurs in approximately 18.2% of HPV-positive mothers, with neonatal HPV positivity of 3.4% at birth and 100% genotype concordance in transmission pairs. Transplacental transmission has been documented in 10.2% of concordant mother–placenta–newborn triads. Reviewed studies report oropharyngeal colonization at birth reaching 58.2% following vaginal delivery, with 94.3% of colonized neonates clearing infection by 24 months. HPV DNA has been detected on fomites and medical devices, in breast milk (8.6–15%), and across body sites in healthy adults (skin 61.3%, vagina 41.5%, oral cavity 30%, gut 17.3%). Metagenomic studies identify HPV DNA in 68.9% of healthy individuals, with 109 distinct types detected. Female virgins show HPV prevalence ranging from 0–51.1% across studies. Conclusions: The reviewed evidence suggests that HPV exhibits characteristics of a ubiquitous virome component with multiple non-sexual acquisition routes. These findings have important implications for vaccination strategies, screening interpretation, infection control in healthcare settings, and counseling of pediatric cases and non-sexually active individuals. Full article

Vaccinations are a cornerstone of primary prevention in pediatric otolaryngology and play a critical role in reducing the burden of pediatric infectious diseases, particularly acute otitis media (AOM) and HPV-related infections. The introduction and widespread use of pneumococcal conjugate vaccines (PCVs) have been associated with substantial changes in the epidemiology of pediatric AOM, particularly through reductions in vac-cine-serotype disease and complicated forms, while contributing to changes in pathogen distribution with an increased role of non-vaccine serotypes and non-pneumococcal bac-teria, requiring continuous epidemiological surveillance. Prophylactic human papillomavirus (HPV) vaccination in adolescents and young adults effectively prevents oral infection with vaccine-type high-risk HPV, a necessary step in the pathogenesis of HPV-related oropharyngeal carcinoma. Clinical and epidemiological studies demonstrate robust antibody responses and significant reductions in oral HPV prevalence among vaccinated individuals. Although direct evidence of a reduction in oropharyngeal cancer incidence is not yet available, vaccination may consequently reduce the future burden of HPV-related oropharyngeal cancers. Long-term surveillance remains essential to confirm this potential benefit. Barriers to optimal vaccine coverage include unequal access, incomplete vaccination uptake, and limited awareness of HPV-related oral disease. In conclusion, vaccinations provide direct and clinically relevant benefits in pediatric otolaryngology by reducing recurrent AOM, severe complications and surgical interventions. HPV vaccination also reduces vaccine-type oral HPV infection and may consequently contribute to reducing the future burden of HPV-related oropharyngeal cancers. Achieving high vaccination coverage, coupled with continuous epidemiological monitoring, is essential to maximize individual and public health benefits and to inform the development of vaccines with broader serotype coverage. Full article

Immune checkpoint inhibitors and antibody–drug conjugates have rapidly expanded treatment options for gynecologic malignancies, although the magnitude of benefit varies substantially across tumor types and biomarker-defined populations. This narrative review summarizes the biologic rationale, predictive biomarkers, pivotal clinical trials, regulatory approvals, guideline-supported strategies, and emerging directions for immune checkpoint blockade and antibody–drug conjugates in endometrial, cervical, and ovarian cancers. In endometrial cancer, molecular classification and mismatch repair status have transformed treatment selection, with PD-1 or PD-L1 blockade now integrated into first-line chemoimmunotherapy and recurrent disease management. HER2-directed and TROP-2-directed antibody–drug conjugates are also emerging as biomarker-directed strategies. In cervical cancer, human papillomavirus-driven tumor biology, PD-L1 expression, and tissue factor expression support the use of checkpoint inhibitors, antibody–drug conjugates, and therapeutic vaccine approaches across locally advanced and recurrent or metastatic settings. In ovarian cancer, single-agent checkpoint blockade has shown limited activity in unselected populations, but recent advances include biomarker-selected chemoimmunotherapy in platinum-resistant disease and clinically meaningful activity of folate receptor alpha-directed and HER2-directed antibody–drug conjugates. Across gynecologic cancers, key challenges include refining predictive biomarkers, optimizing sequencing after prior immunotherapy exposure, managing overlapping toxicities, and designing trials that enrich for biologically responsive subgroups. Future progress will depend on integrating molecular classification, immune contexture, ADC target expression, and patient-specific clinical factors into treatment selection. Full article

Background: Men who have sex with men (MSM) experience a disproportionate burden of human papillomavirus (HPV)-related disease, yet vaccination uptake remains uneven. With MSM as the key population of interest, this review synthesized evidence on uptake, willingness, multilevel barriers and opportunities, and vaccine-oriented outcomes among MSM and related sexual and gender minority populations when MSM-relevant findings could be extracted. Methods: Six databases were searched for original English- or Chinese-language studies published from 1 January 2010 to 31 December 2025. Findings were synthesized narratively. Barriers and opportunities were mapped using a five-level socio-ecological model; study-level willingness–uptake patterns were explored using K-means clustering as an exploratory analysis among the nine studies reporting both outcomes; and genotype-specific and immunogenicity findings were summarized separately. Results: Fifty-three studies involving 169,241 participants were included; 87.2% of participants were MSM, and 79% of studies were cross-sectional. Barriers and opportunities occurred across individual, provider-related interpersonal, organizational/institutional, community, and policy/societal levels. Recurrent paired mechanisms involved knowledge and trust, provider recommendation and communication, service accessibility, community support, and eligibility and affordability. Nine studies contributed data to the exploratory clustering analysis; seven fell into low-uptake clusters, including three with high willingness but low uptake, which may indicate a possible study-level implementation gap. Two studies reporting genotype prevalence and antibody responses provided limited biological context supporting vaccination before exposure and suggesting potential benefit from catch-up vaccination. Discussion: Among MSM and related sexual and gender minority populations, HPV vaccination is shaped by interacting individual and structural conditions, with MSM remaining the principal focus of the evidence base. Improving uptake is likely to require complementary strategies: universal, gender-neutral routine vaccination in adolescence before their sexual debut, and targeted catch-up for MSM who missed routine vaccination, supported by trusted provider endorsement, convenient service delivery, community engagement, and inclusive, affordable policy. The thematic counts were study-level and unweighted, and the nine-study clustering analysis was exploratory rather than definitive. Full article