Search Results (743)

Background/Objectives: Persistent human papillomavirus (HPV) infection can lead to malignancies of the cervix, vulva, vagina, penis, anus, and oropharynx. The increasing incidence of HPV-related head and neck cancers has raised concerns regarding potential occupational exposure and transmission risks among healthcare workers. This study aimed to systematically evaluate the evidence on occupational HPV transmission in healthcare settings. Methods: A systematic review of the literature was conducted using three electronic databases (PubMed, Scopus, and Web of Science) from inception to August 2025, following PRISMA 2020 guidelines. A total of 34 studies met the inclusion criteria and were included in the review. Expert opinions and practical recommendations from members of the European Society of Gynaecological Oncology (ESGO) Prevention Committee were included to support interpretation of the results. Results: The available literature on occupational HPV transmission was limited, with a paucity of high-quality studies. Nevertheless, existing data suggest a potential occupational risk, particularly during aerosol or smoke-generating procedures performed for cervical intraepithelial neoplasia or cervical cancer. Several studies reported the detection of HPV DNA in surgical smoke or on instruments used during such procedures, indicating possible exposure among healthcare workers. Conclusions: Although current evidence is insufficient to definitively classify HPV infection as an occupational disease, available data indicate a potential exposure risk for healthcare workers involved in HPV-related procedures. Preventive measures, like personal protective equipment, should be emphasized. HPV vaccination has been recommended by some professional societies for healthcare workers performing gynecological procedures, though further research is needed to evaluate vaccine efficacy beyond the standard age range and its cost-effectiveness in this context. Full article

Many countries have introduced HPV screening and vaccination programs to reduce the burden of cervical cancer. In Poland, before 2023, HPV vaccination was available only on an individual, non-universal basis, using all types of vaccines, while in 2023, a nationwide vaccination program for boys and girls aged 12–13 years was introduced alongside updated screening guidelines. This retrospective study analyzed 2296 HPV-positive test results obtained from adult patients in Poland, including demographic data, HPV genotypes distribution, infection intensity, and cytological findings. HPV genotyping was performed using the Anyplex™ II HPV28 assay. HR-HPV genotypes accounted for 64.53% of all detected infections, with the highest prevalence observed in individuals aged 26–35 years of both sexes. HPV-18 was significantly more frequently in women (p = 0.0430), whereas HPV-53 predominated in men (p = 0.0030). Men more often presented low-intensity infections, while women showed higher viral load. Multigenotypic infections occurred in 46.5% of cases, particularly among younger patients (p < 0.001), and were significantly associated with LSIL changes in cytology. The HSIL type correlated most strongly with HPV-16 (p < 0.001). These findings confirm the high burden of HR-HPV infections in the Polish adult population and provide an essential epidemiological baseline for evaluating the impact of universal HPV vaccination and updated screening strategies. Full article

Endocervical adenocarcinoma is now classified within an etiologic framework based on the presence or absence of high-risk human papillomavirus (HPV) infection. Gastric-type endocervical adenocarcinoma (GAS) is the prototypical HPV-independent subtype, accounting for up to 25% of endocervical adenocarcinomas and showing a particularly high frequency in East Asia. GAS is typically diagnosed at a more advanced stage than usual-type HPV-associated endocervical adenocarcinoma (UEA); exhibits deep stromal and parametrial invasion, lymphovascular space invasion, and a strong propensity for ovarian and peritoneal metastasis; and is associated with markedly worse survival, even in stage I disease. Radiological evaluation is challenging because of diffuse infiltrative growth, prominent mucin production, and frequent underestimation of extra-cervical spread. Histologically, GAS shows gastric-type (pyloric) differentiation, ranging from minimal deviation adenocarcinoma to poorly differentiated forms, and often overlaps with precursor lesions such as atypical lobular endocervical glandular hyperplasia and gastric-type adenocarcinoma in situ. Immunophenotypically, GAS is typically p16-negative, ER/PR-negative, and frequently exhibits mutant-type p53 and expression of gastric markers including MUC6, HIK1083, and claudin 18.2. Recent next-generation sequencing and multi-omics studies have revealed recurrent alterations in TP53, CDKN2A, STK11, KRAS, ARID1A, KMT2D, and homologous recombination-related genes, together with the activation of PI3K/AKT, WNT/β-catenin, TGF-β, and EMT pathways and characteristic metabolic reprogramming. GAS is highly resistant to conventional chemotherapy and radiotherapy, and its current management follows guidelines for squamous and usual-type adenocarcinoma. Emerging data support precision-medicine approaches targeting HER2/HER3, PD-1/PD-L1, and claudin 18.2, and suggest a role for PARP inhibition and other genotype-directed therapies in selected subsets. Given its aggressive biology and rising relative incidence in the HPV-vaccination era, GAS represents a critical unmet need in gynecologic oncology. Future progress hinges on developing reliable diagnostic biomarkers, refining imaging protocols, and validating targeted therapies through international clinical trials. Full article

Background/Objectives: Human papillomavirus (HPV) is a major cause of cervical, penile, anal, and oropharyngeal cancers. HPV vaccination is the most effective public health strategy for its prevention. Understanding the factors influencing vaccination intentions is critical for developing effective public health policies and improving population-level vaccine uptake. Therefore, in this scoping review, we aimed to examine HPV vaccination research conducted in Korea, identify common trends and gaps in study populations and influencing factors, and provide evidence-based recommendations for public health policies. Methods: We systematically searched four Korean databases—Research Information Sharing Service (RISS), DBpia, Korean Studies Information Service System (KISS), and National Digital Science Library (NDSL)—for studies published from their respective inception dates to January 2025, using “human papillomavirus,” “HPV,” “vaccination,” and “intention” as keywords. Thirty-six studies were ultimately included. Study characteristics, populations, theoretical frameworks, and key variables were extracted and analyzed using descriptive statistics and content analysis. Results: Of the included studies, 61.1% and 38.9% targeted vaccination-eligible individuals (adolescents and adults) and parents/guardians, respectively, with 50% focusing exclusively on women. The major factors influencing HPV vaccination intention were attitude (47.2%), subjective norms (38.9%), and perceived behavioral control (30.9%). Attitude and knowledge were critical for vaccination-eligible individuals (Direct group), whereas subjective norms were key for parents/guardians (Indirect group). Conclusions: Korean HPV vaccination intention research has predominantly focused on women and parents, with insufficient attention to adolescents and men. Public health strategies must employ multilevel interventions tailored to each group’s decision-making structures, including school-based programs for adolescents, gender-inclusive policies for men, and community-based approaches to address social norms among parents. These findings provide evidence for policy development aligned with the WHO cervical cancer elimination goals. Full article

Background: Persistent infection with high-risk human papillomavirus (HPV) is the key driver of cervical carcinogenesis and post-treatment recurrence. Although excisional treatment effectively removes dysplastic tissue, it does not directly target viral persistence. While HPV vaccination is well established in primary prevention, its potential role as an adjuvant strategy in HPV-positive women, particularly with respect to viral clearance, remains incompletely defined. Methods: This retrospective cohort study included HPV-positive women with at least 12 months of follow-up who were managed at a tertiary gynecology clinic. Patients were stratified according to HPV vaccination status with the nonavalent vaccine (Gardasil 9) and excisional treatment status with loop electrosurgical excision procedure (LEEP). HPV clearance at 12 months was defined as the primary outcome, while histological outcomes were evaluated as secondary and independent endpoints. Analyses were performed in the overall cohort and stratified by LEEP status. Multivariable logistic regression was used to identify factors independently associated with HPV persistence, adjusting for baseline disease severity and clinical covariates. Results: A total of 935 HPV-positive women were included in the final analysis. Completion of the three-dose HPV vaccination schedule was associated with significantly higher HPV clearance rates at 12 months compared with no vaccination. This association was consistently observed in women who underwent LEEP as well as in those managed without excisional treatment. In multivariable analysis, HPV vaccination emerged as an independent protective factor against HPV persistence, whereas LEEP status itself was not independently associated with viral clearance after adjustment for baseline histological severity. Histological outcomes differed according to baseline disease severity and did not demonstrate a direct one-to-one relationship with HPV clearance. Conclusions: Adjuvant vaccination with the nonavalent HPV vaccine is independently associated with increased HPV clearance in HPV-positive women at 1-year follow-up, irrespective of excisional treatment status. HPV clearance and histological regression represent related but distinct biological processes and should be evaluated as independent outcomes. These findings support a broader role for HPV vaccination beyond primary prevention and suggest potential clinical benefit of vaccination as an adjunctive strategy in the management of HPV-positive women. Full article

Objectives: To synthesize current evidence and emerging data on systemic treatment strategies for early-stage and locally advanced human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), with emphasis on treatment de-escalation and the integration of immunotherapy. Data Sources: We searched PubMed/MEDLINE, Scopus, and EMBASE for English-language studies published from 2010 to 2025 using terms related to HPV-positive disease, oropharyngeal carcinoma, de-escalation, chemoradiation, and immunotherapy. Review Methods: Peer-reviewed clinical trials, meta-analyses, and key translational studies addressing systemic therapy, biomarkers, and immunotherapeutic strategies in HPV-positive OPSCC were included. Emphasis was placed on phase II–III trials evaluating cisplatin-sparing regimens, cetuximab substitution, radiation dose reduction, and early-phase immunotherapy combinations. Evidence was synthesized qualitatively. Results: Cisplatin-based concurrent chemoradiation remains the standard of care for locally advanced HPV-positive OPSCC. De-intensification trials suggest that reduced-intensity regimens may be feasible in carefully selected low-risk patients; however, replacing cisplatin with cetuximab results in inferior survival. PD-1 inhibitors (e.g., pembrolizumab, nivolumab) provide durable responses in recurrent/metastatic disease and are under active evaluation in earlier stages and in combination with therapeutic vaccines, bispecific antibodies, and viral-vector platforms. Conclusions: Systemic therapy for HPV-positive OPSCC is moving toward biomarker-informed personalization. Cisplatin-based chemoradiation remains the curative backbone, while rational de-escalation and immunotherapy integration may preserve high cure rates while reducing long-term toxicity. Ongoing phase III trials will clarify which patient subsets are most suitable for de-intensified or immunotherapeutic approaches, guiding future standards of care. Full article

Background/Objectives: Cervical cancer remains a major cause of morbidity and mortality among women worldwide, marked by stark geographic and socioeconomic disparities. Preventable via HPV vaccination and screening, progress toward elimination varies widely across and within countries. This narrative review synthesizes the epidemiology, including incidence, mortality, survival, and stage distribution, as well as risk factors and the coverage/equity of HPV screening and vaccination programs. Methods: Comprehensive searches were performed in PubMed, Web of Science, Scopus, and Google Scholar (no date restrictions; English only). Included were original epidemiological studies, systematic reviews, meta-analyses, and international reports on burden, risk factors, or prevention indicators. Data were qualitatively synthesized into three themes: epidemiological patterns, risk factors, and screening/prevention programs. Results: Persistent high-risk HPV infection causes nearly all cervical cancers, predominantly HPV16/18, with regional variation in other types. Strong co-factors include HIV immunosuppression, early sexual debut, multiple partners, high parity, long-term oral contraceptive use, and smoking. Inequalities in incidence, late diagnosis, and survival are driven by socioeconomic disadvantages, low education, rural residence, and poor health system access. Screening ranges from cytology/VIA to primary HPV testing, but coverage is low and inequitable in high-burden settings. HPV vaccination has expanded yet faces major gaps in low- and middle-income countries. Conclusions: Cervical cancer burden concentrates in low-resource and marginalized populations. Global elimination demands accelerated, equitable scale-up of HPV vaccination and screening, alongside health system strengthening and barrier reduction. Full article

Next-generation human papillomavirus (HPV) vaccines encompass newly licensed and emerging formulations that employ alternative production platforms, expanded valency, or novel antigenic targets beyond conventional L1-based vaccines. These vaccines aim to address affordability challenges, supply limitations, and suboptimal vaccination coverage, particularly in low- and middle-income countries. This review aggregates current clinical, immunological, and programme-related evidence on newly licensed vaccines, including the World Health Organization (WHO)-prequalified bivalent formulations (Cecolin^® and Walrinvax^®), the quadrivalent Cervavac^®, and the Escherichia coli-derived nonavalent Cecolin 9^®, which received national licensure in 2025. Additionally, emerging high-valency candidates in Phase I–III trials—9-valent, 11-valent, and 14-valent formulations—are critically assessed. Clinical trials demonstrate that next-generation HPV vaccines provide robust protection; for example, Cecolin^® showed 100% efficacy against HPV-16/18-associated high-grade squamous intraepithelial lesions (HSIL) and up to 97.8% efficacy against persistent HPV infection, while Walrinvax^® demonstrated 78.6% protection against CIN2+ lesions. Cervavac^® showed non-inferior immunogenicity compared with established vaccines. While comparative analyses of efficacy, immunogenicity, and safety indicate that these vaccines are strong alternatives to established products, robust long-term effectiveness and real-world impact data remain essential before full clinical equivalence can be definitively established. Advances in L2-based platforms further aim to broaden cross-type protection, simplify manufacturing, and enable thermostable formulations, thereby enhancing applicability in resource-limited settings. Economic evaluations demonstrating favorable cost-effectiveness emphasize the essential role of next-generation vaccines in improving access and reducing inequity. Overall, innovations in valency, technology, and delivery strategies have the potential to significantly expand global HPV prevention coverage and accelerate progress toward cervical cancer elimination. Full article

Background/Objectives: Human papillomavirus (HPV) vaccines are effective in preventing HPV infection and HPV-related cancers in both males and females. As sexual behavior plays a central role in HPV transmission, male vaccination is important not only for reducing HPV-associated diseases among men but also for limiting viral transmission at the population level. Methods: A cross-sectional study was conducted among male university students in Selangor, Malaysia. Data were collected using a structured questionnaire assessing sociodemographic characteristics, history of sexual intercourse, HPV-related knowledge, and awareness of HPV vaccination. Multivariable logistic regression analysis was performed to identify factors associated with HPV vaccination awareness. Results: Overall, 43.4% of the respondents demonstrated good awareness of HPV vaccination. Multivariable logistic regression analysis identified several factors significantly associated with awareness. Non-Muslim students were more likely to report good awareness of HPV vaccination than Muslim students (AOR = 2.724, 95% CI: 1.150–6.454, p < 0.001). Students who were in a relationship or married demonstrated higher awareness compared with single students (AOR = 3.830, 95% CI: 2.071–7.082, p < 0.001). HPV-related knowledge showed the strongest association, with participants possessing good knowledge being more likely to be aware of HPV vaccination (AOR = 7.012, 95% CI: 4.077–12.059, p < 0.001). In contrast, history of sexual intercourse was not significantly associated with HPV vaccination awareness after adjustment (p = 0.097). Conclusions: Awareness of HPV vaccination among male university students was influenced by religion, relationship status, and HPV-related knowledge. These findings highlight the need for targeted, male-inclusive vaccination education strategies that address sociodemographic differences. University-based interventions may play an important role in improving awareness and increasing HPV vaccine uptake in this population. Full article

Background: Most cancers caused by human papillomavirus (HPV) are preventable through vaccination, yet uptake among U.S. college students remains below national targets. This study examined HPV vaccination rates and factors associated with vaccine uptake among students aged 18–26 years at a large, diverse public university in New York State following the COVID-19 pandemic. Methods: In March 2022, an online survey was distributed to 19,351 students aged 18–26 years; responses were received from 708 students (~4%) and included in the analysis. Descriptive statistics and multivariable logistic regression was used to identify predictors of HPV vaccination. Results: Overall, 59% of students reported receiving at least one HPV vaccine dose, while 17.7% were unsure of their vaccination status. Among students whose healthcare provider recommended the HPV vaccine, 76.4% were vaccinated compared to 16.7% without one (p < 0.001). Healthcare provider recommendation was the strongest predictor of vaccination (OR 17.9; 95% CI: 8.45–37.91). Additional factors significantly associated with uptake included agreement that the HPV vaccine is safe (OR 2.56; 95% CI: 1.54–4.27), importance of a sexual partner being vaccinated (OR 2.65; 95% CI: 1.90–3.69), and valuing family opinion (OR 1.67; 95% CI: 1.23–2.26). Students most preferred receiving HPV information from healthcare providers (73.4%), followed by Internet searches (51.8%) and social media (35.1%). Conclusions: HPV vaccination uptake among college students remains below national targets. Strengthening provider recommendations, addressing safety concerns, and implementing multimodal education strategies during preventive visits for young adults are essential to improve coverage and reduce HPV-related cancer risk. Full article

Background: Human papillomavirus (HPV) infection is the necessary cause of almost all cervical cancers. HPV vaccination programs have been implemented worldwide, yet real-world evidence on vaccine effectiveness against invasive cervical cancer remains limited. Methods: We conducted a retrospective cohort study using synthetically generated data from a large health provider in Israel, including women who underwent a first Papanicolaou (Pap) test during 2014–2015. Their HPV-vaccination status before an index Pap test was obtained from computerized records. Incident cervical cancer and high-grade cervical pathology (cervical cancer, cervical intraepithelial neoplasia [CIN] 1–3, and carcinoma in situ) occurrence were examined through 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models and fitted with propensity score weighting. Results: The cohort included 98,102 women, of whom 9198 (9.4%) were vaccinated against HPV before an index Pap test. While HPV-vaccinated women had a higher risk of cervical pathology compared with unvaccinated women, among women vaccinated before age 18, HPV vaccination was associated with a substantially lower, though not statistically significant, risk of cervical cancer (HR 0.28, 95% CI: 0.07–1.20, p = 0.087). Conclusions: In this large cohort, HPV vaccination was correlated with a higher risk of cervical pathology, likely reflecting residual confounding factors from sexual behavior and differential baseline risks of HPV infection. In contrast, vaccination during adolescence showed a marked trend toward a reduced risk of cervical cancer, consistent with international evidence that early vaccination, prior to HPV exposure, is the most effective preventative treatment. Full article

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and thematically analyzed by two coders, with discrepancies resolved by consensus and reviewed by a third researcher. Results: Participants identified five key dyadic themes and four HCP themes. Adolescents described the gameplay as intuitive and enjoyable, highlighting interactive challenges and realistic avatars. Parents valued the clarity of HPV information and noted that the game helped initiate health-related conversations. Both adolescents and parents suggested enhancements including voice narration and greater customization and agreed that the game was well suited for 10–15-min clinic wait times, with text messaging preferred for follow-up. HCPs emphasized challenges such as parental hesitancy and competing clinical demands and viewed the game as a feasible adjunct to support vaccine-related discussions. Conclusions: Findings suggest the acceptability, usability, and perceived clinical applicability of a brief, clinic-based digital game for HPV-related education and engagement among adolescents and their parents. Full article

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

Background: Sexually transmitted infections (STIs) represent a significant public health problem due to their impact. Knowledge about them, perceptions of the risk of contracting them, and adherence to prevention strategies such as HPV vaccination are, at various levels, key factors in preventing the spread of STIs. The study therefore aimed to investigate and evaluate, in a group of young Italians, the level of knowledge, perception of risk and propensity to adhere to preventive strategies, including vaccination against papillomavirus. Methods: A cross-sectional study was conducted by administering a questionnaire to young people aged between 16 and 30, residing in four macro-geographical areas, collecting socio-demographic, behavioral and knowledge data. Levels of knowledge about STIs and HPV were classified into four categories (low, medium without awareness, medium with awareness, high). Risk perception was assessed on a scale of 1 to 10. Results: A total of 2576 questionnaires were collected, revealing that general knowledge about STIs is limited: only 12.5% of participants demonstrated a high level of knowledge, while 27.1% demonstrated a low level; with regard to HPV, 41.3% of the sample demonstrated a low level of knowledge. The perception of the risk of contracting HIV and HPV was low in most subjects (average score of approximately 2.9 out of 10), with no significant differences related to levels of knowledge about HPV. Potential adherence to HPV vaccination was high (83.0% considered vaccination useful), but among unvaccinated subjects, almost half expressed concerns about vaccination, related to poor knowledge and mistrust of vaccines in general. Factors associated with a higher frequency of self-reported STIs included older age, transgender identity, non-heterosexual orientation, and risky sexual behavior. Conclusions: The results emerging from the study highlight the urgent need to strengthen educational and preventive interventions aimed at young people. Raising awareness of the risk of contracting STIs and the importance of vaccination are key targets for health promotion interventions. Full article

Background: Vaccination against human papillomaviruses (HPVs) and cervical cancer screening represent effective tools for preventing this neoplasia, but access to health services is limited for vulnerable women. We investigated prevalence of high-risk HPV and abnormal cervical cytology, as well as knowledge about HPV and the HPV vaccine, among homeless and migrant women in Rome, Italy. Methods: Cytologic samples in PreservCyt (Hologic) were employed for liquid-based cytology (ThinPrep Processor 5000, Hologic) and high-risk HPV DNA testing (Xpert HPV assay, Cepheid). Socio-demographic data, anamnestic, and behavioral data were retrieved from electronic archives. A questionnaire was employed to assess knowledge about HPV and HPV vaccination. Results: A total of 134 women were included (median age: 43 years; interquartile range, IQR: 34–50), mostly coming from Central–South America (69, 51.5%). Of the 127 cytologic specimens collected, one (0.8%) was invalid for the HPV test and five (3.9%) were unsatisfactory for the morphological evaluation. High-risk HPV positivity was found in 18 women of the 126 women with a valid HPV test (14.3%). A total of 10 women of the 122 women with an adequate cytology (8.2%) had abnormal cytology. Overall, 57/134 women (42.6%) had never heard of HPV or were unsure about it. Only 29 of the 77 women who had heard of HPV (37.7%) knew of the HPV vaccine, and only 2 had been vaccinated in the entire study group (1.5%). Conclusions: Tailored preventive strategies and comprehensive information campaigns should be developed and implemented to enhance awareness of HPV infection and actively promote vaccination among women in vulnerable groups. Full article