Human Papillomavirus Infection in Penile Cancer: Multidimensional Mechanisms and Vaccine Strategies.

Penile cancer (PC) is a rare male malignant tumor, with early lymph node metastasis and poor prognosis. Human papillomavirus (HPV) plays a key role in the carcinogenesis of PC. This review aims to summarize the association between HPV infection and PC in terms of virus-host genome integration patterns (the disrupted regions in the HPV and PC genome), genetic alterations, and epigenetic regulation (methylation and microRNA modification) occurring in HPV and PC DNA, as well as tumor immune microenvironment reprogramming. In addition, the potential of HPV vaccination strategies for PC prevention and treatment is discussed. Understanding of the HPV-related multidimensional mechanisms and the application of HPV vaccines will promote rational and novel management of PC.

HPV Vaccination: Does It Have a Role in Preventing Penile Cancer and Other Preneoplastic Lesions?

OBJECTIVES: Human papillomavirus (HPV) is the most common sexually transmitted infection globally, which causes nearly all cervix carcinomas and contributes to oropharyngeal, penile, vulva, vagina, and anal cancers. Despite the role of HPV in several preneoplastic and cancerous lesions in men, male vaccine coverage is low. This article aims to provide insights into the pathophysiology of HPV-related penile cancer and penile intraepithelial neoplasia (PeIN). Moreover, this review endeavors to outline the advantages of implementing HPV vaccination in male vaccination programs and the role of health care providers in this mission. DATA SOURCES: This is a narrative review of relevant literature. A search on PubMed and Cochrane database was conducted. The following search terms were used: HPV vaccination, gender-neutral vaccination, male, genital warts, penile cancer, vaccine recommendations. CONCLUSION: HPV is responsible for 50.8% of penile cancers globally, 79.8% of PeIN, and 90% of genital warts. In 2009 the Food and Drug Administration licensed the quadrivalent HPV vaccine for use in males, with a potential efficacy of 90% and 77.5% to reduce genital warts and anal intraepithelial neoplasia, respectively. However, the uptake of HPV vaccination in men is low, and gender-neutral vaccination is estimated to be implemented only in 42 countries worldwide. Because data in penile cancer are lacking, further research is needed to study the efficacy of incorporation of HPV vaccines in male vaccination programs on preventing penile cancer and PeIN. IMPLICATIONS FOR NURSING PRACTICE: Nurses and other members of the multidisciplinary team should take every opportunity to recommend HPV vaccination in adolescent men. Moreover, they play an important role in raising community awareness about the incidence of HPV and the related range of diseases. A practical approach is needed to incorporate HPV vaccines in vaccination programs and to optimize vaccination coverage.

Should men be exempted from vaccination against human papillomavirus? Health disparities regarding HPV: the example of sexual minorities in Poland.

INTRODUCTION: Social campaigns concerning vaccinations against human papillomavirus (HPV) in Poland are mainly addressed to women. In addition to cervical cancer, anal, penile, and oropharyngeal cancers can be caused by the virus, which clearly affects men as well. HPV vaccinations are voluntary and mostly not refunded in Poland. METHODS: A survey was published on social media's group gathering males and contained questions concerning epidemiological data, knowledge about HPV, and opinions of HPV vaccination. A questionnaire was enriched with educational note regarding HPV-dependent cancers and available vaccines against HPV in Poland. RESULTS: Because of age limitations, 169 males (115 heterosexuals, 48 homosexuals) aged 14-39 were chosen for the study. Seventyfive percent of straight and 88% of gay men were aware of HPV, but less than 4 and 17% (respectively) were vaccinated against the virus. Main sources of knowledge about HPV were the Internet (61%), media (28%) and relatives (27%). HPV infection was linked with the development of anal and oropharyngeal cancers by 28, and 37% of heterosexual males, compared with 56.3 and 43.8% of homosexual males. The majority of respondents (88%) indicated that all genders should be vaccinated, although only 57% were aware of HPV vaccination availability in Poland. CONCLUSIONS: The men are at risk of HPV-related cancers and the danger is poorly understood amongst Polish men. Despite awareness of HPV vaccines, the vaccination rate is low. Consequently, there is a serious need to broaden educational campaignes with a special attention to LGBTQ+ communities.

Prevention of Human Papillomavirus Infection. Beyond Cervical Cancer: A Brief Review.

INTRODUCTION: Human papillomavirus is responsible for almost all cases of cervical cancer, an important portion of anogenital and oropharyngeal invasive and preinvasive lesions, as well as genital warts (condyloma acuminatum) and recurrent respiratory papillomatosis. Currently, three prophylactic vaccines against high-risk Human papillomavirus are commercialized in many countries worldwide. METHODS: To this non-systematic review the authors searched in MEDLINE/PubMed for systematic reviews, meta-analysis and randomized controlled trials, published in the last six years, using the terms "HPV", "non-cervical cancer" and "vaccine". Non-cervical cancers caused by human papillomavirus are less common lesions. However, its incidence has been increasing, while cervical cancer has declined, due mainly to highly effective screening programs. There are no formal screening programs for non-cervical cancers, so universal vaccination could have an important impact. The preventive effect of the vaccine is mainly studied and established in relation to cervical cancer, although it has also been demonstrated in the development of vulvar and vaginal lesions. To date, the efficacy in preventing anal and oropharyngeal diseases related with human papillomavirus is uncertain due to scarce supporting data and low vaccination coverage in men. The prevalence of injuries and subsequent absolute benefit of vaccination is lower in men, but it provides an additional benefit to the herd immunity achieved with the vaccination of women. CONCLUSION: The total fraction of malignant and pre-malignant lesions attributed to Human papillomavirus genotypes contained in the nonavalent vaccine is significant in both women and men, which turns this vaccine into a great asset in terms of Public Health.

Introdução: O vírus do papiloma humano é responsável por quase todos os casos de cancro do colo do útero, de uma importante fração de lesões anogenitais e orofaríngeas pré-invasivas e invasivas bem como de condilomas genitais e da papilomatose respiratória recorrente. Atualmente existem três vacinas profiláticas contra o vírus do papiloma humano de alto risco comercializadas em vários países do mundo. Métodos: Para esta revisão não-sistemática, os autores pesquisaram na MEDLINE/PubMed revisões sistemáticas, metanálises e ensaios clínicos randomizados, publicados nos últimos seis anos, utilizando os termos "HPV", "cancro não cervical" e "vacina". Os cancros não cervicais causados pelo vírus do papiloma humano são lesões menos comuns. Contudo, a sua incidência tem aumentado, a par de uma diminuição do cancro do colo do útero, devido principalmente à implementação de programas de rastreio altamente eficazes. Uma vez que não existem programas oficiais de rastreio para cancros não cervicais, a vacinação universal pode ter um impacto importante. O efeito preventivo da vacina é principalmente estudado e estabelecido em relação ao cancro do colo do útero, embora também tenha sido demonstrado no desenvolvimento de lesões vulvares e vaginais. Até ao momento, a eficácia na prevenção de doenças anais e orofaríngeas relacionadas com o vírus do papiloma humano é incerta, devido à escassez de dados na literatura e baixa cobertura de vacinação em homens. A prevalência de lesões e o consequente benefício absoluto da vacinação é inferior nos homens, porém proporciona um benefício adicional à imunidade de grupo alcançada com a vacinação de mulheres. Conclusão: A fração total de lesões malignas e pré-malignas atribuídas aos genótipos de vírus do papiloma humano contidos na vacina nonavalente é significativa tanto em mulheres quanto em homens, o que confere a essa vacina um grande potencial em termos de Saúde Pública.

EBCOG position statement: Gender neutral HPV vaccination for young adults.

Human Papilloma Virus (HPV) has been implicated in the initiation of several types of cancers in both females and males. Therefore, it is imperative that national immunization programs should ensure that both young women and young men receive full immunization for herd immunity in their teenage years. A recent review confirmed that vaccination of boys and girls would be most cost-effective under the circumstances that both individual costs and coverage are low. By doing so, it would be possible to reduce the incidence of HPV-related malignancies to a large extent at later age in both sexes.

Human papillomavirus vaccination and prevention of intraepithelial neoplasia and penile cancer: review article.

PURPOSE OF REVIEW: The objective of the current article is to promote a literature revision of the relationship between the prevention of intraepithelial neoplasms (PeIN) and invasive penile cancer, and human papillomavirus (HPV) vaccination, aiming to enumerate the pros and cons of immunization. RECENT FINDINGS: The immunization against the HPV is sufficiently safe and many countries have incorporated the vaccine to their immunization calendar. Compared with men, the sampling size and the evidence quality of scientific researches among the female population are more robust. Some randomized and nonrandomized studies suggest that vaccination reduces the incidence of genital warts and no PeIN and penile cancer cases were developed in the vaccinal group. However, 70% of patients can evolve with the neoplasia despite having been immunized and even among HPV infected patients, only 1% will develop cancer. SUMMARY: The studies about vaccination against HPV and prevention on penile cancer are conflicting and the main academic urology societies still have not incorporated vaccination of men in their guidelines. Future studies are necessary to confirm the efficiency and cost-benefit of the vaccine in men to prevent intraepithelial neoplasms and invasive penile cancer.

Urologic Conditions in Infants and Children: Circumcision.

Circumcision is the surgical removal of some or all of the foreskin (ie, prepuce) of the penis. Among high-resource countries, the United States is the only country in which the majority of newborns are circumcised for nonreligious reasons. The rate of circumcision in the United States has been decreasing. Circumcised males have a lower risk of urinary tract infections, penile cancer, and several sexually transmitted infections. The benefit of circumcision is greater for males with certain urologic conditions, such as isolated hydronephrosis, vesicoureteral reflux, and ureteropelvic junction obstruction. Complications develop in approximately 1 of every 200 procedures. The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks. However, they do not endorse routine neonatal circumcision. Local anesthesia should be used to decrease pain during the procedure. Three devices commonly are used. Each has risks and benefits, and no one device has been proven to be superior to another.

Aplicação do arco de Charlez Maguerez na implementação de estratégias para prevenção do câncer de pênis / Application of the arch of Charlez Maguerez on the implementation of penis cancer prevention strategies / Aplicación del arco de Charlez Maguerez en la implementación de estrategias para prevención del cáncer de pene

Objetivo: Descrever a aplicação do Método do Arco da Problematização de Charles Maguerez para promover estratégias de promoção e educação em saúde nos acadêmicos de uma IES localizada no interior do estado de Goiás em relação à prevenção do câncer de pênis. Método: Trata-se de em estudo descrtivo, com abordagem qualitativa. Utilizou-se para este estudo a população dos 422 estudantes dos cursos de enfermagem, farmácia e fisioterapia de uma IES, de uma cidade goiana. A partir deste pressuposto teórico e abordagem, foi realizada intervenção com base no arco da problematização. Resultados: Foram executados e descritos os passos: observação na realidade, levantamento de pontos chaves, teorização, indicação de hipóteses de solução e aplicação à realidade. Foi criado um projeto extensionista intitulado "Lave o Seu Pinto" que teve foco na conscientização dos 27,5 % dos estudantes que apresentaram médio e baixo nível de conhecimento acerca do câncer de pênis. Considerações finais: A utilização de novas práticas educacionais e a avaliação do modo de ensino possibilitam a formação de um profissional holístico detentor de aptidões, a fim de prevenir doenças, como o câncer de pênis através de estratégias de promoção e educação em saúde.

Objective: Describe the application of Charles Maguerez's problem arc method to promote health promotion and education policies in academics of an HEI located in the interior of the state of Goiás in relation to penis cancer tests. Method: This is a descriptive study, with a qualitative approach. Used for this study in the population of 422 students of nursing, pharmacy and physiotherapy courses at an HEI, in a city in the interior of Goiás. Based on this theoretical assumption and approach, an intervention was carried out based on the problem arc. Results: the following steps were carried out and monitored: observation in reality, survey of key points, theorization, indication of solution hypotheses and application in reality. It was created in an extension project entitled "Wash your Pinto", which resulted in the awareness of 27.5% of students who had medium and low level of knowledge about penile cancer. Final considerations: The use of new educational practices and an assessment of the teaching method makes it possible to train a holistic professional who holds strategies for disease prevention professionals, such as penis cancer using health promotion and education strategies

Objetivo: Describe la aplicación del Método del Arco de Problematización de Charles Maguerez para promover políticas de educación y promoción de la salud en académicos de una IES ubicada en el interior del estado de Goiás en relación a la prevención de cáncer de pene. Método: Este es un estúdio descriptivo, con un enfoque cualitativo. Se utilizó para este estudio 422 estudiantes de cursos de enfermería, farmacia y fisioterapia en un IES, en una ciudad brasileña. A partir de este presupuesto y enfoque teóricos, se realizó una intervención basada en el arco de problematización. Resultados: Se llevaron a cabo y monitorearon los siguientes pasos: observación en la realidad, recogido de puntos clave, teorización, indicación de hipótesis de solución y aplicación en la realidad. Se creó un proyecto de extensión titulado "Lave o seu Pinto", que resultó en la concienciación del 27.5% de los estudiantes que tenían un nivel medio y bajo de conocimiento sobre el cáncer de pene. Consideraciones finales: El uso de nuevas prácticas educativas y una evaluación del método de enseñanza permiten capacitar a un profesional holístico que posee estrategias profesionales de prevención de enfermedades, como el cáncer de pene, utilizando aptitudes de educación y promoción de la salud.

Awareness of human papillomavirus infection complications, cervical cancer, and vaccine among the Saudi population. A cross-sectional survey.

OBJECTIVES: To determine human papillomavirus (HPV) infection, cervical cancer, and vaccine awareness among the Saudi population. METHODS: This cross-sectional study of a convenience sample comprising 1033 participants (males and females) from different parts of Kingdom of Saudi Arabia was conducted between August 2018 and January 2019 using a web-based questionnaire. This self-administrated questionnaire was distributed to all participants. Collected data included age groups, cervical cancer, Papanicolaou (Pap) smear, and HPV vaccine awareness. RESULTS: The response rate was 95%. Approximately 50% of the participants were 15-22 years old, less than 3% were more than 46 years old, and less than 10% had heard of HPV. Awareness and previous knowledge of the Pap smear as a screening tool was variable with male (5.9%) and female (27.9%) participants, having knowledge of the test. There were no statistically significant differences (p more than 0.05) between males and females in their knowledge of HPV's role in cervical and penile cancers, the HPV vaccine availability in the hospital, its role in cervical cancer prevention, and suggestions that this vaccine should be provided to married and non-married women. CONCLUSION: There is a lack of knowledge and misinformation regarding cervical cancer, Pap smears, HPV, and HPV association with cervical cancer. These data can be used as a basis to formulate effective population awareness programs.

Conhecimento de homens universitários sobre câncer de pênis e práticas preventivas / Knowledge of university men about penile cancer and preventive practices / Conocimiento de hombres universitarios sobre cáncer de pene y prácticas preventivas

Objetivo: descrever o conhecimento de homens universitários sobre câncer de pênis e práticas preventivas. Método: estudo descritivo, exploratório e com abordagem quantitativa, realizado em 2017, na Universidade Federal de Mato Grosso. Utilizou-se amostragem não probabilística, por acessibilidade. Para coleta de dados, utilizou-se questionário estruturado autoaplicável elaborado pelos próprios pesquisadores. Resultados: foram entrevistados 57 indivíduos, com idade média de 24 anos. Destes, 77,19% já ouviram falar sobre o câncer de pênis e somente 28,07% realizam o autoexame respectivo. O principal meio de obtenção de informação em educação e saúde apontada pelos acadêmicos foi a internet (31,82%) e 43,18% dos entrevistados associaram a higiene íntima como forma de prevenção ao carcinoma do pênis. No entanto, o serviço da atenção primária não é a preferência ao buscar atendimento, acessando prioritariamente serviços hospitalares e farmácias. A maioria já ouviu falar sobre o câncer de pênis e sabem que a higiene íntima com água e sabão é a maneira mais eficaz de prevenção. Conclusão: observa-se a necessidade de estabelecer medidas educativas a fim de esclarecer essa população sobre o câncer de pênis como medida de estabelecimento de cultura de cuidado.(AU)

Objective: to describe the knowledge of university men about penile cancer and preventive practices. Method: a descriptive, exploratory study with a quantitative approach, carried out in 2017, at the Federal University of Mato Grosso. Nonprobabilistic sampling was used for accessibility. For data collection, a selfadministered structured questionnaire prepared by the researchers themselves was carried out. Results: 57 subjects were interviewed, with a mean age of 24 years. Of these, 77.19% have already heard about penile cancer and only 28.07% carry out self-examination of the penis. The principal means of obtaining information on education and health pointed out by scholars was the internet (31.82%) and 43.18% of respondents associated personal hygiene as a form of prevention of penile carcinoma. However, the primary care service is not the preference when seeking care, with hospital services and pharmacies being the priority. Most have heard about penis cancer and know that intimate hygiene with soap and water is the most effective way of preventing. Conclusion: it is observed the need to establish educational measures to clarify this population about penile cancer as a measure of establishment of culture of care.(AU)

Objetivo: describir el conocimiento de hombres universitarios sobre cáncer de pene y prácticas preventivas. Método: estudio descriptivo, exploratorio y con abordaje cuantitativo, realizado en 2017, en la Universidad Federal de Mato Grosso. Se utilizó muestreo no probabilístico, por accesibilidad. Para la recolección de datos, se utilizó un cuestionario estructurado autoaplicable elaborado por los propios investigadores. Resultados: fueron entrevistados 57 individuos, con edad media 24 años. De ellos, 77,19% ya oyeron hablar sobre el cáncer de pene y sólo el 28,07% realizan el autoexame del pene. El principal medio de obtención de información en educación y salud apuntada por los académicos fue la internet con 31,82% y el 43,18% de los entrevistados asociaron la higiene íntima con forma de prevención al carcinoma del pene. Sin embargo, el servicio de atención primaria no es la preferencia al buscar atención, accediendo prioritariamente a servicios hospitalarios y farmacias. La mayoría han oído hablar sobre el cáncer de pene y saben que la higiene íntima con agua y jabón es la manera más eficaz de prevención. Conclusion: se observa la necesidad de establecer medidas educativas a fin de esclarecer a esa población sobre el cáncer de pene, como medida de establecimiento de cultura de cuidado.(AU)

Treating advanced penile cancer: where do we stand in 2019?

PURPOSE OF REVIEW: Penile squamous cell carcinoma (PSCC) remains a challenging malignancy to treat and there is an urgent need of significant improvements at all levels of medical care. In the current review, we summarized the significant obstacles encountered during management of PSCC and discussed the clinical relevance of novel findings and their potential to address these obstacles. RECENT FINDINGS: The recent genetic and immunological advances suggest that patients with PSCC can benefit from available targeted therapy and immunotherapy options. Moreover, evidence has accumulated over time suggesting that majority of the patients diagnosed with PSCC suffer from psychosocial problems and impaired rehabilitation. SUMMARY: Effective prevention strategies against PSCC are urgently needed especially in developing countries given the limited therapeutic options. About a quarter of patients with metastatic PSCC appear to benefit from available targeted therapies and about half of the patients can be a suitable candidate for immune checkpoint blockade as half of the PSCC cases exhibit PD-L1 expression. Moreover, increased public awareness, healthcare provider education and social support programs may help patients suffering from PSCC coping with the psychosocial burdens of the disease.

Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates.

BACKGROUND: Many economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews. METHODS: We conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$. RESULTS: Sixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124-US$883 (anogenital warts), US$6912-US$52 579 (head and neck cancers), US$12 936-US$51 571 (anal cancer), US$17 524-34 258 (vaginal cancer), US$14 686-US$28 502 (vulvar cancer) and US$9975-US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer). CONCLUSIONS: Differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients.

Balanitis xerotica obliterans: a review of diagnosis and management.

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.41 There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.

Young Deaf Adults' Knowledge of Human Papillomavirus and Human Papillomavirus Vaccine's Effectiveness in Preventing Cervical, Anal, Penile, and Oral Cancer.

STUDY OBJECTIVE: To describe knowledge and risk perception of human papillomavirus (HPV) among deaf adults who use American sign language (ASL) comparison with hearing adults in the United States. DESIGN: Secondary HPV knowledge data for the deaf subset sample were drawn from the Health Information National Trends survey in ASL that was administered between 2015 and 2018. HPV knowledge data for the hearing subset sample were drawn from cycle 5 of the Health Information National Trends survey in English that was administered in 2017. SETTING: Surveys are a nationally based survey of deaf ASL users in the United States and a nationally based survey of hearing non-ASL users in the United States. PARTICIPANTS: The age of the deaf and hearing subset samples was determined on the basis of catchup vaccine eligibility criteria as outlined by the Centers for Disease Control and Prevention that recommends catchup vaccination in women, men who have sex with men, immunocompromised individuals, and those who identify as transgender. INTERVENTIONS AND MAIN OUTCOME MEASURES: We examined HPV, HPV vaccine, and HPV-related cancer knowledge in deaf and hearing subsets. RESULTS: Our sample consisted of 235 deaf and 115 hearing adults aged 18-26 years. Of the deaf participants 58% (136/235) reported knowledge of HPV compared with 84% (97/115) of hearing participants (P < .001). Hearing participants showed higher accuracy in risk perception of HPV relation to cervical cancer compared with deaf participants (P < .001). Hearing participants were more likely to have heard of the HPV vaccine as well as believe it is successful in preventing cervical cancer compared with deaf participants (P < .001). CONCLUSION: Deaf ASL users are less likely to have knowledge of HPV, virus-related cancer risk, and preventative vaccination compared with hearing peers.

The Role of Human Papilloma Virus in Penile Cancer Prevention and New Therapeutic Agents.

Penile cancer remains an aggressive disease with poor prognosis in advanced stages. Another specific problem of any rare disease is that the population is not aware of prevention strategies and higher chances for curation by early diagnosis. In penile carcinogenesis, two major pathways are known. Besides a non-human papilloma virus (HPV)-related pathway (mainly caused by phimosis and chronic inflammation), up to 50% of penile carcinomas are HPV-related (HPV high-risk types). Prophylactic HPV vaccination has proven its efficacy against cervical cancer; its B-cell-mediated immunity against HPV capsid proteins provides probably lifelong protection against specific HPV subtypes covered by the vaccine. Therefore, a consequent HPV vaccination program for children of both sexes might dramatically reduce the incidence of not only cervical cancer but also partially prevent penile cancer. However, for the treatment of already existing intracellular HPV infections, an antigen-specific T-cell immunity is necessary. Appropriate therapeutic HPV vaccines are under investigation. This article gives an overview about different levels of prevention of the HPV-related penile cancer.

Epidemiological dynamic modeling of human papillomavirus-related diseases to assess vaccination strategies in Argentina.

Our objective was to develop and test a dynamic simulation model of human papillomavirus (HPV)-related diseases to assess rational vaccination strategies in Argentina. A dynamic stochastic transmission model for hetero- and homosexual transmission of HPV oncogenic and low-risk oncogenic types among females and males was developed. The model included HPV transmission and vaccination, the natural history of HPV-related diseases, disease outcomes, and cervical cancer screening. Considering all cervical cancers, covered or not by the current quadrivalent vaccine, the existing coverage rate would lead to 60% reduction in the global incidence of cervical cancer at 25 years, and to 79% at 50 years. Isolated current female vaccination without a screening program would need around 100 years to eliminate cervical cancer from the local population. Current coverage rate would lead to 59% reduction of vulvar cancer, 76% of vaginal cancer, 85% of anal cancer, and 87% of oropharyngeal cancer, estimated over a 25-year time prospect. Female HPV vaccination within the context of current cervical cancer screening should reach a minimum long-term mean coverage of 60% of girls, receiving at least a two-dose vaccine schedule, to significantly reduce or virtually eliminate cervical cancer at 50 years. Including vaccination to boys to improve herd immunity did not influence the incidence of cervical cancer over time, as long as female coverage did not fall below 50%. Regarding vulvar, vaginal, anal, penile, and some oropharyngeal cancers, current girls-only based vaccination could virtually eliminate these cancer types after 35-40 years, both in women and men.