HPV-Genital Infections, Men and the HPV Vaccine: New Horizons

Zahvaljujući razvoju suvremenih metoda molekularne medicine, prije svega rekombinantne tehnologije DNK, do danas se utvrdilo oko 150 tipova HPV-a. Genitalne infekcije uzrokovane HPV-om klinički se najčešće manifestiraju kao širok spektar dermatoveneroloških bolesti, od čega posebno ističemo: condylomata acuminata (šiljasti kondilomi), condylomata plana (ravni kondilomi), gigantski kondilom Buschke-Löwenstein, papulosis bowenoides, kao i razne druge kliničke manifestacije intraepitelnih neoplazija (IN) vanjskoga genitalnog sustava (dakle, ne samo cervikalne intraepitelne neoplazije, CIN), poput npr. penilne (PIN), analne (AIN), vulvarne (VIN), skrotalne (SIN) ili vaginalne (VAIN) intraepitelne neoplazije. Genitalne infekcije uzrokovane humanim papilomavirusom (HPV) najčešće se pojavljuju u mladoj, generativno sposobnoj populaciji te je stoga njihovo uspješno praćenje i liječenje obveza svakog društva koje teži napretku. Ove su bolesti sve više predmetom istraživanja s obzirom na njihovu najvišu učestalost unutar skupine virusnih spolno prenosivih infekcija (STIs, engleski: sexually transmitted infections), sklonost recidivima, dugotrajno liječenje i povezanost s pojavom zloćudnih bolesti. Izbor liječenja ovisi o općem stanju i dobi bolesnika, o obliku, veličini i lokalizaciji promjena, kao i o iskustvu terapeuta. No, svakako treba istaći da još ne postoji specifi čno protuvirusno liječenje HPV-genitalnih infekcija, recidivi su česti (30-70%), a raznovrsni terapijski pristupi ponekad vrlo neugodni za bolesnika i zahtjevni za liječnika. S obzirom na sve navedeno, kao i na dostupnost cjepiva protiv HPV-infekcija, danas je HPV-cijepljenje obaju spolova ozbiljan pomak koji značajno unaprjeđuje pristup ovom problemu.Up to 150 HPV DNA types have been identified so far. Anogenital warts (condylomata acuminata) are the most common lesions presented in men. However, during the last decade the other HPV-associated lesions such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias, as well as the penile, urine bladder and prostate cancer have been studied a little bit more extensively. The clinical variations might range from clinically "invisible", "asymptomatic" lesions to the bizarre forms of giant condyloma of Buschke-Löwenstein type, including Bowenoid papulosis, Mb. Bowen, different kinds of erythroplasia in both men and women and a large spectrum of HPV-induced dermatovenereological entities in genital region including high-grade intraepithelial genital neoplasias, such as penile, anal, scrotal, vulvar, vaginal etc. (thus not only cervical), and, last but not least, anogenital warts. In general, anogenital infections caused by Human papillomavirus (HPV) are the most frequently diagnosed sexually transmitted infections (STIs) of viral origin. A prophylactic vaccine that targets these types should thus substantially reduce the burden of HPV-associated clinical diseases. Ultimately, within the spectrum of therapeutic options for condylomata, no method is really superior to others; recurrences occurred in 30-70% of cases. We definitely need the HPV vaccination program to eradicate one of the oldest and up to now unsolved problems of mankind. Since HPV is transmitted by sexual intercourse, managing both partners is necessary in order to eliminate the virus in the population. The appropriate approaches include prophylactic vaccines such as the quadrivalent HPV vaccine for both men and women