To protect yourself from the most common sexually transmitted infection in the world, you need the vaccine up to the age of 45

The one from the human papilloma virus (HPV) today is the most common sexually transmitted infection in the world. In most cases it is asymptomatic and the body gets rid of it spontaneously, but sometimes it becomes chronic: over time, the permanence of the virus in the cells can lead to benign pathologies (such as warts, genital warts), but also tumors (uterine cervix, head and neck, genitals), to infertility in men and to multiple abortions.

The results of a recent study published in The Lancet show the presence of at least one strain of HPV in 31% of men over 15 years of age. Considering that the Italian male population between 18 and 50 years old is estimated at more than 10 million, at least 3 million Italians would be positive for the papilloma virus.

On World Papilloma Virus Day, theandrologist Carlo Forestaformer full professor of Endocrinology at the University of Padua, asks that both men and women can benefit from free vaccination up to the age of 45 of age, to reduce HPV-related disease and mortality.

In fact, if the prevention of HPV-related pathologies in women has made giant strides (today only 2,400 cases of cervical cancer are recorded per year), in 2022, as many as 7,300 cases of head and neck tumors were recorded in humans, among the main HPV-related tumors in 40% of cases, in addition to genital and anal ones. In Italy the vaccine is recommended and offered free of charge to males and females from the age of twelve. «However, the coverage varies depending on the region», explains Foresta. «Currently, among eighteen-year-olds, 69% of girls and 54% of boys in Italy have completed the vaccination cycle. But coverage is drastically lower if we look at 12-year-old children who should have completed the last vaccination cycle, in which coverage falls below 30% at a national level”.

Professor, why are males at greater risk of HPV infection and therefore of related diseases such as tumors?
«Unlike women, who have a peak of infectivity before the age of 26 which then decreases with age, the presence of the virus in males remains high and constant at least until the age of 50. This phenomenon is the result of a reduced immunological response against the virus by the male, which determines a longer stay of the virus compared to the woman. This also translates into greater susceptibility to reinfections. And this is the reason why the presence of the virus in humans remains constantly high even in adulthood. Males, therefore, at any age represent an important reservoir for the infection. The combination of these phenomena therefore entails an increased risk of developing HPV-related pathologies in males, such as warts (100,000 per year), oropharyngeal tumors (7300 per year), anal tumors (500 per year), penile tumors (500 per year)”.

Why are head and neck tumors HPV related?
«The papilloma virus particularly attacks the mucous membranes, as happens with the cervix and the anus: for this reason the mucous membranes of the oral cavity are susceptible to infection as a result of unprotected oral intercourse. Once the virus penetrates the oral mucosa, like any other mucosa, it can integrate into the cells, transforming them into tumor cells.”

How does HPV also cause infertility?
«In addition to the well-known clinical manifestations associated with HPV, such as warts and tumors, it has recently been demonstrated that the presence of the virus in the seminal fluid, where it adheres to the spermatozoa, causes difficulty in conceiving, justifying approximately 20% of those infertility cases which today they were not explained. In these cases, infertility is not resolved by in vitro fertilization techniques, since the fertilization of the oocyte can occur by infected spermatozoa which transfer the viral DNA to the oocyte itself, preventing the correct development of the embryo.”

Contagion is very easy.
«Yes, and in the majority of cases the infection is asymptomatic, so a large part of the sexually active population is infected without knowing they are, and this facilitates the spread of the virus and contagion. On the other hand, contagion does not necessarily require complete sexual intercourse, nor does a condom guarantee total protection from the virus, since contagion can also occur with contact between skin and mucous membranes. We have recently shown that the virus can also be present on hands or objects such as smartphones, if handled by infected individuals.”

Is the vaccine a safe prevention?
«The vaccine protects against the 9 most frequent strains of HPV and above all those with a high oncogenic risk, stimulating the immune response and therefore preventing contagion, with very high efficacy. In countries where vaccination coverage has reached the 90% threshold, HPV-related cancers have been virtually eliminated.”

Does it have any contraindications or particular side effects?
«No, no particular side effects or contraindications have been reported».

Why is the vaccine still needed for those who have already contracted HPV?
«The administration of the vaccine was carried out in conditions in which the infection is underway, and the motivation for this treatment is found above all in humans, since it induces an important stimulation of the immune system which raises the antibody rate, favoring the elimination of the virus in a few months. This phenomenon is much more evident in males, who normally require several years for the natural elimination of the virus, while in women spontaneous recovery has been documented in 5-6 months. For these reasons it would be important to extend the free vaccination up to the age of 45, in order to prevent transmission in those who have not yet come into contact with the virus, but also to intercept that reservoir of 3 million Italian males which keeps the spread of the virus high. virus”.

Why is the number of vaccinated people still so low among young people?
«The low number of young people vaccinated, especially among males, derives from a poor participation of parents in this type of prevention. Therefore the campaigns, although aimed at young people, should involve the participation of families with greater determination. If for girls the first gynecological visit represents a moment for prevention through the Pap test, for boys there is not yet a moment of information and invitation to prevention for HPV”.