hpv vaccine

1. HPV VACCINATION
Leonardo Micheletti, M.D.
Department of Gynaecology and Obstetrics
University of Torino
No disclosures or conflicts of interest

2. Garland et al. N Eng J Med 2007

3. LOWER FEMALE GENITO-ANAL TRACT
Starts from the
Cervical Squamo-Columnar Junction
Ends at the Anorectal Pectinate Line
Transition from Squamous to Columnar Epithelium

4. LOWER FEMALE GENITO-ANAL TRACT
ANATOMOBIOLOGIC
UNIT
DIFFERENT ORGANS
SAME SQUAMOUS EPITHELIUM
MUCOSAL / CUTANEOUS
HPV
ACTION-FIELD
REGARDLESS OF
the SITE of the LESION

5. LOWER FEMALE GENITAL TRACT
a continuum of squamous epithelium from the cervix to the vulva
commonly infected by HPV
the outcome depends on
Viral Genotype
Cervical Squamocolumnar Junction
more susceptible to HPV disease
Vaginal cancer 20 times Vulval cancer 6 times
Less common than Cervical cancer
Low Risk HPV 6 and 11 Benigne Lesions
High Risk HPV 16, 18, … Malignant Lesions
Site of infection
CERVIX
> 95 %
VAGINA
80-95 %
VULVA
< 50 %
Cutaneous epithelium less susceptible to oncogenic HPV
compared to mucosal epithelium

6. HPV interacts with squamous epithelia in 2 basic ways
Benigne Transient Lesions Precancerous Lesions
low grade lesions,
grade 1 intraepithelial neoplasia
mild dysplasia
condyloma
high grade lesions
grade 2-3 intraepithelial neoplasia
moderate-severe dysplasia
carcinoma in situ
Histopathologic Terminology of HPV-associated lesions
of the lower genito-anal tract
remains disparate, complex, and clinically confusing
2 different interest groups
focusing on specific body sites
Gynaecologists
and
Gynaecologic Pathologists
Dermatologists
and
Dermatopathologists
Bowen disease/papulosis
Erithroplasia of Queyrat

7. International Journal of Gynecological Pathology
2012; 32:76-115

8. Lower Anogenital Squamous Terminology
LAST
Reflect the current HPV biology and pathogenesis knowledge
Overcome the disparate diagnostic terms derived from multiple specialties
in order
to
Specifically created for human papillomavirus (HPV)-associated squamous lesions
of the lower anogenital tract
Facilitate clear communication across different medical specialties
goal
Improve accuracy of histologic diagnosis and Provide optimal patient care
Facilitating
Communication between pathologists and their clinical colleagues

9. E. T. 36 years
LOWER GENITO-ANAL TRACT
MULTICENTRIC INTRAEPITHELIAL NEOPLASIA
HPV-Related
VIN 2 – 3
AIN 2 – 3
CIN 3
Lacking VaIN
VHSIL
AHSIL
CHSIL
VaHSIL

10. Usual type,
caused by HPV
Differentiated type,
not caused by HPV
2004 ISSVD terminology for vulvar intraepithelial neoplasia
2 types of VIN
histologically, biologically, and clinically differents
Younger patient Older patient
Condylomatous aspect Lichen sclerosus context
Multifocal Unifocal
Less aggressive More aggressive

11. The outcome of HPV infection depends on
Viral Genotype and Site Infection
Low Risk HPV 6 and 11 Benigne Lesions , Common
High Risk HPV 16, 18, …
Malignant Lesions, Rare,
20 times less common
than the cervix.
80-95 % HPV-related
50 % Not HPV-related
Primary Prevention through HPV Vaccination
useful
VAGINA VULVA
Low Risk HPV 6 and 11
High Risk HPV 16, 18, …
Malignant Lesions, Rare,
6 times less common
than the cervix
50 % HPV-related
Psychological distress control Management economic burden
GWs most commonly STI
160-289 per 100,000

12. Sex Transm Infect 2011;87:544-7
4 years after the
national HPV
vaccination programme
dramatic decline and
near disappearance
of GW
in women and men
under 21 years

13. Joura et al. 2015, ACIP 27 March 2015

14. The economic burden of noncervical HPV disease is substantial
HPV Vaccination, by protecting both female and male from HPV infection,
can dramatically reduce diagnostic and treatment costs