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Open Access Highly Accessed Correspondence

Rome consensus conference - statement; human papilloma virus diseases in males

Andrea Lenzi1*, Vincenzo Mirone2, Vincenzo Gentile3, Riccardo Bartoletti4, Vincenzo Ficarra5, Carlo Foresta6, Luciano Mariani7, Sandra Mazzoli8, Saverio G Parisi9, Antonio Perino10, Mauro Picardo11 and Carla Maria Zotti12

Author Affiliations

1 Institute/Department of Endocrinology, La Sapienza University, Rome, Italy

2 Institute/Department of Urology, Federico II University, Naples, Italy

3 Institute/Department of Urology, La Sapienza University, Rome, Italy

4 Department of Urology, Santa Maria Annunziata Hospital, Florence, Italy

5 Department of Urology, University of Padua, Padua, Italy

6 Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padua, Padua, Italy

7 Department of Obstetrics and Gynaecology, Regina Elena National Cancer Institute, Rome, Italy

8 Centre Responsible, Sexually Transmitted Disease Centre, Santa Maria Annunziata Hospital, Florence, Italy

9 Department of Histology, Microbiology and Medical Biotechnologies, University of Padua, Padua, Italy

10 Head of Obstetrics and Gynecology Department, University of Palermo, Palermo, Italy

11 Laboratory of Skin Physiopathology San Gallicano Dermatological Institute IRCCS, Rome, Italy

12 Department of Public Health and Microbiology, University of Turin, Turin, Italy

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BMC Public Health 2013, 13:117  doi:10.1186/1471-2458-13-117

Published: 7 February 2013

Abstract

Background

Human Papillomavirus (HPV) is a very resistant, ubiquitous virus that can survive in the environment without a host. The decision to analyse HPV-related diseases in males was due to the broad dissemination of the virus, and, above all, by the need to stress the importance of primary and secondary prevention measures (currently available for women exclusively). The objective of the Consensus Conference was to make evidence-based recommendations that were designed to facilitate the adoption of a standard approach in clinical practice in Italy.

Methods

The Sponsoring Panel put a series of questions to the members of the Scientific Committee who prepared a summary of the currently available information, relevant for each question, after the review and grading of the existing scientific literature. The summaries were presented to a Jury, also called multidisciplinary Consensus Panel, who drafted a series of recommendations.

Results

The prevalence of HPV in males ranges between 1.3–72.9%;. The prevalence curve in males is much higher than that in females and does not tend to decline with age. Women appear to have a higher probability of acquiring HPV genotypes associated with a high oncogenic risk, whereas in males the probability of acquiring low- or high-risk genotypes is similar. The HPV-related diseases that affect males are anogenital warts and cancers of the penis, anus and oropharynx. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in males aged 16–26 years in 90.4%; (95%; CI: 69.2–98.1) of cases. It has also proved to be effective in preventing precancerous anal lesions in 77.5%; (95%; CI: 39.6–93.3) of cases in a per-protocol analysis and in 91.7%; (95%; CI: 44.6–99.8) of cases in a post-hoc analysis. Early ecological studies demonstrate reduction of genital warts in vaccinated females and some herd immunity in males when vaccine coverage is high, although males who have sex with males gained no benefit at all. Males with an immunodeficiency disease are at greater risk of developing disease. Infertility seems to be caused by HPV in some cases. Studies demonstrate vaccination to both genders can be more efficacious and social equity matters are to be taken into consideration.

Conclusions

The Jury made Recommendations based on the scientific evidence presented by the Scientific Committee. Accordingly, for prevention purposes and social fairness and equality, as both sexes are affected by the disease, the vaccination of 12-year-old males against HPV should be recommended in order to guaranty protection to everyone. Aspects related to healthcare policy and economic sustainability, are to be discussed by respective public system representatives. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts, but for HPV-related diseases in general in males in accordance to new scientific evidences.

Keywords:
HPV-related diseases; Vaccination; Males; Consensus conference; Policy