Efficacy of Human Papillomavirus Vaccines for Recalcitrant Anogenital and Oral Warts

Abstract

Human papillomavirus (HPV) vaccines are preventive measures to decrease HPV infection rates. Knowledge of their efficacy as treatment options for anogenital warts (AGWs) and oral warts (OWs) is limited. To evaluate the efficacy of HPV vaccinations in recalcitrant AGWs and OWs (lesions persisting more than 6 months despite conventional treatments), we compared a group of patients treated with standard therapies plus an HPV vaccine with a group of patients treated with standard therapies only. The response to treatment (in terms of the number of lesions) in the two groups was compared. Data were analyzed with the χ2 test and p values < 0.05 were considered to be statistically significant. The study included 14 patients (group A = cases) who received 3 doses of an intramuscular HPV vaccine (Gardasil 4 or Gardasil 9) in addition to the standard treatments for AGWs and OWs, and 15 age- and sex-matched patients (group B = controls) with an analogous number of lesions to group A who received only standard therapies. After 12 months, 85% of patients of group A versus 33% of group B had positive clinical outcomes (0.004). Our findings suggest a possible therapeutic role of HPV vaccines in addition to standard treatments for AGWs/OWs. Preventive vaccines, blocking the viral entry through the induction of L1-specific antibodies, can prevent autologous reinfections (through auto-inoculation) and favor the elimination of the virus.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases—A Comprehensive Review

“…Reports have surfaced regarding the open-label utilization of human papillomavirus (HPV) vaccines as a therapeutic avenue for treating warts, thereby prompting further exploration within the research domain. To evaluate the treatment efficacy, the commonly employed system involved classifying the response as complete if there was a total clearance of lesions and partial if there was more than a 50% reduction in the number of lesions [ 9 , 10 , 11 ]. An illustrative instance is the case series described by Hayashi et al in 2020, wherein the administration of the qHPV vaccine resulted in the complete resolution of multiple warts in two individuals at disparate ends of the age spectrum, namely 70 years old and 9 years old [ 12 ].…”

“…Notably, the response rate was lower in patients aged over 26 years compared to those aged 9 to 26 years (55.0% vs. 84.0%, p = 0.049) [ 18 ]. A younger age (less than 45 years old) emerged as a notable factor, along with a smaller number of lesions (less than 10), a shorter duration of the disease (less than two years), and immunocompetence, collectively enhancing the clinical response to both qHPV and the 9vHPV vaccine, in conjunction with standard treatments ( p > 0.05) [ 9 ]. Despite the inclusion of five immunosuppressed patients in the study, a statistically significant difference was evident in the cumulative complete and partial responses to treatments.…”

“…Despite the inclusion of five immunosuppressed patients in the study, a statistically significant difference was evident in the cumulative complete and partial responses to treatments. Notably, 85% of patients subjected to combined therapy (standard therapy and HPV vaccination) exhibited a positive clinical response, whereas only 40% of patients undergoing standard treatments alone demonstrated a favorable outcome ( p = 0.01) [ 9 ]. Interestingly, despite a subgroup of three patients having previously received the qHPV vaccine, the clinical outcomes did not show a statistically significant difference when compared to individuals exclusively administered the 9vHPV vaccine in the study ( p > 0.05) [ 9 ].…”

“…Notably, 85% of patients subjected to combined therapy (standard therapy and HPV vaccination) exhibited a positive clinical response, whereas only 40% of patients undergoing standard treatments alone demonstrated a favorable outcome ( p = 0.01) [ 9 ]. Interestingly, despite a subgroup of three patients having previously received the qHPV vaccine, the clinical outcomes did not show a statistically significant difference when compared to individuals exclusively administered the 9vHPV vaccine in the study ( p > 0.05) [ 9 ]. Moreover, the 9vHPV vaccine demonstrated noteworthy outcomes in the treatment of young patients with both genital and extragenital warts following the administration of two doses [ 10 , 19 ].…”

“…These findings highlight that the HPV vaccine demonstrates its highest effectiveness against HPV-related disease outcomes when administered at younger ages, underscoring the crucial importance of timely vaccination [ 60 ]. Moreover, it was established in two of our included studies that vaccine effectiveness, when employed as a treatment, is also contingent on age [ 9 , 18 ].…”