Introduction: Genital human papillomaviruses (HPVs) are readily transmissible and commonly acquired after sexual debut. With HPV being uncultivatable, it has taken the application of molecular biology to describe the virus' natural history, although it has also given us sensitive diagnostic tools, as well as underpinning the development of prophylactic viral-like particle (VLP) vaccines. Molecular epidemiology proved oncogenic HPVs as causing 100% of cervical, plus a proportion of, anogenital and oropharyngeal cancers. The quadrivalent vaccine containing VLPs 6, 11 (cause > 90% of genital warts), 16, 18, (causing 70% of cervical cancers) has shown in Phase III trials excellent safety, high efficacy and immunogenicity.
Areas covered: This review looks at Phase III clinical trial data, plus vaccine effectiveness reported in real-world situations.
Expert opinion: Given the remarkable early successes of vaccine effectiveness in reduction of HPV-vaccine-related infections in vaccine-eligible age females, rapid reduction in genital warts (first marker of disease reduction and herd immunity) and high-grade cervical lesions, in countries where vaccine has high coverage of target populations, vaccination should ultimately translate into reductions in HPV-related neoplasias. The greatest success from this vaccine will only be realized when it is rolled out effectively, with high coverage to those parts in the world with the highest burden of disease. We have the tools; we now need to use them.