HPV Vaccination: A Cornerstone in Cancer Prevention

HPV (Human papillomavirus) is responsible for around 100,000 new cancer cases in Europe every year, primarily cervical cancer (1, 2). In Germany, approximately 7,850 HPV-related cancers are diagnosed annually, affecting the cervix, oropharynx, anus, vulva, vagina and penis, with cervical cancer accounting for the largest proportion (3).

Human papillomavirus comprises over 200 genotypes, of which high-risk types, particularly HPV16 and HPV18, are responsible for the majority of HPV- related malignancies, including cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers. HPV16 and HPV18 together account for approximately 70% of cervical cancers worldwide, while HPV is responsible for approximately 90% of cervical and anal cancers, around 70% of vaginal and vulvar cancers, more than 60% of penile cancers, and 70–90% of oropharyngeal cancers. Additional oncogenic types (31, 33, 45, 52, and 58) further contribute to carcinogenesis (4, 5, 6, 7).

Clinical Manifestations

From a clinical perspective relevant to general practice, genital HPV infection most commonly presents as:

• Anogenital warts, involving the vulvar, vaginal, cervical, penile, scrotal, and perianal regions. These lesions are typically multiple, papular, flat, or filiform, with a hyperkeratotic appearance on keratinized skin or macerated aspect on mucosal surfaces. They are often asymptomatic but may cause pruritus or discomfort.
• Precancerous lesions, grouped under anogenital intraepithelial neoplasia
• Anogenital and Cervical Cancer. Persistent infection with high-risk HPV types can lead to intraepithelial neoplasia that may progress to invasive carcinoma.
• Oropharyngeal cancers resulting from persistent high-risk HPV infection are increasingly observed in younger patients and now represent a major etiological factor independent of traditional risks such as tobacco and alcohol use (8).

Available Vaccines and Coverage Challenges

There are 4 HPV vaccines available: Cervarix (HPV 18, 16), , Gardasil 9 (6, 11, 16, 18, 31, 33, 45, 52, 58).

Despite the availability of effective vaccines, HPV vaccination coverage remains suboptimal. In Germany, only 54% of 15-year-old girls and 27% of 15-year-old boys had completed HPV vaccination in 2021, placing Germany among the EU/EEA countries with comparatively low HPV vaccination coverage (9, 10).The first HPV vaccine was licensed in the European Union in 2006 while in Germany it has been recommended since 2007 (11).

Vaccination Recommendations and Implementation

Current guidelines advise vaccination for girls and boys aged 9–14 years, ideally before the onset of sexual activity. Catch-up vaccination is also recommended up to 17 years in Germany (12, 13, 14).

According to the Standing Committee on Vaccination (STIKO), HPV vaccination is recommended for all girls and boys aged 9–14 years. In 2018, the recommendation was extended to boys (gender-neutral policy). A two-dose schedule is recommended, with an interval of at least 5 months between doses (13, 14, 15).

Catch-up vaccination is recommended for adolescents aged 15–17 years using a three-dose schedule. Beyond 17 years of age, there is no universal STIKO recommendation, although vaccination may still be performed following individual medical consultation (12, 15).

In Germany, HPV vaccination is primarily delivered through office-based physicians, particularly pediatricians. However, the absence of organized school-based vaccination programs and systematic reminder systems has been identified as an important factor contributing to comparatively low HPV vaccination coverage (16, 17).

Countries with school-based vaccination programs achieve significantly higher coverage, suggesting a potential model for improvement (18, 19).

Real-World Effectiveness and Impact

HPV vaccines are highly effective, especially when administered at younger ages, before the first sexual contact. Studies have demonstrated up to a 90% reduction in HPV-related disease, significant decreases in cervical cancer and precancerous cervical lesions, and strong herd immunity effects in highly vaccinated populations (20, 21, 22, 23).

Australia is poised to become the first country to approach the elimination of cervical cancer because it has fully implemented comprehensive HPV vaccination, HPV-based cervical screening, and high-quality treatment of precancerous lesions (24, 25, 26). Multiple studies have documented substantial improvements in health outcomes: the prevalence of vaccine-targeted HPV infections in young women has fallen by approximately 90%, including reductions among unvaccinated women due to herd immunity; the prevalence of anogenital warts has declined markedly in females and heterosexual males; high-grade cervical precancer (CIN2/3) has decreased by approximately 41% among women aged 20–24 years; and rates of excisional treatment for cervical abnormalities have also declined in young women (27, 28, 29, 30).

Safety Profile and Conclusion

As safety is an important consideration, HPV vaccines have demonstrated an excellent safety profile. Most adverse events are mild and localized, such as pain, redness, or swelling at the injection site (31, 32). Serious adverse events are extremely rare, and large-scale epidemiological studies and systematic reviews have found no evidence of a causal association between HPV vaccination and autoimmune, neurological, or other chronic disorders (33, 34, 35).

HPV vaccines remain one of the most effective infectious disease prevention tools in modern medicine, with ongoing evidence reinforcing long-term real-world effectiveness.

Corresponding adresse 

Prof. Dr. Carmen Salavastru  
Carol Davila University of Medicine and Pharmacy  
Colentina Clinical Hospital  
Bucharest, Romania 
Website: https://umfcd.ro 

References:

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3. Robert Koch Institute. RKI-Ratgeber: Humane Papillomviren (HPV). Updated December 22, 2023.https://www.rki.de/DE/Aktuelles/Publikationen/RKI-Ratgeber/Ratgeber/Ratgeber_HPV.html). Accessed June 26, 2026. 
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14. National Immunization Technical Advisory Group Resource Center. Background paper for the recommendation of HPV vaccination for boys in Germany. 2018. (Summarizes STIKO recommendation: vaccination at 9–14 years before first sexual contact; catch-up through age 17; two doses ≥5 months apart, three doses if vaccination starts at ≥15 years.) 
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