What measure would most likely have prevented a 53-year-old man's condition of nonpainful neck swelling and oral ulcers, associated with human papillomavirus (HPV) and cervical lymphadenopathy?

From the Guidelines

HPV vaccination would most likely have prevented the 53-year-old man's condition of nonpainful neck swelling, oral ulcers, and cervical lymphadenopathy associated with human papillomavirus. The recommended HPV vaccine protects against several HPV types, including those most commonly associated with oropharyngeal cancers and related conditions. For adults who weren't previously vaccinated, the vaccine can be administered as a three-dose series (0,2, and 6 months) 1. While HPV vaccination is most effective when given before exposure to the virus (ideally during adolescence), it may still provide protection against HPV types not previously acquired. HPV is transmitted through intimate contact, including oral sex, and can cause oropharyngeal infections leading to symptoms like oral ulcers and cervical lymphadenopathy 1. The virus can remain dormant for years before causing clinical manifestations, which explains why HPV-related conditions can appear later in life. In addition to vaccination, regular dental check-ups and avoiding high-risk behaviors like smoking would complement prevention efforts. Key points to consider include:

• HPV vaccination is an effective primary intervention to prevent HPV infection and its associated disease burden 1
• The quadrivalent HPV vaccine can be used in males aged 9–26 years to prevent genital warts 1
• Consistent condom use by male partners of sexually active women can reduce the risk for cervical and vulvovaginal HPV infection 1
• HPV vaccines are available and recommended for girls and young women aged 9–26 years, even those who have been diagnosed with HPV infection 1 However, the most recent and highest quality study 1 suggests that HPV vaccination is the most effective measure to prevent HPV-related conditions. Therefore, HPV vaccination is the most likely measure to have prevented the patient's condition.

From the Research

Prevention Measures

The patient's condition is associated with human papillomavirus (HPV) and cervical lymphadenopathy. To determine the most likely preventive measure, we need to consider the available evidence.

• HPV vaccination has been shown to be safe, immunogenic, and highly effective against type-specific HPV infection 2.
• The implementation of HPV vaccination within a national screening program is likely to be cost-effective relative to current clinical practice 2.
• Physicians should routinely assess the sexual practices of all male patients, especially those with multiple sexual partners, and educate them on the HPV infection risks, diagnosis, and treatment options 3.
• HPV vaccine should be administered routinely to all girls and boys between the ages of 9 and 13 years of age, and all youth who have not received the vaccine in a routine program should receive the vaccine in a 'catch-up' program 4.

Risk Factors

The patient's history of smoking and drinking, as well as his multiple sexual partners, increase his risk of HPV infection and associated conditions.

• The incidence of HPV infection drops in women older than 30 years but remains high for men with multiple sexual partners in all age ranges 3.
• Alcohol and tobacco use increase the risk of developing oral cancer, which is associated with HPV infection 5.

Recommended Prevention Measure

Based on the available evidence, the most likely preventive measure for this patient's condition would be HPV vaccination, which has been shown to be highly effective against type-specific HPV infection 2, 4. Additionally, education on safer sex practices and the risks associated with HPV infection would also be beneficial 3.