Infection with one or more mucosotropic (species in the Alphapapillomavirus genus) HPV genotypes is a near certainty for persons engaging on continued sexual activity over a lifetime. HPV is among the most successful sexually transmissible agents, having coevolved with human populations over many millennia. Primary prevention of HPV infection via behavioral modification and barrier methods is not as effective as for other sexually-transmitted infections, which are more prevalent in core risk groups. HPV infection is not so restricted; condom use provides only partial protection. On the other hand, prophylactic HPV vaccination has been surprisingly efficacious against acquisition of infections with specific genotypes. That HPV vaccination is effective in preventing transmission of HPV in heterosexual or homosexual couples in which one of the members has been vaccinated is difficult to demonstrate via randomized controlled trials. This may be a moot point, however, considering that there is now population-level evidence that vaccination leads to herd protection, which is a consequence of the reduction in overall transmission episodes in the population. Secondary prevention via case detection and treatment is not yet a realistic alternative or complementary solution because of the lack of effective treatment of asymptomatic HPV infections. The author will illustrate the challenges and directions on research on HPV transmission and show examples from a cohort study of heterosexual couples and randomized controlled trials of vaccination and microbicides.
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