[Experimental vaccines for sexually transmitted infections]

Sexually transmitted infections (STIs) are major global public health problems. Present strategies for prevention have limitations. Vaccines are an attractive addition to the current prevention armamentarium because they provide durable protection and do not require repetitive adherence to be effective. Challenges for vaccination include induction and long-term maintenance of mucosal immune responses in the female genital tract.

A REALISTIC GOAL? For the time being, US Centers for Disease Control and Prevention have recommended only hepatitis and HPV immunization to be routinely offered. Final, III stage trials are underway on other prophylactic vaccines for human papillomavirus and genital herpes. Though vaccines against Chlamydia trachomatis and Neisseria gonorrhoeae are in early stages of development they do offer the hope of preventing pelvic inflammations. The high incidence of HIV-infection for which a vaccine would not be readily available, "cries out" for an effective vaccine.

According to a recent meta-analysis of worldwide prevalence data, vaccinating with HPV-16/18 VLP against HPV-16 and HPV-18 could prevent over 70% of invasive cervical cancer worldwide. The latest release of data from the phase III trial of a quadrivalent recombinant non-infectious vaccine HPV-6/11/16/18 L1 VLP, including HPV types 6, 11, 16, 18 have given complete protection against HPV-16/18-related cervical intraepithelial neoplasias 1, 2/3, and adenocarcinoma in situ and cancer through 2 years of post-vaccination follow up.

Despite the fact that the development of vaccines for STI prevention was rather slow in the past, the ideal vaccine would decrease transmission of the infection between partners and would prevent complications of disease. Moreover, in future decades, increasingly successful universal vaccination of newborns and children will substantially reduce the need for vaccination of persons with specific risk factors, including sexual risk.