Total Duration: 90 minutes Speaker 1: Mayura Nathan (UK) Introduction (5 min) Speaker 2: Kimon Chatzistamatiou (Greece) Cervix (20 min) Speaker 3: Pedro Vieira Baptista (Portugal) Vulva and vagina (20 min) Speaker 4: Andreia Albuquerque (Portugal) Anus (20 min) Speaker 1: Mayura Nathan (UK) Penis (20 min) Speaker 2: Andreia Albuquerque (Portugal) Conclusions (5 min) Transplant recipients, patients with inflammatory bowel disease and patients with systemic lupus erythematosus have an increased risk of anogenital HPV infection. This infection is associated with condylomas, precancerous lesions and cancer. In this symposium we will discuss the prevalence of HPV infection and associated complications in the cervix, vulva, vagina anus and penis in pharmacologically immunosuppressed patients, and consider the recommendations for screening, diagnosis and treatment. These patients are an important group for research and they often present with clinical challenges during care provision.

Objectives; How to eliminate cervico-vaginal cancer in Japan. Session time; 60 mins. Cervical cancer incidence has been rising since the late 1990s to 11 per 100,000 women, and this rise is particularly prominent in women of reproductive age in Japan. While the recent resumption of the active recommendations of HPV vaccine was a critical step forward, there are still unresolved issues and fundamental challenges in monitoring and achieving the global targets. Dr. Rei Haruyama aims to synthesize these issues and provide considerations for enhancement of cervical cancer control in Japan. Dr. Tomomi Nakahara investigated mechanisms for HPV genome replication and maintenance in HPV life cycle. She identified that HPV genome can be maintained in an E1, a viral DNA helicase, independent manner in basal cells of the stratified epithelium by using a tissue culture model to recapitulate HPV life cycle. She will discuss how these findings could be exploited to develop a new therapy to eliminate the viral persistence and prevent cervical cancer. Dr. Kaori Okayama developed a system to identify 39 HPV types including all high-risk (HR), all possibly high-risk (pHR), and some low-risk (LR) HPV types using molecular mapping or a single cell sorting procedure. HPV genotyping using cervical or vaginal cell samples reveals that HR-HPV types are predominantly in the uterine cervix, LR-types in the vagina, and pHR types equally in both sites. Tissue tropisms in different HPV-risk types may help us to understand HPV carcinogenesis in the cervico-vagina, providing useful information in clinico-pathological diagnosis.

Transgender and gender diverse (TGD) individuals have a gender identity that differs from their sex assigned at birth. Many TGD individuals will use gender-affirming hormone therapy and/or surgery. Trans men and nonbinary patients assigned female at birth are just as likely as cisgender women (those whose gender identity matches their sex assigned at birth) to be exposed to HPV, but are less likely to have had cervical cancer screening. Evidence suggests that trans women and nonbinary patients assigned male at birth may have higher exposure to both HPV and HIV than cisgender men. TGD patients face many barriers to HPV prevention including harassment in medical settings and fears of experiencing gender dysphoria (distress associated with the disconnect between identity anatomy) during physical exams. Additionally, vaccination rates may be lower among trans women. The symposium aims to summarize the current state of HPV research among transgender individuals worldwide. Content proposed includes an overview of the unique needs of this population regarding attitudes towards HPV screening and vaccination; high-risk HPV prevalence among trans women; urinary HPV testing and prevalence among trans men; and anal cancer screening among transgender persons living with HIV. Learning Objectives: Participants should understand the needs of the transgender community pertaining to HPV testing, anal cancer, and cervical cancer screening, and HPV vaccination. •Needs of transgender individuals regarding HPV testing and cancer screening •HPV testing and vaccination among transgender women •Alternative HPV testing modalities •Anal cancer screening among transgender persons living with HIV

Cervical intraepithelial neoplasia grade 2 (CIN2) is an equivocal diagnosis that is associated with a high inter-observer variation. It is well known that excisional treatment for CIN is associated with increased reproductive harm, and recent studies have demonstrated high regression rates of CIN2, up to 60% in women

This will be a 90 minute session, each speaker will have 20 mins and there will be a 10 - 15 minute discussion at the end. The learning objectives focus on understanding how to bring screening and treating into health care services without loss to follow up and with wide coverage. Linking screening to immediate treatment has many advantages, but also some disadvantages, including over treatment. AVE (Automated Visual Evaluation) may have value either as a primary screening test or as a triage test - if specificity and positive predictive value are high, the problem of overtreatment will become much less of an issue. If functioning properly AVE may provide an instant diagnosis to guide on site, same day treatment. How the algorithms are developed is critical to reliability and accuracy, and this session will explore some of these issues. Recommendations will be based on real-world data. Implementation challenges will be addressed and solutions offered.

We aim to familiarize our colleagues with the contribution that HPV disease has upon the field of Otolaryngology: specifically with regards to recurrent respiratory papillomas in adults and children. We will be discussing the beneficial effects of HPV vaccination, strategies to increase uptake of the vaccine in high and low resource countries and ways to increase awareness of HPV's relationship to this disorder among providers and patients. We will address the latest developments in terms of adjuvant and surgical treatments and the ongoing clinical trials looking at DNA vaccines at treatment and VLP vaccines for prevention.