Saturday , May 15 2021

35-year-old woman with CIN3. Should I receive HPV vaccine before or after capture?



It is good that you have taken samples of cells regularly. Women who undergo examinations every three years when they are 25-69 years of age, following any abnormal findings as recommended, can reduce the risk of developing cervical cancer by up to 80%. In Norway, there are generally 1 in 100 women who develop cervical cancer before the age of 75, but half of them have not been tested for the last five years before cancer diagnosis. Of the 10,000 women with normal cell testing, only 2-3 women develop cervical cancer within 3.5 years.

HPV infections are common. 70-80% of all women and men are infected with HPV one or more times during their lifetime. Approximately 25% of HPV positive individuals have only HPV type 16. Generally, 9 out of 10 women get rid of HPV infection over two years, but in some people the infection persists for many years. It takes an average of approximately 10 years for HPV infection to detect coarse cell changes (CIN3).

Earlier, women with low-grade cell changes (ASC-US / LSIL) and positive HPV tests were asked to wait 6-12 months before new cell and HPV examinations. The updated guidelines are women with low rates of change in gynecologists with colposcopy and biopsy if HPV types 16 or 18 are available, but women with low grade "other" types of HPV can wait 12 months before the new test.

If the tissue sample (biopsy) shows CIN2 or CIN3, the woman is recommended to be treated with a structure that eliminates the area of ​​cellular changes. This is a small procedure that usually occurs in local anesthesia and often only removes 2-3 grams of tissue.

1. The gynecologist meant I had to get a vaccine after the conception. I see you suggest before? Can I make mistakes before making a recommendation before? Is Gardasil 9 I Need to Take as a Gynecologist?

Generally, the HPV vaccine should be taken as early as possible. The only reason for postponing the HPV vaccine is pregnancy. There is a widespread misconception that one has to wait until capture before taking the HPV vaccine. Studies have also been done with the HPV vaccine where waiting for HPV testing is negative after conception prior to administration of the vaccine. Current HPV infections or established cellular changes have nothing to say about the protective effect of the vaccine for subsequent infections and new cellular changes but it will not affect an ongoing HPV infection or cellular changes you already have.

Gardasil 9 is the latest HPV vaccine to cover nine different types of viruses (6, 11, 16, 18, 31, 33, 45, 52 and 58). It replaces the "old" Gardasil 4 vaccine that covers four different types of viruses (6, 11, 16 and 18). The Cervarix antagonist covers two types of HPV (16 and 18), but has a partial effect on three other types of HPV (31, 33 and 45). It also appears that the "old" Gardasil 4 also has a partial effect on HPV types 31, 33 and 45, but in studies comparing Gardasil 9 and Gardasil 4, Gardasil 9 clearly has the best effect on HPV types 31, 33, 45, 52 and 58. There are no studies to compare Cervarix directly with Gardasil 4 or Gardasil 9.

– In the Community list it has no effect on active HPV infection or on established clinical illness.

This is the way you can not expect the disappearance of an HPV infection because you are taking the vaccine or you can not be treated for cellular changes if you take the vaccine but the vaccine has the same effect on new infections and new cellular You take it The vaccine can reduce the risk of recovery in relation and the vaccine can reduce the risk of HPV transfer from one mucous membrane to another or from the mucosa elsewhere in the same mucosa. Several studies show a reduced risk of recurrence of cellular changes following confinement in women who have taken the vaccine and the risk decreases irrespective of whether the vaccine has been taken before or after capture. If the first dose is taken at least two weeks before conception, there will be many HPV antibodies to the wound area by the constitution.

2. Does my husband need to get exactly the same vaccine?

All three HPV vaccines have a good effect on HPV types 16 and 18, so no matter what one of the three vaccines you take or whether you get the same vaccine or not, but most who pay for the vaccine choose the one that covers most types of HPV, namely Gardasil 9.

– Should we avoid sex to prevent infection?

You have infected each other repeatedly, so that the constitution is less important. After capture, it may be a point to use a condom until both have received an HPV vaccine. The vaccine has reasonably good effect already two doses after the first dose. The reason for submitting proposals for three doses is to ensure long-term immunity (likely life expectancy).

"We have recently got a flu vaccine. Does it have anything to say if you recommend the Gardasil 9 vaccine in the near future?

No. The HPV vaccine and the influenza vaccine can be taken at the same time, but some doctors recommend that the vaccines be placed on each arm.

3. Will the vaccine help me prevent HPV16 from growing elsewhere in the body even if I'm already infected with HPV16?

Yes. The vaccine causes the body to make antibodies against the surface of the virus particles. This neutralizes the virus particles so they can not enter new cells. This will reduce the risk of contamination from the cervix to the anus, the oral cavity and the throat. It also reduces the risk of a relapse. However, the vaccine has no effect on the virus particles already present in the cells. Fortunately, in most cases, the immune system will kill the cells with viruses. In addition, the area of ​​the cervical cervix (cervix) will be eliminated by capture.

4. I had anxiety about cancer elsewhere in my body since I'm more vulnerable to HPV16. Could you tell me about the risk of developing cancer elsewhere if HPV16?

While there are several types that can cause cervical cancer (including HPV types 16, 18, 31, 33, 45, 52 and 58), it is primarily HPV type 16 that causes cancer elsewhere in the body (penis, vagina, vulva , anus, oral cavity and neck). In women, this risk is much lower than the risk of developing cervical cancer. While there are 1 in 100 women who have cervical cancer during their lifetime, only 1 in 1,000 women who develop cancer due to HPV in the oral cavity and the throat and 2 out of 1,000 women receive ankle cancer before the age of 75 years old. By comparison, 4 of the 1,000 men suffer from cancer due to HPV in the oral cavity and neck.

What is the likelihood of an active HPV infection elsewhere? Are there any symptoms I need to know?

HPV occurs more frequently in genitalia (cervix, vagina, vagina) and then anal. While 6.5% of all 34-69 year-old women have positive HPV tests in the cervical control, 1.0% of all HPV women in the oral cavity and neck. By comparison, it is 2-3% of all men who have HPV in the oral cavity and neck. I do not think it helps so much to try to feel symptomatic, but if you get a wound that will not develop, bleeding or a hard charcoal that persists for more than a month, consult a doctor.

5. Sometimes there may be some fresh blood on the paper that I dare after the stools. This was a problem during my pregnancy and especially when the stool was tough. Then there may be blood in the toilet. The problem is rare now and sometimes just a little fresh blood on the paper. This could be an anal cancer?

There are many who experience fresh blood on paper, especially in hard stools. The most common cause is haemorrhoids or small mucous membranes. If this happens only rarely, it is unlikely that you have anal cancer. If you bleed frequently, ask for an anal stress test (review). Men who have sex with men have a higher risk of rectal cancer than the risk of developing cervical cancer. The risk of rectal cancer increases with the number of anal comrades, but men who have never had anal sex can develop HPV-induced rectal cancer.


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