Tuesday , June 15 2021

35 year old woman with CIN3. Should I take an HPV vaccine before or after conception?



It's good that you have taken cell samples regularly. Women who attend screenings every three years, when they are 25-69 years old, following abnormal findings as recommended, may reduce the risk of cervical cancer by up to 80%. In Norway, there are mostly 1 out of 100 women who have cervical cancer before 75 years of age, but half have not taken a cell test during the last five years before cancer diagnosis. Of the 10,000 women with normal cell assays, 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 once or more times throughout their lives. About 25% of people with positive HPV tests have only HPV type 16. Generally, 9 out of 10 women are getting HPV infection over two years, but some people have been infected for many years. It takes approximately 10 years for HPV to detect severe cellular changes (CIN3) about 10 years.

Previously, women with low cellular changes (ASC-US / LSIL) and positive HPV tests were expected to wait 6-12 months before new cells and HPV tests. Updated guidelines recommend women with a low degree of gynecologist colposcopy and biopsy if HPV types 16 or 18 are available, but women with low levels of "other" HPV types can wait 12 months before new control.

If a tissue sample (biopsy) shows CIN2 or CIN3, a female is recommended for treatment with a constitution where the area of ​​cellular changes is eliminated. This is a small procedure commonly performed in local anesthesia, and often only 2-3 grams of tissue are removed.

1. A gynecologist meant I should take the vaccine after conception. I see you recommend it before? Can I make a mistake if I first submit it to the Constitution? Is Gardasil 9 should be taken as recommended by a gynecologist?

Generally, the HPV vaccine should be taken as soon as possible. The only reason for postponing an HPV vaccine is pregnancy. There is a widespread lack of understanding that it has to wait until conception before the HPV vaccine is taken. Even HPV vaccine studies are where HPV test expectation is negative after conception before the vaccine. Pending HPV infection or established cellular changes have nothing to say about the protective effect of the vaccine for later infections and new cellular changes, but this will not affect the permanent HPV infection or cellular changes that you already have.

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

– in the community's catalog that no influence on active HPV infection or established clinical disease.

This is the way you can not expect HPV to disappear because you are taking a vaccine or you can not cure for cellular changes if you are taking a vaccine but the vaccine has the same effect on new infections and new cellular claims regardless of when you take it The vaccine can reduce the risk from resuscitation, the vaccine may reduce the risk of HPV transfer from one mucosa to the other or from the mucosa to another place in the same mucous membrane. Several studies have shown a reduction in the risk of repetitive cellular changes after closure in women taking the vaccine, and the risk is reduced, regardless of whether the vaccine is before or after conception. If the first dose is taken at least two weeks before conception, it will be an HPV antibody in the area of ​​the wound for the constitution.

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

All three HPV vaccines have a good effect on HPV types 16 and 18, so it is not important that one of the three vaccines you are taking, or if you are taking the same vaccine, but most of those who pay the vaccine will select the one that covers most HPV types, ie Gardasil 9.

– Should we refrain from sex to prevent infection?

You have been infected many times, so the constitution is less important. After conception, this may be a point to use a condom while both do not take HPV vaccine. The vaccine has a reasonably good effect, but two doses after the first dose. The reason for recommending three doses is to provide long-term immunity (probably life expectancy).

"We have both recently taken a flu vaccine. Is this what you can say if you recommend Gardasil 9 vaccine in the near future?

Not. HPV vaccine and a flu vaccine can be taken at the same time, but some doctors recommend that vaccines be placed in each hand.

3. Will my vaccine help to prevent the development of HPV16 viruses elsewhere on the body, even though I have already been infected with HPV16?

That. The vaccine causes the body to form antibodies on the surface of the virus particle. It will neutralize the virus particles so they can not enter the new cells. This will reduce the risk of cervical infection to anus, mouth cavity and throat. It also reduces the risk of re-establishing relationships. However, the vaccine has no effect on virus particles already in the cells. Fortunately, in most cases, the immune system will kill virus cells. Furthermore, the cervical area of ​​the cervix (cervix) will be eliminated by the conception.

4. She had anxiety about cancer somewhere else on my body, because I'm more susceptible to HPV16. Can you tell me about cancer risk somewhere else if HPV16 is?

Although there are several types that can cause cervical cancer (including HPV types 16, 18, 31, 33, 45, 52 and 58), it is primarily the type of HPV 16 that causes cancer elsewhere on the body (penis, vagina, vulva, anus, cavities and throats). In women this risk is significantly lower than the risk of cervical cancer. Although in life there are 1 out of 100 women with cervical cancer, only 1 out of 1,000 women who work for HPV in the oral cavity and throat and 2 in 1,000 women get ankle cancer 75 years ago. For comparison, 4 out of 1,000 males have HPV cancers in the oral cavity and throat.

– What is the likelihood of having an active HPV infection elsewhere? Are there any symptoms I should be aware of?

HPV most commonly occurs genital (cervix, vagina, vulva) and then anal. While 6.5% of all women aged 34 to 69 have positive HPV tests on the cervical test, 1.0% of all women with HPV in the oral cavity and throat. For comparison, it is 2-3% of all men who have HPV in the oral cavity and throat. I do not think it helps so much that it is trying to feel symptomatic, but if you get a wound that does not grow, bleeding or hard coal lasting more than a month, contact your doctor.

5. Sometimes I get some fresh blood on a piece of paper that I can afford after my chair. This was a problem during my pregnancy, especially when the chair was heavy. Then there could be blood in the toilet. The problem is rare now, and sometimes just a little fresh blood on the paper. Can it be anal cancer?

There are many people who have experienced fresh blood on paper, especially in hard chairs. The most common cause is hemorrhoids or small mucous membranes. If this happens only rarely, you are unlikely to have anal cancer. If you are often bleeding, seek anal anxiety (anoscopy). Men who have sex with men have higher risk of anal canal cancer than women with cervical cancer. Anal cancer risk increases with the number of anal partners, but men who have never had anal sex can develop anal cancer caused by HPV.


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