Tuesday , July 5 2022

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


It's good that you have taken samples of cells regularly. Women who attend screening every three years when they are 25-69 years old, following any abnormal findings as recommended, may reduce the risk of cervical cancer to 80%. In Norway there are a total of 1 out of 100 women who develop cervical cancer before 75, but half of them have not made a test cell in the last five years before cancer diagnosis. Of 10,000 women with normal cell tests, only 2-3 women develop cervical cancer within 3.5 years.

HPV infections are common. 70-80% of all women and men were infected with HPV once or more during their lifetime. About 25% of those with positive HPV tests have only HPV type 16. In general, 9 out of 10 women have become infected with HPV for two years, but in some people, the infection has lasted for many years. It takes about 10 years of HPV infection to detect severe cellular changes (CIN3).

Earlier, low-grade (ASC-US / LSIL) and positive HPV patients were asked to wait 6-12 months before new cell and HPV tests. Updated guidelines recommend women with changes in low-grade gynecologists with colposcopy and biopsy if types 16 or 18 are available, but women with low-grade "other" HPV types can wait 12 months before new controls.

If a tissue sample (biopsy) shows CIN2 or CIN3, a woman is recommended to treat a constitution in which the area of ​​cellular changes is eliminated. This is a small procedure usually done in local anesthesia, and often only 2-3 grams of tissue is removed.

1. Gynecologist meant that I should take a vaccine after the conception. Do I see what you recommend earlier? Can I make a mistake before setting it up? Should Gardasil 9 be taken as a gynecologist?

In general, the HPV vaccine should be taken as early as possible. The only reason for the disposal of HPV vaccine is pregnancy. There is a widespread misunderstanding that needs to be awaited before the HPV vaccine is taken. Even HPV vaccine studies where waiting for the HPV test is negative after the conception before the vaccine is given. Existing HPV infections or established cell changes have nothing to say about the protective effect that the vaccine has for subsequent infections and new cell changes, but it will not affect current HPV infections or cell 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). It replaces the "old" Gardasil 4 vaccine that covers four different types of viruses (6, 11, 16 and 18). The Cervarik champion 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 seems that the "old" Gardasil 4 also has a partial effect on HPV types 31, 33 and 45, but in studies compared to Gardasil 9 and Gardsil 4, Gardasil 9 apparently has the best effect on HPV types 31, 33, 45, 52 and 58. There are no studies comparing Cervarik directly with Gardasil 4 or Gardasil 9.

– In the community catalog there is no effect on active HPV infection or established clinical illness.

So you can not expect the HPV infection to disappear because you are taking a vaccine or can not be treated because of cell changes if you are taking a vaccine, but the vaccine has the same effect on new infections and new cell claims regardless of when you take it. The vaccine can reduce the risk of resuscitation in a relationship, and the vaccine can reduce the risk of transmitting HPV from one mucous membrane to another, or from the mucous membrane to another site in the same mucous membrane. Several studies have shown a reduced risk of a recurrence of cell changes after closure in women who have taken the vaccine, and the risk is reduced regardless of whether the vaccine was taken before or after the conception. If the first dose is taken at least two weeks before conception, there will be a lot of HPV antibodies in the area of ​​the wound according to the constitution.

2. Does my husband take the same vaccine?

All three HPV vaccines have a good effect on HPV types 16 and 18, so it really does not matter which one of the three vaccines you are taking, or if you are taking the same vaccine or not, but most who pay the vaccine that covers most HPV types, i.e. Gardasil 9.

– To refrain from sex to prevent infection?

You've been infected many times, so it's less important for the constitution. After the conception, it may be a point to use a condom while both do not take the HPV vaccine. The vaccine has a reasonably good effect of two doses after the first dose. The reason for recommending three doses is to provide long-lasting immunity (a probable lifetime).

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

Not. HPV vaccines and influenza vaccines can be taken at the same time, but some doctors recommend that vaccines be placed on each hand.

3. Will the vaccine help you prevent HPV16 from developing elsewhere on the body even though I am already infected with HPV16?

Yes. The vaccine causes the body to make antibodies against the surface of the virus particles. This will neutralize virus particles so that they can not enter new cells. This will reduce the risk of infection from the cervix to anus, cavity, and throat. It also reduces the risk of re-establishing the connection. However, the vaccine has no effect on the virus particles but in the cells. Fortunately, in most cases, the immune system will kill viruses. Moreover, the area of ​​the cervix cells (cervix) will be eliminated by the conception.

4. I was worried about cancer somewhere else on my body, because I'm more vulnerable to HPV16. Could you tell me about the risk of cancer elsewhere if it is HPV16?

Although 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 on the body of the penis, vagina, vulva, anus, oral cavity and throat). In women, this risk is much lower than the risk of cervical cancer. Although there are 1 in 100 women who have cervical cancer during their lifetime, only 1 in 1,000 HPV-treated women in the oral cavity and throat, and 2 out of 1,000 women receive ankle cancer 75 years ago. By comparison, 4 out of 1,000 men get cancer because of HPV in the oral cavity and throat.

– What is the probability of having an active HPV infection elsewhere? Is there any symptoms I need to know about?

HPV most commonly occurs genital (cervix, vagina, vulva), and then anal. While 6.5% of all women aged 34-69 had positive HPV tests in the cervical test, 1.0% of all HPV women 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 to try to feel symptomatic, but if you get a wound that will not grow, bleed or hard coal lasts more than a month, consult a doctor.

5. Sometimes it can be fresh blood on paper that dares after a chair. It was a problem during pregnancy, especially when the chair was heavy. Then there could be blood in the toilet. The problem is now rare, and sometimes only a little fresh blood on paper. Can this be anal cancer?

Many are on a piece of fresh blood, especially in hard chairs. The most common cause is hemorrhoids or small mucous membranes. If this happens infrequently, it is unlikely that you have anal cancer. If you frequently bleed, ask for anal anxiety (anesthetics). Men who have sex with men have a higher risk of anal cancer than the risk of cervical cancer in women. The risk of anal cancer increases with the number of anal sexual partners, but men who have never had anal sex can develop anal carcinoma caused by HPV.

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