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



It is good that you took samples of cells regularly. Women participating in screening every three years, aged 25-69 years, following any abnormal findings as recommended, can reduce the risk of cervical cancer by up to 80%. In Norway, 1 out of 100 women who developed cervical cancer before reaching the age of 75 are generally 1, but half do not have a cell test for the last five years before the diagnosis of cancer. Of the 10,000 women with normal cellular tests, only 2-3 women develop cervical cancer within 3.5 years.

HPV infections are common. 70-80% of all females and males are infected with HPV once or more during life. About 25% of HPV-positive people have only HPV type 16. Generally, 9 out of 10 women get rid of HPV infection for two years, but some people persist for many years. It lasts on average about 10 years after HPV infection to detect gross cellular changes (CIN3).

Previously, low-grade women (ASC-US / LSIL) and positive HPV tests were asked to wait 6-12 months before new cell and HPV tests. The updated guidelines recommend women with a low degree of change in gynecologists with colposcopy and biopsy when 16 or 18 HPV types are available, but low-change women may have "other" types of HPV wait 12 months before new control.

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

1. The gynecologist meant I should take the vaccine after vaccination. I see you recommend earlier? Can I make a mistake by doing it before the constitution? Is Gardasil 9 to be used as a gynecologist?

Generally, the HPV vaccine should be given as soon as possible. The only reason why the HPV vaccine is postponed is pregnancy. There is a widespread misunderstanding that it is necessary to wait until the concept of vaccination against HPV. Studies with HPV vaccine have even been performed, where waiting for the HPV test is negative after the conception prior to vaccine administration. Current HPV infections or established cellular changes do not have to do with the protective effect of the vaccine for later infections and new cellular changes but will not affect the ongoing 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). It replaces the "old" Gardasil 4 vaccine, which covers four different types of viruses (6, 11, 16 and 18). Concurrent Cervarix includes two types of HPV (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 also has a partial effect on HPV types 31, 33 and 45, but Gardasil 9 and Gardasil 4 have clearly the best effect on Gardasil 9 in HPV 31, 33, 45, 52 and 58. There are no studies comparing Cervarix directly with Gardasil 4 or Gardasil 9.

– in the community catalog that it has no effect on active HPV infection or on established clinical disease.

This is a way you can not expect HPV infections to disappear because you are taking a vaccine or have no treatment for cellular changes if you are taking a vaccine but the vaccine has the same effect on new infections and a new cellular claim no matter when taking it The vaccine can reduce the risk of resuscitation in the relationship and the vaccine can reduce the risk of transmission of HPV from one mucosa to another or from the mucosa to another site in the same mucosa. Several studies show a reduced risk of recurrent postpartum cell changes in women taking the vaccine and the risk is reduced regardless of whether the vaccine was administered before or after conception. If the first dose is given at least two weeks before the start, large amounts of antibodies will be detected in HPV antibodies in the wound site.

2. Should a husband have the same vaccine?

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

– Should we have sex to prevent infection?

You know that you have repeatedly infected each other and that is why it is less important. Conception may be due to condom use until both have taken HPV. The vaccine has a reasonably good effect already after two doses after the first dose. The reason for recommending three doses is to ensure long-term immunity (probable life expectancy).

"We've recently received a flu vaccine. Is there something to say if you recommend Gardasil 9 in the near future?

No. HPV vaccine and flu vaccine may be taken at the same time, but some doctors recommend that the vaccine be placed in each arm.

3. Will the vaccine help prevent the development of HPV16 elsewhere on the body even if I'm already infected with HPV16?

Yes. The vaccine causes the body to produce antibodies against the surface of the viral particles. This neutralizes viral particles so they can not enter new cells. This will reduce the risk of infection from the cervix to the rectum, the oral cavity and the throat. It also reduces the risk of recovery in a relationship. However, the vaccine has no effect on the virus particles already in the cells. Fortunately, in most cases, the immune system kills cells with viruses. In addition, the area of ​​the cervix of the cervix will be excluded by the concept.

4. I was afraid of cancer elsewhere on my body because I'm more vulnerable to HPV16. Could you tell me about cancer risk 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 on the body (penis, vagina, vulva, rectum, oral cavity and throat). For women, this risk is much lower than the risk of cervical cancer. While in 1 in 100 women who have cervical cancer during their lifetime, there is one out of 100 women who develop cancer due to HPV in the oral cavity and neck and 2 out of 1,000 women get ankle cancer 75 years ago. For comparison, 4 out of 1,000 men receive cancer due to HPV in the oral cavity and neck.

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

HPV is most commonly found in the genitals (uterus, vagina, vulva) and then anal. While 6.5% of all women aged 34-69 had positive HPV assays in the cervical test, 1.0% of all HPV women in the oral cavity and neck. For 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 grow, bleed or charcoal that lasts for over a month, talk to your doctor.

5. Sometimes there may be some fresh blood on the paper I'm stomping on the stool. It was a problem during pregnancy, especially when stools were heavy. There could also be blood in the toilet. The problem is now rare and sometimes just a little fresh blood on paper. Could it be an anal cancer?

There are many people who experience fresh blood on paper, especially in hard chairs. The most common cause is haemorrhoids or small mucous membranes. If this is rare, it is unlikely that you have cancer. If you are bleeding frequently, ask for anal anxiety. Men who have sex with men have a higher risk of rectal cancer than the risk of cervical cancer in women. The risk of breast cancer increases with the number of anal sex partners, but men who have never had anal sex can develop anal cancer caused by HPV.


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