Saturday , February 27 2021

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



It is good that you took samples of cells regularly. Women participating in screening every three years when they are aged 25-69 years, following any abnormal recommended findings, can reduce the risk of cervical cancer by up to 80%. In Norway, in general, there are 1 in 100 women who develop cervical cancer before the age of 75, but half of them did not have a cell test for the last five years before the diagnosis of cancer. Of the 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 are infected with HPV once or several times over life. Approximately 25% of those with HPV positive tests have only HPV type 16. Generally, 9 out of 10 women get rid of HPV infection in 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 gross cellular changes (CIN3).

Previously, 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 tests. The recommended guidelines recommend women with low-grade gynecology with colposcopy and biopsy if HPV types 16 or 18 are available, but low-change women "other" types of HPV can wait 12 months before new control.

If the tissue sample (biopsy) shows CIN2 or CIN3, the woman is recommended for treatment with the constitution in which the cell changes are removed. It is a small procedure, usually performed in local anesthesia and is often only 2-3 grams of tissue that is removed.

1. The gynecologist meant I should take a vaccine after conception. I see we recommend before? Can I make a mistake by taking it before setting up? Is Gardasil 9 a must as a gynecologist recommended?

Generally, the HPV vaccine should be taken as soon as possible. The only reason to postpone the HPV vaccine is pregnancy. There is a widespread misunderstanding that you have to wait until conception before the HPV vaccine is taken. There have even been studies with the HPV vaccine if the expectation of the HPV test is negative after conception prior to administration of the vaccine. Ongoing HPV infections or cellular changes have nothing to say about the protective effect of the vaccine for further 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 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). Competition Cervarix covers two types of HPV (16 and 18) but has a partial effect on three 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 types HPV 31, 33, 45, 52 and 58. There are no studies to compare Cervarix directly with Gardasil 4 or Gardasil 9.

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

This is how you can not expect an HPV infection to disappear because you take 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 demands no matter when you take it. reduces the risk of resuscitation in a relationship, and the vaccine can reduce the risk of transferring HPV from one mucous membrane to another or from a mucous membrane to another site in the same mucosa. Several studies show a low risk of recurrence of cellular changes after confusion in women taking the vaccine and the risk is reduced regardless of whether the vaccine was taken before or after conception. If the first dose is given at least two weeks before conception, there will be a lot of antibodies against HPV in the wound area by constitution.

2. If my husband will take exactly the same vaccine?

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

– We have to abstain from sex to prevent infection?

You have infected yourself repeatedly so the constitution is less important. After conception, it may be a point of using the condom until both have taken an HPV vaccine. The vaccine has a reasonably good effect after two doses after the first dose. The reason for the three-dose recommendation is to ensure long-term immunity (probable life expectancy).

We have recently received the influenza vaccine. Does this have something to say if we recommend the Gardasil 9 vaccine in the near future?

Not. The HPV vaccine and the influenza vaccine can be taken at the same time, but some doctors recommend that the vaccines be placed in each arm.

3. Will the vaccine help prevent the development of HPV16 elsewhere in the body, even if it is already infected with HPV16?

Yes. The vaccine causes the body to make antibodies against the surface of the virus particles. This will neutralize the virus particles so they can not enter new cells. This will reduce the risk of infection from the cervix to the anus, mouth and throat. It also reduces the risk of resumption in a relationship. 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 cervical cervical area (cervix) will be eliminated by conception.

4. Have anxiety for cancer elsewhere in my body because I'm more vulnerable to HPV16. Can you tell me about cancer risk elsewhere if HPV16?

Although there are many 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, mouth 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 1000 women who develop cancer due to HPV in the oral cavity and throat and 2 out of 1,000 women have ankle cancer before the age of 75 years. By comparison, 4 in 1,000 men get cancer due to HPV in the oral cavity and in the neck.

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

HPV occurs most commonly genital (cervix, vagina, vulva) and then anal. While 6.5% of all women aged 34 to 69 have HPV positive cervical screening tests, 1.0% of all women with HPV in the oral cavity and in the neck. By comparison, it is 2-3% of all men who have HPV in the oral cavity and in the neck. I do not think it helps so much to try to feel symptoms, but if you have a wound that will not increase, bleeding or a hard coal that persists for more than a month, consult a doctor.

5. Sometimes there may be fresh blood on the paper with which I dare after the chairs. This was a problem during my pregnancy and especially when the chair was tough. Then there might be blood in the toilet. The problem is rare now and sometimes just a little fresh blood on the paper. Could it be an anal cancer?

There are many who are experiencing fresh blood on paper, especially in tough stools. The most common cause is small hemorrhoids or mucous membranes. If this happens only rarely, you are unlikely to have anal cancer. If you have frequent bleeding, ask for an anal examination (anoscopy). Men who have sex with men have a higher risk of anal cancer than the risk of women with cervical cancer. The risk of anal cancer increases with increasing numbers of anal sex partners, but men who have never had anal sex can develop anal cancer caused by HPV.


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