HPV vaccination after dysplasia

  25. September 2021
    

Cell changes in the sense of dysplasia occur due to infection with human papillomaviruses (HPV). Of these, well over 200 different types are known, making them the most common, sexually transmitted disease.

In addition to changes in the cervix, they are also responsible for various cancer precursors, but also cancers in the vagina, vulva, anus and penis, as well as in the throat and throat area.

An effective vaccine has been available since 2006. Initially against 4 different HPV types, it is now possible to vaccinate against 9 types, which are responsible for both cancer precursors and genital warts (condylomas).

In Switzerland, almost 50% of 16-year-old girls are sufficiently vaccinated. The costs for this are covered by the health insurance company up to the 27th birthday. Ideally, the vaccination should be done before sexual intercourse begins; the current recommendation is aimed at 11-14 year old girls and boys.

After the onset of sexual activity, infection with HP viruses occurs very quickly. However, this infection is very often transient, over 90% are eliminated within 1-2 years by their own immune system. With persistent virus, it often takes 10-20 years for a carcinoma to develop.

The use of condoms only partially protects against HPV infection.

In addition to primary prophylaxis for the prevention of cancer precursors and condylomas, studies have also shown an indication of the avoidance of re-infection with the virus in patients with dysplasias. Thus, the patients who were already suffering from a precursor after the operation (conization) to remove this change were divided into two groups. One group received an additional vaccination against HP viruses after the operation, the other did not. In the vaccinated, a significant reduction in re-infection could be demonstrated and, in the best case, further interventions could be avoided. Consequently, all women should be offered a vaccination after a conization in order to avoid the risk of re-infection with especially high-risk types. Due to the new data situation, the vaccination is now also covered by the health insurance companies. In our practice, we recommend this to all patients who have had a conization, i.e. also to all women up to the age of 26 who have not yet been vaccinated in puberty.