Dysplasia

Question 1

When after a cone can someone try to conceive

Answer 1

6 months to 1 year to decrease risk of PTD

Question 2

How common is HPV infection

Answer 2

85% of sexually active individuals

Question 3

How effective is the vaccine at preventing HPV infection?

Answer 3

FUTURE II Study Group NEJM 2007
randomized double bling RCT 12000 women 15-26, all got 3 doses of gardasil 4 or placebo

Followed patients for 3 years: 98% of susceptible population was negative, in ITT (but may have tested positive for HPV early on in study) 44% were negative

Question 4

What are side effects from gardasil

Answer 4

Severe adverse events are rare: <0.1%
Most common are injection site pain
Deaths were due to car accidents

Question 5

Whats the difference between the HPV vaccines

Answer 5

Gardasil 9: 6, 11, 16, 18, 31, 33, 45, 52, 58 - 98% efficacy
Gardasil: 6 11 16 18 98% efficacy
Cervarix: 16 18 92%

Question 6

How much does HPV vaccine cost?

Answer 6

200 per shot (600 total)

Question 7

what is the HPV regimen

Answer 7

<15: 0 and 6 months (need 5 months between)
15-26 and immunocompromized (***)

Question 8

Describe HPV Vaccine catch up regimen

Question 9

What is the effect of HPV vaccine in patients with dysplasia

Answer 9

Lichter et al meta analysis

RCT or cohorts hpv vaccination in patients getting treatment (CKC LEEP or cryo)
recurrence CIN 2 or greater
Recurrence of CIN 1 or greater

Inclusion - at least 1 dose of vaccine, needed treatment and control groups, excluded immunocompromise and malignancy, also excluded pregnant patients

Had 2900 patients in this study
45% got vaccination, 54% did not

REsult:
CIN 2 or higher recurrence: RR 0.36 1.9% recurrence vaccinated, 5.5% unvaccinated (64% reduction)
CIN 1 or higher : 6% in vaccinated, 10% in unvaccinated group (33% reduction)

Limitations: 2 studies account for 60% of data, not all were RCTs, each vaccinated at different time points

Other meta-analyses
CIN 3 or higher : no statistically significant vaccinated 0.6% and unvaccinated 2.2% (only 1100 women in this analysis)

Question 10

Why does vaccine work in women with HPV before

Answer 10

cross protection across strains not yet exposed to

Change in the immune microenvironment following surgery which may create a new background - new mucosal immune status

Question 11

What negative margin do you need to pursue fertility sparing

Answer 11

3mm