TEALE FENNING

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

58 y old Caucasian woman presents to physician's office to establish care
G2 P2, no STD History
Mildly abnormal pap smear during her last preganncy 30 years ago-- never followed up
Combination hormone therapy for 4 years
husband died 6 years previously

Reflex HPV test after ASCUS is positive for low-oncogenic-risk HPV tupe. She has haerd about HPV vaccine and now wants to know why she was not given that vaccine?
She wants to be given a vaccine now.
Advice her and discuss further management

Hopeful · Joined: 03 May 2007 Posts: 49

I will tell her that HPV vaccination program is still under development and there is currently no general consensus regarding how to implement this vaccination.

Furthermore HPV vaccine is only developed in last 25 years and is generally targeted to women aged less than 20 years of age. So in her case research was not available regarding vaccination.

Still data regarding vaccination after exposure to HPV is not widely available to make it clear whether vaccine is protective or not to middle aged women.

I will make diagram to describe hpv and its different types and that vaccine is type specific

Also duration of protection in those who are given vaccine is on average 5 years and data is scarce regarding further screening

Further Mx will be to repeat smear in 6 and 12 months and if neg routine recall

On the whole I would like to cover following points regarding HPV vacc

Advantages
1. HPV vaccine is effective in countries where screening programmes are not established
2. Also in countries like the UK, where secondary prevention by screening and treating premalignant lesions is not only expensive but sometimes imprecise, this results in unnecessary anxiety and intervention for some women, while at the same time failing to detect lesions in others.
3. There is evidence of some cross-protection against infection with related HPV types such as 31 and 45.
4. Excellent safety record of vaccine

Disadvantages
1. Protection against CIN offered by vaccination is type-specific
2. Public acceptability
3. Duration of protection (immune responses persist through 5 years)
4. Unlikely to benefit women who have already been exposed to the relevant virus type
5. Not 100% effective
6. Need for continued cervical screening in a vaccination era.
7. Costeffectiveness of program is yet to be established