Hpv Vaccine

[Sheryl]

The thread on gyn problems reminded me that I need to get my niece the new HPV vaccine and I thought it might be helpful to remind other ladies as well...for yourselves and (where applicable) your daughters.

The vaccine protects from the Human Papilloma Virus which is known to be a significant cause of cervical cancer, hence it can indirectly prevent many cases of cancer of the cervix. Strongly recommended for all young women/girls and best given before the onset of sexual activity. For those of us for whom that was a LONG time ago, it is still a good idea if you are likely to have a new sexual partner in the future or if you are not 100% sure of a current partner's future fidelity, since in both cases you may get exposed if you haven't been already.

I assume it is available at the international hosps in BKK -- anyone know for sure and the cost? (Even if pricey, it is still well worth it, especially for younger women)

[cathyy]

This vaccine is considered to be so important that the CDC is recommending it be given to all 11 to 12 year old girls, and older females who have not already been vaccinated. Some states are planning to add it to the list of immunizations required for school admission -obviously not to Kindergarten, but to middle school or junior high. I wish it was this easy to prevent other kinds of cancer!

[November Rain]

I'm assuming this vaccine is preventative, not curative?

[english_farang_lady]

I tried to get the HPV vac in the Bangkok Pattaya Hospital (in Pattaya) for my 16 year old son while he was there for something else, fairly recently. They said they did not offer it.

As a side note; my PAP smear came back saying that I had HPV. Probably from my philandering (and now ex) husband of almost 20 years. So far seen 3 obgyn docs (dont ask!) and all said it was absolutely nothing to worry about, but nevertheless, they all suggested hysterectomy. When I said I was not in favour they were mostly aghast. One (a female) said if I was her aunt or mother, she would suggest strongly that I did have it.

Maybe this is because I have endometriosis, but not even sure of that now. All I really know for sure is that I had a PAP smear done (finally, after putting myself at the bottom of the list of things to be done), which came back LSIL. This apparently is a low risk result, although still was suggested that the female plumbing be removed.

Sorry, off topic with that, but read online that all youngsters should have the HPV shot, males included. Anyhow, not available at what seems to be held as the most efficient hospital in Pattaya by many people. That was as at about three weeks ago.

I would be very interested to know if males ought to get it too.

[Sheryl]

It is girls/women who are at risk of getting cabcer from HPV, but as it is males who transmit it to them, obviously males should also be immunized. If enough are, it will help reduce or even eliminate this disease. And what man would want to someday learn he had infected his wife with a virus that might make her steril or give her cancer?

For your endometrial or cervical dysplasia (common in women with HPV), you do NOT have to get a hysterectomy but if you choose not, DO get regular thin prep (new version of the pap smear) and an annual endometrial biopsy (simple office procedure) is also advisable. That is what most docs would advise you to do in the West.

I think one reason that Thai docs may push for hysterectomy rather than regular follow-up is that women in Thailand rarely go for Gyn exams, so they may not think of close follow up as a realisitic option. A large percentage of Thai women have never had a pap semar or exam except as part of pregnancy care...even very educated ones tend not to.

You know yourself best, if you can be sure to get a check-up every 6-12 months faithfully then fine. If you can't then surgery is the lesser evil...the one thing you should NOT do is just let it go and skip regular follow up, because then you are putting your life at risk.

Cervical and uterine cancers are relatively slow growing and very curable when caught early, so with low grade dysplasia and regular check ups you are pretty safe.

[RickFarang]

There is a lot of misinformation on the web about HPV. Its a good idea to get this immunization regardless. HPV can be spread by many means, no just sexually. This includes accidental infection via hands and fingers. Get that immunization.

[Sheryl]

I got the scoop on availability in LOS (from te BUPA newsletter, of all things). It isn't here yet but Thai FDA approval to import it is "in the works" and it is expected very soon, i.e. first part of this year.

It's a series of 3 injections initially then a booster about every 5 years. Not cheap (US $120 a pop) but of course a lot cheaper than cancer treatment......

Cost is main reason why US Public Health authorities have limited recommendation to young girls/women (ages 10-24); this is the age group most likely to benefit sufficiently to offset the cost (once they recommend a vaccine, the government is under an obligation to make it accessible for those who can't afford it). Doesn't mean it isn't a good idea for older women or males too.

[jts-khorat]

Just out of interest; this vaccine, does it also work curative, eg after infection?

[nikster]

This vaccine is considered to be so important that the CDC is recommending it be given to all 11 to 12 year old girls, and older females who have not already been vaccinated. Some states are planning to add it to the list of immunizations required for school admission -obviously not to Kindergarten, but to middle school or junior high. I wish it was this easy to prevent other kinds of cancer!

I find this reaction somewhat over the top.

http://en.wikipedia.org/wiki/Human_papillomavirus

There are hundreds of different types of HPV, the vast majority of which is completely harmless, and another good chunk is taken out by the immune system all by itself.

If you happen to have one of the high-risk types, time to act. But otherwise....

Before I let anyone stick a needle in me - or my kids - I want to know exactly what the infection rate is for the injection (there's always one) vs. the risk of contracting it by other means vs. the effectiveness against other types out in the wild. Meaning if there's hundreds of types, will the vaccine protect against them all, and what are the risks involved.

This is the reason many of my friends don't get injections for their kids anymore - especially those working in medicine (Senior Researcher at UCSF medical school).

And asking a hospital if you should have surgery "just in case" is like asking them "do you want my money?".

cheers!

[Sheryl]

Just out of interest; this vaccine, does it also work curative, eg after infection?

No. It is only effective as prevention, which is why it is recommended to be given, if possible, before the start of sexual activity.

Given that it is a fairly costly vaccine, women who have been sexually active for some time would probably do well to first verify they have not already been infected, because if so the vaccine will serve no purpose.

[lingling]

Maybe this is because I have endometriosis, but not even sure of that now. All I really know for sure is that I had a PAP smear done (finally, after putting myself at the bottom of the list of things to be done), which came back LSIL. This apparently is a low risk result, although still was suggested that the female plumbing be removed.

Did they do a DNA typing for HPV after the LSIL result?

[english_farang_lady]

Hullo Lingling - to the best of my knowledge, there was no DNA typing, does that mean determining which type of HPA I have? If so, no -- nothing mentioned about the type of

hpv. Had the PAP smear type test done twice, once in Bangkok/Pattaya Hospital, and secondly in Bumrungrad Bangkok. Neither mentioned different types, or specifically what type I have.

Is it that with a LSIL result but with a certain type of HPV then there is a higher risk of cancer? They did both (both obgyns were Thai) suggest hysterectomy.

Thanks for everyones input, extremely interesting.

EFL

[Sheryl]

EFL,

Sorry for late reply, I have been off in remote rural Cambodia and just recently back online.

I'm going to PM you but as the issue is relevant to all women will post here as well.

LSIL means "Low-Grade Squamous Intraepithelial Lesion" which in turn means that there were abnormal (abnormal, not necessarily cancerous) cells in the surface layer of your cervix. It is considered a mild abnormality, but one that needs to be watched carefully because it can advance to cancer.

Although LSIL may be caused by HPV, it is not always. I am unclear as to whether or not they actually tested for HPV itself??

In any case -- with or without HPV -- the usual procedure is to conduct 2 additional tests"

(1) a colposcopy, which is just a careful examination of the cervix with a special magnifier; could have been done already as to you it would just seem like another internal exam; and

(2) a cervical, and possibly endometrial, biopsy.

Do you know whether or not a biopsy was done (not the same as pap smear), and if so, what the results were?

It is only by biopsy that they can definitely exclude a cancerous or pre-cancerous condition.

I am puzzled by the recommendation to have a hysterectomy. In the west, a variety of more conservative treatments are preferred. A lot depends on what is seen on coloscopy in terms of how far into the cervix the lesion extends. Usual treatments are one of the following:

laser, cryosurgery (freezing the lesion off) and cauterizing. All of these can be done as an outpatient and do not involve the removal of any organs, just the removal of the superficial lesion on the cervix.

If the lesion seems to extend all the way up the cervix, then the treatment options are what they call conization (removal of a part of the cervix, leaving the rest of it and the uterus intact) or as a last result, hysterectomy.

What I do not have enough information to figure out is why they recommended only hysterectomy: whether it was because of specific findings on colposcopy (and, if so, why the alternative of conization wasn't presented to you) or whether it is just common practice in Thailand to jump straight to hysterectomy (perhaps in part because women here tend to be shy about coming for regular follow up?)

In any case, while you may well be right in not having a hysterectomy, you almost certainly do need to have something done to that lesion; doing nothing is dangerous.

Will PM you with some suggested approaches.

[Prakanong]

Just out of interest; this vaccine, does it also work curative, eg after infection?

No - its a prohylactic vaccine and not therapeutic

There are therapeutic vaccines on trial and moving to the next stage ie certain small cell lung cancers and certain breast cancers

[Prakanong]

This vaccine and the other to follow protect mainly against type 16 and 18 HPV which cause 70% of Cervical Cancer

They may protect against some other sub-types too

[Prakanong]

In the International Herald Tribune today there is a story that Merck are now testing the vaccine on 4000 men including 500 gay men to try and licence it for Anal Cancer.

[bina]

just read yesterday in our papers here, that here in the holyland, no gov;t funded health clinics *there are three different 'brands' of public health insurance here* will give the vaccines. u can purchase them for a costly sum but no one will inject them. they claim that it hasnt been proven safe yet as a vaccine bla bla and are waiting. so my daughter, at the very ripe age of 19 will not be getting it, nor will her peers and this si just the age when a majority of israeli girls become sexually active (enter army so boy soldier away from family meets girl soldier away from family and its party time between marches shifts and active duty)

u can however look for a private doctor that wil be willing for a small 'donation' to give the injection.... so much for socialized medicine in second world countries.

bina

Edited February 7, 2007 by bina

[Prakanong]

Bina

In our briefings we have had on the vaccine it has always been said it will be religious groups that will object to the vaccine the most as they will use the argument it will promote promiscuity 0 the same arguments they have for promoting condom use.

The Fox News Channel is highlighting now the State of Texas which the governor there has made the vaccine complulsory - I am sure we know what that fair and balanced reporting is going to be like.

If and when we have the HIV vaccine will these ame groups be against it for the same reasons I wonder?

It has been proven safe though - phase 1 studies are safety studies and this is tracked through all the following phases.

[english_farang_lady]

EFL,

Sorry for late reply, I have been off in remote rural Cambodia and just recently back online.

I'm going to PM you but as the issue is relevant to all women will post here as well.

LSIL means "Low-Grade Squamous Intraepithelial Lesion" which in turn means that there were abnormal (abnormal, not necessarily cancerous) cells in the surface layer of your cervix. It is considered a mild abnormality, but one that needs to be watched carefully because it can advance to cancer.

Although LSIL may be caused by HPV, it is not always. I am unclear as to whether or not they actually tested for HPV itself??

In any case -- with or without HPV -- the usual procedure is to conduct 2 additional tests"

(1) a colposcopy, which is just a careful examination of the cervix with a special magnifier; could have been done already as to you it would just seem like another internal exam; and

(2) a cervical, and possibly endometrial, biopsy.

Do you know whether or not a biopsy was done (not the same as pap smear), and if so, what the results were?

It is only by biopsy that they can definitely exclude a cancerous or pre-cancerous condition.

I am puzzled by the recommendation to have a hysterectomy. In the west, a variety of more conservative treatments are preferred. A lot depends on what is seen on coloscopy in terms of how far into the cervix the lesion extends. Usual treatments are one of the following:

laser, cryosurgery (freezing the lesion off) and cauterizing. All of these can be done as an outpatient and do not involve the removal of any organs, just the removal of the superficial lesion on the cervix.

If the lesion seems to extend all the way up the cervix, then the treatment options are what they call conization (removal of a part of the cervix, leaving the rest of it and the uterus intact) or as a last result, hysterectomy.

What I do not have enough information to figure out is why they recommended only hysterectomy: whether it was because of specific findings on colposcopy (and, if so, why the alternative of conization wasn't presented to you) or whether it is just common practice in Thailand to jump straight to hysterectomy (perhaps in part because women here tend to be shy about coming for regular follow up?)

In any case, while you may well be right in not having a hysterectomy, you almost certainly do need to have something done to that lesion; doing nothing is dangerous.

Will PM you with some suggested approaches.

Hi Sheryl

So sorry for awfully late reply, just got back from 2 weeks away, mostly spent on airplanes crossing the int'l dateline (yeuk)! Just wanted to acknow. your reply here and will PM you later this evening. Trust all is well.

[english_farang_lady]

EFL,

Sorry for late reply, I have been off in remote rural Cambodia and just recently back online.

I'm going to PM you but as the issue is relevant to all women will post here as well.

LSIL means "Low-Grade Squamous Intraepithelial Lesion" which in turn means that there were abnormal (abnormal, not necessarily cancerous) cells in the surface layer of your cervix. It is considered a mild abnormality, but one that needs to be watched carefully because it can advance to cancer.

Although LSIL may be caused by HPV, it is not always. I am unclear as to whether or not they actually tested for HPV itself??

In any case -- with or without HPV -- the usual procedure is to conduct 2 additional tests"

(1) a colposcopy, which is just a careful examination of the cervix with a special magnifier; could have been done already as to you it would just seem like another internal exam; and

(2) a cervical, and possibly endometrial, biopsy.

Do you know whether or not a biopsy was done (not the same as pap smear), and if so, what the results were?

It is only by biopsy that they can definitely exclude a cancerous or pre-cancerous condition.

I am puzzled by the recommendation to have a hysterectomy. In the west, a variety of more conservative treatments are preferred. A lot depends on what is seen on coloscopy in terms of how far into the cervix the lesion extends. Usual treatments are one of the following:

laser, cryosurgery (freezing the lesion off) and cauterizing. All of these can be done as an outpatient and do not involve the removal of any organs, just the removal of the superficial lesion on the cervix.

If the lesion seems to extend all the way up the cervix, then the treatment options are what they call conization (removal of a part of the cervix, leaving the rest of it and the uterus intact) or as a last result, hysterectomy.

What I do not have enough information to figure out is why they recommended only hysterectomy: whether it was because of specific findings on colposcopy (and, if so, why the alternative of conization wasn't presented to you) or whether it is just common practice in Thailand to jump straight to hysterectomy (perhaps in part because women here tend to be shy about coming for regular follow up?)

In any case, while you may well be right in not having a hysterectomy, you almost certainly do need to have something done to that lesion; doing nothing is dangerous.

Will PM you with some suggested approaches.

Hi Sheryl

So sorry for awfully late reply, just got back from 2 weeks away, mostly spent on airplanes crossing the int'l dateline (yeuk)! Just wanted to acknow. your reply here and will PM you later this evening. Trust all is well.

Sorry --- missed out the most important bit --- another question about HPV. I have some type of HPV, although which type I do not know, but am now wondering whether I can pass the virus on to my new husband? Is it completely without symptoms in men?

[Sheryl]

Yes, if you still have the lesions (i.e. they haven't been removed by surgery, laser etc) then you could infect your husband. Odds of this are higher if he is uncircumcised. Condoms will protect.

HPV produces small warts, in men and women, but they can be hard to see. In women these are often on the cervix and so asymptomatic to the woman although visible on pelvic exam. In men the lesions can be in the scrotal area where hair may obscure them or inside the urethra where they can't be seen, and in that sense may be asymptomatic. The best thing advice I can give is to use condoms for now until you (1) get your lesions treated and (2) your husband gets a check up from a urologist to verify that he is not already infected. (A good time to get a prostate check while he's at it, all men should get one periodically). When you have your lesions treated, ask if this means you are no longer infective. But be sure your husband is not, otherwise you could be re-infected by him if he has already acquired the infection.