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Human papillomavirus – vaccines and laser treatment

From its launch on the market in 2006 until today, vaccines against the human papilloma virus (HPV) have divided medical professionals into two – “for” and “against”, each of them fighting for an advantage, and the end and coming out with a unified opinion on the subject still seem distant.

Although the World Health Organization (WHO) recommends HPV vaccines as part of routine vaccination in all countries, along with other prevention measures, they currently have legal status in very few countries. It is widely believed that widespread vaccination has the potential to reduce cervical cancer deaths worldwide by two-thirds if all women are vaccinated and if the protection the vaccines provide is long-lasting. From a practical perspective, vaccines may reduce the need for medical care, biopsies, and invasive procedures associated with follow-up of abnormal Pap tests, thereby helping to reduce health care costs and anxiety associated with abnormal Pap tests and follow-up. procedures.

The latest generation of preventive HPV vaccines are based on non-infectious and non-oncogenic particles assembled from recombinant HPV proteins. The vaccines target two of the most widespread and high-risk types of the virus – 16 and 18, which are the causes of cervical cancer (cervical dysplasia in the initial stages) in about 70% of cases. Some of the vaccines, such as Gardisal, also protect against infection with types 6 and 11, which together with types 16 and 18 cause about 90% of genital warts. It is important to note that vaccines do not contain live viruses, do not contain DNA, and cannot infect the patient. In addition, the virus is composed of two proteins, L1 and L2, but vaccines contain only L1, respectively in the Gardisal vaccine, for example, L1 proteins of type 6, 11, 16 and 18 are present. Vaccines such as Gardasil and Cervarix are designed to induce virus-neutralizing antibody responses that prevent initial infection with HPV types, the information to do so being contained in said viral proteins. Vaccines have been shown to offer 100 percent protection against the development of cervical cancer and genital warts caused by HPV types. The protective antibody response is expected to last a minimum of 4.5 years after the initial vaccination.

Vaccines are recommended for boys and girls over 12-13 years of age before starting sexual contact, but they are also used at an older age – up to 45 years, before the onset of menopause.
Vaccine side effects are generally mild, and contraindications are hypersensitivity to any of the vaccine ingredients or moderate or severe acute illness.

If we look globally at the penetration of HPV vaccines into the health care of different countries, it is noticeable that the UK and Ireland are introducing HPV vaccination for boys aged 12 and 13 years as part of their National Immunization Plan in 2019. Portugal includes universal HPV vaccination for boys aged 10 and over as part of its National Immunization Plan in 2020.

In Bulgaria, the situation still remains unclear and uncertain regarding future development, but there are still patients with complaints related to the disease. Adverse psychological effects, as a result of genital warts, lead to a reduction in the quality of life and lead to anxiety.

The most widely used therapies in the fight against HPV include operative and ablative therapies such as cryotherapy, trichloroacetic acid (TCA), CO2 laser therapy.

A number of studies have shown that CO2 laser therapy is significantly more atraumatic compared to surgery, due to the absence of incisions and a shorter recovery period, but at the same time with the same effectiveness, due to the deep penetrating ability of the laser beam. Other analyzes focused on a comparison between cryotherapy and CO2 laser therapy, and the conclusions were extremely curious – the effectiveness of CO2 on external genital warts was approximately twice that of cryotherapy and was associated with a lower recurrence rate. On the other hand, often the results of treatment with trichloroacetic acid (TCA) are unsatisfactory and lead to subsequent treatments. These are the reasons why leading specialists from the University of Babylon, for example, recommend CO2 therapies as a treatment method for already infected patients.

Dr. Velislava Tomova

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