“Last year at the age of 29, doing the pap test, I discovered that I had a CIN1 lesion. Six months after the conization surgery and the histological examination which indicated that the problem had resolved, I had the pap test again -test and the results are: low-grade squamous intraepithelial lesion (LSIL) with some elements suspicious for the presence of HSIL. I kindly ask how I should proceed and whether in these circumstances it is possible to have a free HPV vaccine at the local health authority.”
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The letter makes no mention of the result of the HPV test which I take for granted was carried out. Furthermore, it would be advisable to know the full result of the histological examination to understand whether the previous lesion had been entirely removed. Only in this way is it possible to correctly interpret the results of the recent Pap test. However, I would recommend a new colposcopy, perhaps a second level one. As regards the anti-HPV vaccine, I must assume that she has not been vaccinated previously and therefore it is still useful to get vaccinated now as – regardless of the test for HPV – the current nonavalent vaccine, although not therapeutic but preventive, offers broad protection from new infections by other viral strains.
The anti-HPV vaccine can be carried out in your local health authority, which will offer it free of charge to eligible categories. According to a recent regulation, which several Italian regions have signed up to, the vaccine is free not only for boys and girls aged 11 years and over, but also for women up to their 26th birthday who have not previously been vaccinated (after 26 years of age, vaccination is offered at a discounted price), for women already undergoing gynecological treatment for pre-cancerous lesions, for subjects at risk for certain behaviors or conditions, including men who have sex with other men, subjects with HIV infection, immunocompromised or those who need to start therapy with immunomodulators and immunosuppressants.
*Carlo Maria Stigliano is National Secretary of Aogoi (Italian Hospital Obstetricians-Gynecologists Association)
The information provided is intended for informational purposes only: it does not represent medical advice in any way and cannot replace diagnoses or treatment indications recommended by your doctor or a specialist..