[Question #8750] Gardasil-9 after receiving the Gardasil-4 series?
 |
40 months ago
|
I know there aren't a lot of studies to support this, but are there any advantages of receiving the Gardasil-9 series after the quadrivalent series? Does having exposure to some antigens offer some universal protection against the other strains? I have tested HPV+ (not 16/18) during my latest normal pap smear, and for the last ~2.5 years (LSIL/HPV+ previously). I was wondering if receiving the Gardasil-9 series will maybe jump start my immune system into possibly clearing this persistent infection. I was reading somewhere that one woman's PHP thought that those with HPV infections lasting longer than 2 years might be more prone to future HPV infections, so she thought in her individual case receiving Gardasil-9 might be beneficial. For context, I am 31, have not had that many previous partners (4), but may have more partners in the future if I decide to re-enter the dating scene or find my long-term partner, so in my case I think it might be worth it to have that extra protection.
As for my normal pap smear/ HPV+ result, I'm specifically wondering:
Does HPV actually clear from the body or does it just go dormant like chicken pox or HSV/ cold sores? Can it just randomly reactivate and cause problems when I'm like 50 and my immune system is weaker?
 |
Edward W. Hook M.D.
40 months ago
|
Welcome to the Forum. Thanks for your questions. I'll be glad to comment (FYI, I happened to be on the site when your question arrived so this response is coming somewhat more quickly than is typical. There may be a longer interval involved for any responses for your up to two follow-ups).
Gardisil-9 contains antigens to five more HPV types, all of which have been associated with genital tract cancers. The additional HPV types in Gardisil-9 comprise about 20% of cervical cancers and Pap smear abnormalities so, while the amount of protection gained with Gardisil-9 vs Gardisil-4 is less than for your initial vaccination, 20% is a relatively large amount of additional coverage. In addition, while most of the protection which follows HPV vaccination is type-specific, emerging data suggest that there is some modest cross reactivity with other HPV types as well. I would have my family members get it if they were in the same position.
Regarding your 2nd question, in at least a portion of persons in who HPV is detected and then, with or without treatment, becomes undetectable, sophisticated research tests indicate that HPV DNA can still be detected. Despite this, in these situations, recurrences in these situations are rare as is the likelihood of transmission to partners.
These are complex issues. I hope the information I've provided is helpful EWH
--- |
40 months ago
|
Thank you Dr. Hook! I am definitely going to ask my PHP about rec
|
40 months ago
|
Thank you Dr. Hook, I am definitely going to ask my PHP about receiving the Gardasil-9 series at my colposcopy appointment. Hopefully they are willing to administer it. It also makes sense that the virus may not be completely eradicated or achieve total clearance, but even in cases of viral latency, the cases of viral re-activation in mid-life are not significant. As a follow up question, I am wondering if HPV+/ normal pap means the infection is resolving after an LSIL result? Why is there a colposcopy follow-up in the case of a normal pap? I hear that this is a two-pronged approach. One woman told me that she had a dysplasia at the colposcopy in spite of the normal pap. I'm not sure how common this is, or if they'd like to rule out any false negatives. I'd like to think a normal pap is a good sign? Thank you again!
|
Edward W. Hook M.D.
40 months ago
|
It is difficult to provide a timeline fact or guess what the natural history of your HPV positive/ normal Pap smear would be. The Pap smear findings could have always been normal, could have been abnormal and resolving, or the specimen taken could have missed an abnormality (this is the reason colposcopy would be done following a positive test. Different health care providers approach this combination of findings differently). Pap smears note often miss abnormalities but it does happen. Overall however, I agree with you that your normal Pap smear is a good sign.
EWH
--- |
40 months ago
|
Ok thank you Doctor! For my last follow up question, I am wondering how safe it would be to receive the 9vHPV series after 4vHPV series? Does the risk of Arthrus reaction or any other adverse reactions go up or is it still relatively safe & efficacious?
|
Edward W. Hook M.D.
40 months ago
|
Good question. Adverse reactions are rare with the HPV vaccine. With a dose of Gardisil-9 you will be “boosted” in terms of your immunity to the 4 types in your original vaccine series and should develop new antibodies to the 5 additional types. I would not worry about reactions.
I hope that the information I’ve provided has been helpful. Take care. EWH
---