Persistent high-risk human papillomavirus (HR-HPV) is strongly associated with the development of CIN2 –3, which is considered the the beginning of the progression to cervical cancer . Excision procedures ( LLETZ, conization) are both a diagnostic and therapeutic procedures that can effectively eradicate CIN2–3 . However, , residual/recurrent disease associated with HR-HPV persistence after conisation varies between 5%- 30%, requiring retreatment of the lesions .
The aim of the study was to determine whether vaccination with the bivalent human papillomavirus (HPV) vaccine Cervarix after electrosurgical conisation for high-grade cervical intraepithelial neoplasia (CIN2 -3) is effective in preventing of HG-HPV persistence .
115 patients (mean age 35.5 years, range 23–47 years) with histologically verified CIN 2 or CIN 3 who underwent electroknife conization with negative margins between December 2011 and January 2014 were enrolled in this study.
55 patients were vaccinated with Cervarix after surgical treatment (vaccination group), and 60 patients were followed without vaccination (non-vaccination group). The patients in vaccination group received the first dose at 3 weeks after conisation and the remaining two doses one and six months later. Postconisation follow-up was performed at 3, 6, 9, 12, 18, and 24 months during the first 2 years and yearly thereafter.The cytology, colposcopy and HPVgenotyping by PCR before surgery and at 8-12 monthes follow up was performed to all patients.
High-risk HPVs were detected in the primary cervical lesions of 113 of 115 patients (97.1%) prior to conization. Follow-up at 12-16 months revealed that HR- HPVs were eradicated by conization in 80 % without vaccination. HPV-genotyping after treatment identified persistent viral infection in 12 of 60 (20%) nonvaccinated patients. In vaccinating group the presence of HG-HPV at the 12-14 month visits was found in 5 of 55 of patients (12.5 %) . Persistence of HPV 51, 58 was revealed in 4 patients in vaccinated group. Persistance of HPV16 was found in one patient.
Vaccination with with the bivalent human papillomavirus (HPV) vaccine Cervarix after electroconization improved the level of HG-HPV elimination and may be considered in preventing recurrence of CIN2 –3.