Vaccine Against Papillomavirus

In the USA, every year, 500,000 cases of genital warts are discovered, caused in 90% of cases by type 6 and 11 Papillomavirus, while serotypes 16 and 18 are accountable for 70% of cervical cancers. Since 2006 a quadrivalent vaccine (HPV4) is available, containing all the 4 serotypes and put to the disposal of female population between 9 and 26 years of age. In October 2009, a new vaccine has been marketed for women and FDA has authorized the use of HPV4 also in males. The new vaccine (HPV2) is a bivalent vaccine with an action against serotypes 16 and 18, advised for girls between 10 and 25 years of age: in clinical trials, the vaccine has been shown to have a preventive efficacy of 93% towards stage-2 and stage-3 cervical intraepithelial cancer lesions and towards adenocarcinoma in situ, but not having efficacy in patients resulting positive to HPV 16 or 18 before vaccination. Side reactions have been above all local reactions in the seat of injection (pain, reddening, swelling), while severe reactions have been similar to the ones found in the control group. The administration schedule of HPV2 and HPV4 are similar, but it is opportune to use always the same kind of vaccine, since interchange has not been shown yet. HPV4 vaccine has been now approved also for its use in males between 9 and 26 years of age, as a prevention against genital warts caused by HPV 6 and 11. The preventive efficacy of three administrations in seronegative males reaches 90%. The administration schedule and side effects are the same as female ones.

Having two vaccines at one’s disposal, now the problem the general practitioner has is to choose the kind of vaccine: HPV4 is more complete, but many patients prefer to use less possible viral strains. No doubt, it is necessary to warn potential addressees that the vaccine has no action on an existing HPV infection. In spite the vaccine is available now also for males, the best strategy to contrast the spreading of HPV-related lesions remains to vaccinate all females at the age of 11-12. For males, it is probably necessary to vaccinate the ones having very risky sexual behaviours.

Pregnant Women Who Develop Life-Threatening Blood Clots Should Receive Aggressive Treatment

Pregnant women who develop dangerous blood clots in the leg often forgo the most effective treatment for fear of harming the baby. Yet treatment to remove the clot is not only safe, it can prevent serious problems, including death, suggests research being presented at the 24^thannual International Symposium on Endovascular Therapy (ISET).

Iliofemoral deep vein thrombosis (DVT) – a blood clot that forms deep in the thigh and pelvis – is four to six times more common in pregnant women than those who are not pregnant. This blood clot can break off and travel to the lung causing a potentially deadly condition called pulmonary embolism. When DVT is not treated early and effectively, the clot can become permanent, causing lifelong pain and blood flow problems in the leg. The most effective treatments include the minimally invasive delivery of clot-dissolving drugs directly to the clot, or surgery to remove them.

The study included 11 pregnant women with DVT: Nine were treated with minimally invasive techniques by guiding a tiny tube called a catheter into the clot to deliver clot-dissolving drugs, and two had surgery to remove the clot. Treatment successfully eliminated the clot in all cases. All but one of the pregnancies resulted in a successful birth. One woman in her second trimester miscarried a week after treatment. The woman suffered from antiphospholipid antibody syndrome, which causes the blood to clot abnormally and increases the risk of miscarriage, so the underlying condition likely was the cause of her miscarriage, researchers said. Three of the women had successful subsequent pregnancies.

Pregnant women who develop DVT typically are treated less aggressively with blood thinners, which rarely clears the clot.

“Pulmonary embolism is the leading cause of maternal death in North America,” said Anthony Comerota, M.D., director of the Jobst Vascular Institute at The Toledo Hospital, Ohio. “Physicians should use more effective treatment to prevent these women from having serious life-long problems that can affect their ability to function normally.”

Chlamydia Screening

Chlamydia-related genital infections are mostly asymptomatic, but if they are not treated, they can lead to an irritating pelvic inflammatory disease (PID). In women under 25 years of age and sexually active, the CD recommends the annual performance of Chlamydia screening. In this randomized trial performed in England, the risk of PID has been assessed  in 2529 sexually active women undergoing screening: genital samples have been randomized to an immediate screening for Chlamydia (with
following treatment in case of positiveness) or to storage and analysis after one year (using these samples as controls). At the baseline, 68 of the women undergoing screening and 75 controls were positive to Chlamydia. During one-year follow-up, 38 women have developed a pelvic inflammatory disease.
The incidence of PID has been of 1.3% in the group
undergoing screening and of 1.9% in the control group (the difference is not statistically significant). Among the women already presenting Chlamydia-related infection at the beginning of the trial, only 1 in the group undergoing screening and 7 in the control group have developed a PID afterwards, and, even in this case, statistical significance was not reached. We must note that 30 PIDs out of 38 occurred in women not having Chlamydia-related infection at the beginning of the trial.
The trial does not show that Chlamydia screening reduces the risk of PID: non-significant results could, however, be due to a non-sufficient sample. In any case, it is interesting to note that most part of PIDs
occurred in women not positive for Chlamydia. It follows then that the best way to prevent PID is to reduce risk factors (making women with a recent change of their partners or with a history of Chlamydia in the
last months undergoing screening) as much as possible.