jcoloproctol(rioj).2015;35(2):137–138
w w w . j c o l . o r g . b r
Journal
of
Coloproctology
Letter
to
the
Editor
Reflections
on
the
role
of
the
vaccine
against
human
papillomavirus
(HPV)
in
Sexually
Transmitted
Diseases
(STDs)
DearEditor,
Sexually Transmitted Diseases (STDs) cause serious dam-age; among other, gynecological and anal cancers, in that HPV is the carcinogen in 90% ofcases. The prevention of thesediseasesisbasedonpeople’seducation,buttheir treat-mentandvaccinationoccupyanincreasinglygreaterspace.In thiscontext,areparticularlyimportant(www.aids.gov.brand
www.dst.uff.br):
1. Hygiene,particularlyperi-intercoursehygiene;
2. Responsibilitywithrespecttoone’spartners,forinstance, thecorrectuseofcondomsandcarewithextramaritalsex; 3. Acorrectand earlytreatmentofSTDsand thepartner’s
protectionduringthisperiod;
4. General preventivecare,such asaregular gynecological review;
5. Access to diagnosis, treatment and information about STDs,and
6. Vaccination, currentlyavailable forsome STDs, such as HPV.
Concerning HPV vaccination, ANVISA currently recom-mendsthetetravalentvaccineformenandwomenaged9–26 years;andthe bivalentvaccineforwomenover9yearsold
(www.anvisa.gov.br).Ontheotherhand,somestudiesdiscuss
thebenefitsofexpandingtheindicationforotheragegroups, andalsoforpeoplealreadyinfectedwithHPV.Thereisevena projectoflawmovingthroughBrazilianCongress(PLS238/11) mandatingthevaccinationforwomenbetween9and40years. TheextentofthisbenefitforalargernumberofBrazilian peo-plealsodependsonpublicawareness,costs,sideeffectsand benefitsofthevaccine.
Theawarenessofthepopulationdependsoninformative campaignstoclarifyaboutSTDs,especiallythebenefitsofHPV vaccination,vaccineindicationsandlocationofvaccination posts.Thevaccinecostswilldecreasewiththedevelopment ofanationaltechnologyaimingtoalarge-scalevaccine
pro-duction.Thevaccinehasminorsideeffects,comparedtoits benefits,andthesesideeffectsshoulddecreasewithvaccine improvement.1–6
Somefactsemphasizethebenefitsofthevaccine,leading toreflectionsonthepossibilityofexpandingitsindications forotheragegroupsandforpeoplealreadyinfectedwithHPV, suchas:
1. HPVvaccines cover partofviraltypes. Inanindividual, theinfectioncanoccurbytypesdifferentfromthosethat constitutetheviralvaccine,inwhichcasethevaccinated individualwouldbeprotected,ifanewinfectioncausedby anyofHPVtypestargetedbythevaccineoccurs.7In
addi-tion,somestudiessuggestthatthe vaccinecanimprove immunity against viral types not present in the vac-cine,influencingthetreatmentandtheresistanceagainst disease.8–11
2. STDsareentrypointsforotherSTDsorfordifferentviral types of the same STD. When the body’s immunity is improvedwiththevaccineandwheninfectionsbythose HPVtypespresent inthe vaccine are prevented,weare improvingtheprotectionofthebodyfrombeinginfected bynewSTDs,orbyotherviraltypes.9
3. There is abetter chancethat a STD-infected individual donotfollowthosepreventivecaremeasuresabove men-tioned,thereforebeingatgreaterriskofrecontamination. Inthiscase,thevaccineprotectsagainstdiseasescausedby thoseHPVtypesthatmakeupthevaccine, notwithstand-ingthisbehavior.
138
jcoloproctol(rioj).2015;35(2):137–138R
e
f
e
r
e
n
c
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JoãoCarlosMagi
ServiceofColoproctology,HospitalHeliópolis,SãoPaulo,SP,Brazil E-mail:[email protected]
http://dx.doi.org/10.1016/j.jcol.2015.02.008
