Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6–12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22–0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group (p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment (p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.

A fully government-funded human papillomavirus (HPV) vaccination program started in 2007 in Spain (only 11–14-year-old girls). The first of those vaccinated cohorts, with the quadrivalent vaccine (Gardasil), turned 25 years old in 2018, the age at which cervical cancer screening begins in Spain. The current study could provide the first evidence about the effectiveness of the quadrivalent vaccine against HPV in Spain and the influence of age of vaccination. The present ambispective cohort study, which was conducted on 790 women aged 25 and 26 years old, compares the rate of HPV prevalence and cytologic anomaly according to the vaccination status. The overall infection rate was 40.09% (vaccinated group) vs. 40.6% (non-vaccinated group). There was a significant reduction in the prevalence of HPV 6 (0% vs. 1.3%) and 16 (2.4% vs. 6.1%), and in the prevalence of cytological abnormalities linked to HPV16: Atypical Squamous Cells of Undetermined Significance (ASCUS) (2.04% vs. 14%), Low-grade Squamous Intraepithelial Lesions (LSIL) (2.94% vs. 18.7%) and High-grade Squamous Intraepithelial Lesion (HSIL) (0% vs. 40%), in the vaccinated group vs. the non-vaccinated group. Only one case of HPV11 and two cases of HPV18 were detected. The vaccine effectively reduces the prevalence of vaccine genotypes and cytological anomalies linked to these genotypes.

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La operación cesárea que hoy en día realizamos de forma casi rutinaria en la mayoría de centros hospitalarios del mundo es consecuencia de una apasionante búsqueda de mejoras por las generaciones precedentes de obstetras. A lo largo de los años, la cesárea ha experimentado importantes cambios en la técnica quirúrgica, en la frecuencia de su práctica y en sus indicaciones, tanto maternas como fetales. En los siglos XVII, XVIII y XIX implicaba una elevadísima mortalidad materna, por lo que únicamente se realizaba en casos desesperados, con la esperanza del salvar al nasciturus. La introducción de los principios de asepsia-antisepsia por Semmelweis, Koch, Lister y Halsted, la sutura de la herida uterina, la incisión en el segmento uterino inferior y la incisión transversa en el segmento inferior del útero supusieron una importante disminución de la mortalidad materna. En la segunda mitad del siglo XX, el empleo de la antibioticoterapia, la transfusión sanguínea, el perfeccionamiento de la anestesia y de los cuidados perioperatorios, así como la modificación ulterior de algunas técnicas quirúrgicas, ha conseguido reducir ampliamente la morbimortalidad asociada a esta intervención. Todos estos cambios han conseguido que la cesárea haya pasado de ser una operación in extremis que condenaba con gran probabilidad a la paciente, a una técnica que en la actualidad es demandada por algunas mujeres como sustitución del parto vaginal.

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