Monday, September 29, 2008


(Written on 19/09/2009)

*Disclaimer: This is simply one of my personal experience during medical school. This article does not imply or compare superiority amongst different HPV vaccines available in the market. This does not prove or shown that any certain HPV vaccine is more superior than others. thank you.

I had my second dose of GARDASIL today. It was rather funny, the scene at the treatment room, a group of medical students, jabbing each other intramuscularly at the deltoid region… anyway, that’s beside the point. Today, I would like to introduce you to my new friend: GARDASIL.

Readers, meet GARDASIL
Readers, meet GARDASIL upclose.... note: this single dose vaccine package came with it's syringe. You could even choose your prefered needle size!

GARDASIL meet your clients
(picture removed)

What the heck is GARDASIL, you may ask… GARDASIL is a Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine.

Allow me to elaborate…

The second highest leading cause of death from cancer amongst Malaysian Women, and worldwide, is CERVICAL CANCER, first being Breast Cancer. Cervical cancer, as the name implies, is the cancer of the cervix, which is the lower part of the uterus that connects to the vagina.

(anatomy of cervix)

Cervical cancer is caused by certain high-risk type of Human Papillomavirus Virus (HPV). When a female becomes infected with this virus, it may causes abnormal cells to develop in the lining of the cervix, which can lead to precancerous cells, and if not discover early and treated, will lead to cancer.

Over the years, women with cervical cancer, had suffered from minor operations, hysterectomy (removal of the whole uterus), radiotherapy, chemotherapy and even death from cancer spread.

? How is HPV transmitted?
According to the Centers for Disease Control and Prevention, the only way you can totally protect yourself against HPV is to avoid any sexual activity that involves genital contact. In summary, abstinence is the ONLY way to prevent cervical cancer. And I am not talking about multiple partners. A single partner, let’s say your future spouse, can also cause cervical cancer to you. So, unless you are very sure that you can avoid sexual activity life long, I suggest you read on.

? How to prevent cervical cancer?
Thank God, now, researches had developed a vaccine against HPV (Human Papillomavirus Virus), the causative agents of cervical cancer = GARDASIL. HPV types 16 and 18 causes 70% of cervical cancer cases, and HPV types 6 and 11 causes 90% of genital warts cases. GARDASIL is so far the only vaccine that help guard against diseases caused by HPV type 6, 11, 16 and 18.
Note: Anyone who is allergic to the ingredients of GARDASIL should not receive the vaccine. Also, GARDASIL is not for women who are currently pregnant.

? Why am I telling you this now?
A research done on the effectiveness of GARDASIL was done on a population sample on those non-sexually active between 16-26 years old and the result was significant. In fact, the earlier you are vaccinated, the better it is. Therefore, since most of my friends and blog readers are among this age group, I would like to introduce this vaccine to you. It is recommended for girls between 9-26 years old.

? Do one still have to go for PAP smear after vaccinated?
YES. GARDASIL does not protect you 100% from cervical cancer. PAP smear is still the number one screening tool for cervical cancer. It is a cheap and simple procedure. Therefore, once you are sexually active, you still have to go for PAP smear anually (for 3 years, and if all previous smears were normal, screen every 3 yearly).

? Where can I get this and how much?
You can get yourself vaccinated at any local clinic. The price is about RM350 per dose, with a total of 3 dose altogether. Be aware that some vaccine only covers for 2 HPV. Make sure you asked your doctor for more information. Or else, just insist on GARDASIL which provides vaccination against the 4 HPV mentioned above.

? How effective is this vaccine?
As for all vaccine, vaccination with GARDASIL may not result in protection in all vaccine recipients. The efficacy of GARDASIL was assessed in 4 placebo-controlled, double-blind, randomized Phase II and III clinical studies. These studies evaluated 20451 women 16 to 26 years old of age at enrollment. The efficacy of GARDASIL against HPV 16- and 18-related CIN 2/3 or AIS was 100% in all four studies (Protocol 005, Protocol 007, FUTURE I and FUTURE II and combined protocols). The efficacy of GARDASIL against HPV 6,11,16 and 18 CIN was 100%, 100%, 90.7% and 95.2% respectively in studies : Protocol 007, FUTURE I and FUTURE II and combined protocols . While the efficacy of GARDASIL against HPV 6,11,16,18 genital lesions (eg warts, VIN, VaIN) was 100%,100%, 98.6% and 99.1% respectively.

? Possible side effects?
Commonly: Fever, redness, pain and swelling at injection site.
Sometimes: Pruritus (itchiness) and hemorrhage (bleeding) at injection site
Very Rarely: Bronchospasm, syncope

? Is it worth the money?
I shall leave it for you to decide. (It sucks right? When women have to suffer from a cancer spread by man. Sigh.. ) Thinking down the line, between a thousand and cervical cancer, if you have some extra savings to spare, why not?

I wanted to include some pictures of cervical cancer and cervical warts, but I was a bit worried that it might upset some readers, certainly not for the faint heart, and I do not know how to include spoilers in a blog… maybe, some other time, perhaps… or you could try goggling for pictures, the internet makes it so convenient…


Match the blood before you match for horoscope of marriage
blue sclera
Spread the word about the Golden Window of Opportunity. Save your love ones from stroke~


  1. not bad.. directly link ur post and MSN to friends... LOL.. but it is so damn expensive..

    allow me to be evil for a while

    *luckily i'm not a 'she'*

  2. I really scare of needles. Have phobia when going to blood test and etc

  3. jocelyn....1 more dose n u will ve the pass for promiscuity!!!wahaha...go go chick!!=p just joking....hahaha there any pre-requisite for the vaccination besides being 9-26 years old??

  4. I've heard of this vaccine. Somebody's telling me I should bring my daughter for it. Quite expensive, I heard...but never mind! As long as it's good for her!

  5. >peanut>> i'm glad you enjoyed reading this and spread it to your friends.. this is a recently popular vaccine, but most people are still not convince about it... perhaps it's the price... if your friends are medical student/staff.. they can purchase straight from the pharmaceutical company in bulk for a cheaper price.. but they have to make sure they maintain the cold chain, or else the vaccine would be ineffective..

    well, although you don't have a cervix.. you still have lungs and colon.. and there's no vaccine against those.. =P (touch wood!)

    >borneo falcon>> haha... you need to overcome the phobia... when you are relaxed and less anxious, it's less painful, really..

    >anonymous>> other pre-requisite? erm... well, it's recommended for the age group... preferably girls who are not yet exposed to HPV.. and you are suppose to complete all 3 dose within 1 year... according to the schedule... and if there's an allergic reaction after the first dose, you cannot take the next dose.. otherwise, so far, no 'pre-requisite'.. it's not a live vaccine.. so, it's not contraindicated in low grade fever or URTI.. this should be used with caution in individuals with thrombocytopenia or any coagulation disorder because bleeding may occur following IM injection of this vaccine...

    p/s: Please do leave your name instead of being anonymous next time ya.. thanks =)

    >STP>> such a good daddy!! this is perhaps one of the greatest gift you can give her.. =)

  6. some countries offer it for free for their citizens already.
    dunno when our country would include it into the national vaccine calender..year 3030 maybe?

    so..u gals buy bulk? or uni sponsor?

  7. the studies state women 16-26. did they state whether they are sexually active or not?

    they are always good at manipulating results.

    i wonder whether sexually active women would have poorer results

  8. >wicrap>> yes, some countries included that in their immunization schedule...

    our uni where got so good sponsor..... siGh... now super broke liao... =(

    according to a study by a pharmaceutical company, sexually active women can benefit from the vaccine too, although the efficacy is not as good as those who are not yet exposed to HPV. MOH, generally recommended GARDASIL to those who are not yet exposed, and annual PAP smear for those who are already exposed...

  9. if hysterectomy has been done, do we need to go for pap smear regularly?

  10. Well if you ever become a doctor your " money no enough" problems will soon be over :)

    - D

    (sorry no blog :P )

  11. >anita>> actually, it depends on:

    1. What type of hysterectomy was done? Was it a TAHBSO, total hysterectomy, or subtotal hysterectomy? In other words, is the cervix removed together with the uterus, or only the uterus removed??? As a general rule, if the cervix is still retained, a PAP smear is necessary. If the cervix is no longer there, a PAP smear is not necessary unless the hysterectomy was done because of cancerous condition, ie: cervical cancer or its precursors.

    2. What reason was the hysterectomy done for? Was it done because of cancer? If there was a history of abnormal or cancerous cell growth, cytology screening is still necessary. Besides that, post hysterectomy gynecology exam is important as the doctor will examine the pelvic area for signs of cancer, as well as infections. Patients will also be examined for signs of breast lumps and to perform annual mammogram.

    I would advice patients who had underwent hysterectomy to discuss with their doctor or surgeon, whether annual PAP smear is still necessary for them, as well as the importance of other gynecology follow-up.

    References: ACOG, American College of Obstetrics and Gynecology. Recommendations on Frequency of Pap Test Screening.

    Women who have had a hysterectomy with removal of the cervix for benign reasons and with no history of abnormal or cancerous cell growth may discontinue routine cytology testing. Women who have had such a hysterectomy but who have a history of abnormal cell growth (classified as CIN 2 or 3) should be screened annually until they have three consecutive, negative vaginal cytology tests; then they can discontinue routine screening.

    -i hope this that answered your question-

  12. >anonymous>> ask any doctor, and you'll realize that being a doctor does not solves money problems... doctors in Malaysia are generally underpaid... but i guess, the satisfaction of healing, the smiles on patients faces, knowing that you can make a difference, those things pays much more... ^^

    do drop a name, Mr/Ms Anonymous

  13. I carry around my notepad sponsored by Gardasil! Quite a few has noticed it

  14. >fengy>> haha! don't know why, somehow, it sounded funny.. my friend, he uses a pen with Miss Lo imprinted on it ( an OCP brand)... =P

  15. and btw, I have a name, I just don't have a blogger account so it says "anonymous" every time.

    -DN <--- that's a name :)

  16. yeah.. i just wanted to illustrate that HPV can lead to --> precancerous lesion --> cervical cancer...

  17. nice to meet you DN.. =)
    p/s: actually, you can select the 3rd option, and type in DN and leave the URL blank.. hehe...

  18. Thanks for your medical informations and advice.

  19. lolz.. this sounds more like an advertorial.. :P

  20. >yee ming>> it's not advert when i don't gain any money from it.... this is called public awareness =P

  21. Thanks God!! for give us the new way to prevent cervical cancer.. hope vaccine can work nearly 100% soon. I think everyone don't want cancer!!


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Author's Note

Dear friends and readers, Thank you for dropping by and leaving comments/ shoutouts. More importantly, thank you for being there... please accept my apology that, lately, i may be busy with work and not have time to reply youir messages/comments, but rest assured, each and everyone is read, and highly appreciated :) have a nice day! ^^

of love

Today, i heard a story which was not a story of falling...
of living in the dark end of winter turmoil..
instead, it was a love story..
of a couple who did not live happily ever after...
but they live, loving each other..