OSCE: HPV Vaccine & HPV DNA Testing Counseling

Scenario:

You are a healthcare provider in Thailand counseling a patient (or guardian) about the HPV vaccine and HPV DNA testing as part of cervical cancer prevention.

Step 1: Patient Introduction & Communication

OSCE Expected Tasks:

1. Introduce yourself and confirm patient’s identity.

2. Ensure privacy.

3. Ask open-ended questions to explore any concerns.

4. Use layman’s terms and culturally appropriate language.

Example Opening:

“Hello, my name is Dr. [Your Name]. I’d like to talk to you about the HPV vaccine and cervical cancer screening. What concerns or questions would you like to discuss today?”

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Step 2: History Taking

Key OSCE Questions to Ask:

1. Age and gender – “How old are you?”

2. HPV vaccination history – “Have you ever received an HPV vaccine before?”

3. Sexual activity status (ask sensitively) – “Are you currently sexually active?”

4. Previous Pap smear or HPV tests – “Have you ever had a Pap smear or HPV DNA test?”

5. History of HPV-related issues (e.g., genital warts) – “Have you or your partner been diagnosed with HPV?”

6. Pregnancy status or immunocompromised state – “Are you pregnant or have any immune-related illnesses?”

(Tailor your counseling based on these responses.)

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Step 3: Explanation of HPV & Vaccine Recommendations

1. What is HPV?

   • “HPV is a common virus transmitted through sexual contact. Certain types can lead to cervical cancer, while others cause genital warts.”

2. Why is the HPV vaccine important?

   • “It protects you from the high-risk HPV types that cause most cervical cancers. Vaccination significantly reduces the chance of developing cervical cancer later in life.”

3. Who should get the vaccine?

   • Age 9–14 (ideal): Recommended 2-dose schedule.

   • Age 15–26: Recommended 3-dose schedule (some guidelines extend to age 45 after individualized discussion).

   • Ideally before first sexual intercourse for maximum effectiveness.

Dosing Schedule by Age Group:

Age Group	Doses	Schedule
9–14 years	2	0, 6–12 months
15–26 years	3	0, 1–2, 6 months
27–45 years	3	Consider risk factors

Note: “Even if you are already sexually active, you can still benefit because you may not have been exposed to all HPV types.”

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Step 4: Types of HPV Vaccines in Thailand

Vaccine	HPV Types Covered	Protection Coverage
Cervarix (2v)	16, 18	High-risk HPV (cervical cancer)
Gardasil (4v)	6, 11, 16, 18	Cervical cancer + genital warts
Gardasil 9 (9v)	6, 11, 16, 18, 31, 33, 45, 52, 58	Broadest coverage (cancer + warts)

• Mild side effects (arm soreness, low-grade fever, headache).

• Serious adverse reactions are extremely rare.

  
  

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Step 5: HPV DNA Testing in Cervical Cancer Screening

What is HPV DNA Testing?

“HPV DNA testing detects high-risk (oncogenic) HPV strains directly from cervical samples. It is more sensitive than a Pap smear alone, allowing earlier identification of women who may be at higher risk for cervical cancer.”

Screening Recommendations in Thailand

1. Target Age Group: Typically, women aged 30–60 years for HPV DNA testing (according to current Thai guidelines).

2. Under 30 Years: Pap smear every 3 years (generally, HPV DNA testing is not first-line in this younger age group).

3. 30–60 Years:

   • HPV DNA testing (alone) or co-testing (HPV DNA + Pap smear) at intervals advised by local/national guidelines—commonly every 5 years if negative.

(Adapt these recommendations based on patient risk factors and local health policies.)

Interpretation of HPV DNA Results (Thai Guidelines in English)

Result	Next Step
HPV Negative	Repeat HPV DNA testing in 5 years (low risk).
HPV Positive → Genotyping	1. HPV 16 or 18: Refer for colposcopy immediately. 2. Other high-risk HPV types: Perform Pap smear/Liquid-Based Cytology (LBC).
If LBC ≥ ASCUS (Atypical Squamous Cells of Undetermined Significance)	Refer for colposcopy (to evaluate possible precancerous lesions).
If LBC < ASCUS (Normal cytology)	Repeat Pap smear (or co-testing) in 1 year to ensure no progression.

Key Point: HPV 16/18 are the highest-risk types; patients with these strains should proceed to colposcopy without delay. Other high-risk HPV (e.g., HPV 31, 33, 45, etc.) requires additional cytological assessment.

ASCUS or higher indicates possible cellular changes, necessitating closer inspection via colposcopy.

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Step 6: Counseling & Addressing Patient Concerns

Common questions you may encounter:

1. Will the vaccine affect fertility?

   • “There is no evidence that HPV vaccines impact fertility.”

2. Is it still useful if I’m sexually active?

   • “Yes. You might not have been exposed to all HPV types, so you can still benefit.”

3. Do men need the vaccine?

   • “Yes. HPV can cause cancers in men as well (e.g., penile, anal, or oropharyngeal cancer), and men can transmit HPV to partners.”

     
     

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Step 7: Closing & Key Take-Home Messages

1. Summarize the importance of the HPV vaccine and regular screening.

2. Encourage the patient to ask any remaining questions.

3. Offer follow-up or schedule the vaccination/screening.

Example Closing:

“The HPV vaccine is safest and most effective from ages 9–26, ideally before becoming sexually active. However, even if someone is older or already sexually active, vaccination and screening can still protect against future HPV infections. Would you like help scheduling a vaccination or a screening test?”

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OSCE Performance Checklist (Self-Evaluation)

• Introduced self & maintained privacy

• Asked relevant history (age, sexual activity, prior vaccinations)

• Explained HPV, vaccine importance, and screening clearly

• Used understandable language & checked for comprehension

• Summarized key points & arranged appropriate follow-up