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She underwent loop electrosurgical excision procedure for persistent CIN 1, which demonstrated CIN 3. Genotyping revealed HPV type 56 infection. The advancement of Gardasil-9 vaccine only offers 90% protection to patients against HPV-related disease. Lay literature may mislead patients to think they have no risk of HPV infection.<\/jats:p>","DOI":"10.1136\/bcr-2019-230366","type":"journal-article","created":{"date-parts":[[2019,8,10]],"date-time":"2019-08-10T13:05:19Z","timestamp":1565442319000},"page":"e230366","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cervical intraepithelial neoplasia grade 3 in a patient following Gardasil vaccination"],"prefix":"10.1136","volume":"12","author":[{"given":"Bruce","family":"McLucas","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Vail","sequence":"additional","affiliation":[{"name":"Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine Jane","family":"Chua","sequence":"additional","affiliation":[{"name":"Anatomy, St. George\u2019s University, School of Medicine, St. George\u2019s, Grenada"},{"name":"Obstetrics and Gynecology, Saint Peter\u2019s University Hospital, New Brunswick, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Walt","sequence":"additional","affiliation":[{"name":"Gynecology, Fibroid Treatment Collective, Beverly Hills, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,10]]},"reference":[{"key":"2025082707280571000_12.8.e230366.1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.antiviral.2016.03.016","article-title":"Gardasil-9: A global survey of projected efficacy","volume":"130","author":"Zhai","year":"2016","journal-title":"Antiviral Res"},{"key":"2025082707280571000_12.8.e230366.2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22751"},{"key":"2025082707280571000_12.8.e230366.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1201-9712(07)60017-4"},{"key":"2025082707280571000_12.8.e230366.4","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-014-0392-4"},{"key":"2025082707280571000_12.8.e230366.5","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/cas.12106","article-title":"Efficacy of quadrivalent human papillomavirus (types 6, 11, 16 and 18) vaccine (GARDASIL) in Japanese women aged 18-26\u00a0years","volume":"104","author":"Yoshikawa","year":"2013","journal-title":"Cancer Sci"},{"key":"2025082707280571000_12.8.e230366.6","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1097\/AOG.0000000000002052","article-title":"Human papillomavirus vaccination. 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