[Question #10732] HPV

20 months ago

Hello Dr. I’ve asked a few questions on this forum. I would like you to go back to the first discussion I had about a new encounter 8 months ago. Symptoms still persisted and no answers for cervicitis infection 14 days after the sexual encounter my husband and I had with another woman after years of marriage. I had a 19 week negative HIV 4th Gen from the lab & a 23 week negative HSV 1/2 igg test. Nothing to explain my infection and persistent symptoms. Followed by today, My Pap smear was due last week and results came back today positive for HPV mrna E6/E7. Ive had multiple Pap smears and never have had HPV, being that the woman gave me this, Could this be the reason for my cervicitis? I’m worried that the woman maybe had something else like HIV or HSV? Is my testing conclusive for both and I can put it to rest? Does having HPV affect the negative result taken from HIV 4th generation combo test at 19 weeks or the HSV testing at 23 weeks?

H. Hunter Handsfield, MD

20 months ago

Welcome back to the forum. Thank you for your continued confidence in our services.

Cervicitis often is a conundrum: the cause is unknown in roughly half of al cases. Given the negative test results described in your first thread, most likely you have none of the identifiable causes. That said, you might speak with your doctor about retesting -- just to be assured that something wasn't missed last time either you or your husband. In this case, I would advise testing for gonorrhea, chlamydia, trichomonas (with a PCR test, not microscopy), and Mycoplasma genitalium. I would expect negative results for all of them, but you don't want to take the chance of missing any of them.

As for other causes, HPV might indeed be responsible for some cases of cervicitis -- or for abnormalities of the cervix that mimic cervicitis. Your doctor -- whoever does your Pap smears -- is the best person to discuss this with. As for herpes, that's definitely not in the picture. No genital herpes ever causes continuing symptoms for weeks or months; all herpes outbreaks resolve within 2-3 weeks, no exceptions.

It is possible that your sexual threesome eight months ago was not the source of your recently documented HPV infection. HPV can lie dormant for years, only to show up on a routine Pap smear. In fact, most cervical HPV infections are longstanding -- i.e. recently reactivated, but not recently acquired. Depending on the specifics of the three way sexual encounter, perhaps you indeed acquired it from your female partner, especially if there was direct genital apposition -- i.e. her vulva in direct (and forceful) contact with your own -- or perhaps via shared sex toys.

You needn't worry about HPV. There are no medical conditions of any kind that have any effect at all on the reliability or timing of the standard HIV blood tests: none, ever. Your HPV infection has had no effect on your HIV test results. The HIV AgAb (4th generation, "combo") tests never take more than 6 weeks to become positive.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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20 months ago

The testing that was ordered was “thinprep tis pap and hpv mrna e6/e7 reflex to hpv 16/18/45” my results came back: abnormal pap LSIL & HPV mRNA E6/E7. To my knowledge this is the more high risk one and mRNA E6/E7 is just a mile marker and they don’t know which strain, is this correct? If my testing was ordered reflex to mRNA 16/18/45 then my results would specify one of those? Does this mean it’s one of the high risk strains but not 16/18/45? Also it’s been 8 months is this the type of HPV that causes warts? I have never had one ever? Also, am 100% conclusive on HSV and HIV? Why do some medical experts specify to take a 4th gen combo past 6months? Does this also mean if my husband and I continued having our regular sex without condoms that he’s almost sure to have HPV as well?

H. Hunter Handsfield, MD

20 months ago

Your gynecologist is the one to advise you on this. The most important finding on your Pap smear is not HPV itself, but the LSIL result. Low grade squamous intraepithelial lesion (LSIL) rarely progresses to pre-cancer or cancer itself. Most likely your gynecologist will reassure you and recommend follow-up Pap smears, but probably not treatment, expecting the LSIL to clear up on its own.

Warts are not likely.

Yes, your other test results are conclusive. HPV has no effect on testing for either HSV or HIV.

Some physicians and clinics simply are not up to speed on the newer (AgAb, 4th gen) HIV blood tests and still recommend 3 months or more for conclusive results; or are simply more conservative. No genuine HIV expert advises a need to wait 6 months for conclusive testing; 6 weeks (or 45 days) is the norm, although a few might still recommend 3 months. Never longer. To my knowledge, in the 10-15 years since AgAb testing became available and widely used, I am not aware of even a single reported case in which a positive results took longer than45 days (except rarely in persons who took HIV drugs (post-exposure prophylaxis) that failed to prevent infection.

That completes the two follow-up exchange included with each question and so ends this thread. I hope the discussion has been helpful.

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