[Question #11374] Positive HPV test, to Negative HPV test, to Positive HPV test again - help

14 months ago

I have had a long history with HPV and my last pap came back normal but HPV+ (not 16/18/45). Below is my history. can anyone give me advice if i should take my doctors advice to just repeat pap in 1 year? should i push for colopo?

37/F

2015: HPV+ (not 16/18/45) LSIL ->CIN 1
2016 - 2020 HPV - / Normal pap
2021: didnt test (got covid this year & was also married this year)
2022: HPV+ (not 16/18/45) / Normal pap
2023: HPV - / Normal pap
May 2024: HPV+ (not 16/18/45) / Normal pap - pregnant & 6 week miscarriage on 4/27/2024 (not sure if this is relevant)

Not sure if this is an old infection popping back up bc i got covid then pregnant, or if i got reinfected from my now husband (been together since 2017) not sure how i should handle my next steps

H. Hunter Handsfield, MD

14 months ago

Welcome back to the forum; thanks for your continued confidence in our services. In preparing to respond, I scanned your discussion two years ago with Dr. Hook, in which these same issues were largely discussed. I agree with all he said; you might go back and re-read it, if you haven't done so lately (question no. 8781).

You are a poster child for the natural course of cervical HPV infection in some women. Nothing unusual or abnormal is going on, and there are no serious health implications of your positive HPV test now or in the future. Many HPV infections persist for years but remain undetectable most of the time. At least HPV DNA persists in inactive form (i.e. dormant infection) and can reactivate to again become detectable and/or to cause Pap smear changes, warts, etc. Some experts believe all infections persist for life in all infected persons; other experts aren't so sure, but all agree it's very common.

In addition to reactivation in you, you're also correct in raising the possibility of a new infection from your husband. Just as your old HPV infection may have reactivated, the same could have happened in your husband: that is, reactivation of a distant past infection, recently transmitted to you for the first time. These considerations and the uncertainties they imply are the main reason it is rarely possible to ever know when and from whom any particular genital HPV infection was acquired. (Therefore, even if you were infected by your husband, it doesn't imply he has had other sex partners recently -- in case you were wondering.)

Almost certainly one of these cicrumstances explains your currently positive HPV test. Your recent pregnancy also might partly explain the situation. Pregnancy is a state of immune deficiency; the immune system is suppressed so that the pregnant person does not reject the foreign tissues growing inside her -- the baby and placenta. I'm not aware of data showing a higher rate of HPV reactivation during pregnancy, but it might explain some cases. Covid is unlikely to have anything to do with it.

As for your next steps, nothing unusual is required. That your current Pap smear is normal is reassuring. Your gynecologist likely will advise retesting you for HPV, and perhaps another Pap smear, in the not too distant future. That's all you need to do in order to assure no future HPV related health problem, or at least re-detection in the event it starts to cause recurrent CIN. Follow her advice. (Nearly all gyns have lots of experience with exactly this sort of situation. You could even consider printing out this thread as a framework to discuss it with her; I expect she would agree with most or all I've said.)

I'm sorry to hear of your miscarriage. Best of luck in another round of successful conception!

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

HHH, MD

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14 months ago

Thank you so much, I did read my question from last year but now I feel like I am in a new category of women that have a strange timeline to HPV & bc the guidelines are for the norm, I’m worried I should be doing more. Thank you for saying I have nothing to worry about & my 1 year follow up is a good recommendation from my doctor given my positive, negative, positive cadence. I just making sure that bc my cadence is different that I should be more worried / diligent , that’s my main concern

H. Hunter Handsfield, MD

14 months ago

I really don't think this sequence has any significant meaning in regard to your health, other than following up as advised by your doctor.---

14 months ago

Great to know that you for your time, it has greatly helped me

H. Hunter Handsfield, MD

14 months ago

Thanks for the thanks; that's why we're here! Best wishes-- HHH, MD---