[Question #1277] HPV question for Dr Handsfield Ideally

49 months ago

Hello,

 This question is  ideally directed at Dr Handsfield if possible.

My partner recently had an abnormal pap smear which stated low grade Dyskaryosis and HPV type change suggesting CIN 1. However the high risk HPV test came back as negative.

 1 – Could anything else have caused the cell abnormalities other than high risk HPV? i.e could it have been caused by low risk hpv? Could it also have been caused by folic acid deficiency which I have read can be misdiagnosed as dysplasia? (she was also diagnosed with folic acid deficiency) or is it likely that it was high risk HPV which has now cleared?

 2 – Is there any need to disclose that I might have had high risk HPV (if that is what may have caused the abnormal pap) to future partners (based on the fact that it may come back with changes to ones immune system) if we were ever to break up?

Thanks in advance. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome to the forum. Thanks for your question and your personal confidence in my perspectives. However, it is by chance that I am replying. Dr. Hook and I take non-herpes questions in turn or randomly, without regard to requests for one or the other. Our professional opinions and advice are always identical, even if our styles are different from one another.

Your test results are typical for a low risk HPV infection. You seem to have the impression that only high risk types of HPV cause pap smear abnormalities. Not true; low risk types frequently do so as well. Indeed, CIN1 usually is due to a low risk infection, with HR strains more likely to show up as CIN II or III. Folic acid deficiency has nothing to do with her HPV or pap smear reult.

Partners of people with HPV are never obligated to tell future partners unless they are diagnosed themselves with HPV, e.g. genital warts. This is the same for either high or low risk HPV.

You and your partner should be on the alert for genital warts, which can take several months or even a year to show up. In that event, see a doctor for treatment. In addition, if you and/or your partner are below age 26, you should be immunized against HPV. The vaccine won't do anything for the HPV infection you currently are sharing, but will prevent future infection with any of 9 types that you haven't already had, including the 7 most common high risk types and the two that cause most genital warts.

I hope this has been helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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49 months ago
Thanks Dr Handfield for your response, that is very helpful. Btw - we are over 26 and a male & female couple.

So can this dyskaryosis in this case be caused by anything other than HPV?

Lastly we are a bit confused since the private gynecologist when he saw the results said everything was fine and she should simply return to be screened a year later. However the GP (nhs) when they saw the results referred her for a colposcopy (which as I see it is unnecessary and actually against NHS guidelines (which state low grade + hpv negative = return to 3 year screening) and you would only refer for colposcopy if high risk HPV were found and the CIN was 2 or 3.

What is your view on this? As I see it, if it is low grade cell change with HPV negative you should allow the cells time to return to normal of their own accord.....

Thanks for your time.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
HPV for sure is the cause of dyskaryosis and CIN I.

While I am not personally up to speed on the details of UK guidelines (which probably also are available from the British Association for HIV and Sexual Health, BASHH), your description of the usual management of CIN I is consistent with what you say and with the gynecologist's advice and not the GP, i.e. watchful waiting and no immediate need for colposcopy, with the expectation that the abnormality will clear up entirely, as it usually does within a year. That would be the usual advice and guidelines in the US. However, treatment of cervical HPV, CIN, etc is highly individualized, i.e. not necessarily identical for all patients, and there are occasional circumstances that warrant management outside the usual guidelines. Accordingly, I cannot say what care is best for your partner. My suggestion is to clarify the advice with both doctors, and perhaps even put them in touch with one another. But I'll add that most gynecologists are more expert in HPV/CIN management than most GPs.

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49 months ago
Thank you very much Dr, we will heed your advice. 

The Gynecologist actually just got back to us confirming there was no need for a colposcopy at this stage; however he also stated that " ....this change is not necessarily related to HPV and often reverts to normal naturally".

Thanks for your help today, or cheers as we say here ; )
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Respectfully, I disagree with the gynecologist. The notion that CIN or other cellular changes like dyskaryosis might have causes other than HPV is an outdated one, from all I understand. Such changes indeed usually revert to normal without treatment, but that doesn't mean HPV wasn't responsible. Most HPV infections and their cellular abnormalities clear up with time, typically in a few months to a couple of years.

"Cheers" is my own routine sign-off on emails -- maybe dating to the 1960s when my dad's employment had him in London (we lived in Kingston). Anyway, that completes the two follow-ups included with each forum question and so ends this thread. Take care, stay safe, and cheers--

HHH, MD

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