[Question #13530] HPV Back? New? Shedding?

1 months ago

Unfortunately, I am back again! Recently had a Pap smear that was normal but positive for HPV. I had a normal pap last year and no hpv test, and about four years ago I had an ASCUS and hpv positive test. I know this is extreme and you don’t deem disclosure necessary, but I don’t want to put other women through this knowingly.

So as for my question, is the hpv dormant? And is this likely the same strand from years ago? According to my doctor friends “There are no abnormal cell changes — so there’s minimal to almost zero viral shedding, and very low chance of transmission.” However, my obgyn insists that the infection is just as transmissible as an infection actively causing cell changes. What is the truth? When I discuss this with people, I want to accurately be able to describe the circumstance I’m in.

Per chatgbt as well:

“Cytology normal + HR HPV positive” = dormant HPV in practical terms.

The virus is present but not actively harming cells, and the risk to others is extremely low.

H. Hunter Handsfield, MD

1 months ago

Welcome back to the forum.

This situation is very common. Most and maybe all genital HPV infections are permanent -- with the virus usually undetectable ("dormant") but with the potential for reactivation, i.e. the possibility of being detected again by HPV DNA testing. There are no data on how transmissible the virus might be in this situation -- which largely explains why there are differing opinions from various health care providers. I am unaware of any research or other data to support the opinion of the person who said transmission chance can be predicted by presence or absence of cellular changes.

Are you shedding the same HPV strain you had four year ago? You don't mention virus typing, but If both times showed the same (e.g. HPV type 43, 16, 11, 34, or whatever -- I'm just picking a few of the more common types) it might well be the same. If the numbers are different, then it's clearly a different type.

In any case, informing partners of your HPV infection in this situation is optional. Since 90% of all people acquire genital HPV at least once, often several times, any single sexual encounter is not likely to increase a partner's risk of infection or of a serious health outcome as a result. On the other hand, if in an ongoing relationship, that partner might expect and hope to know. And some couples routinely share their past sexual histories, including HPV or other STIs -- often a measure of mutual respect and caring more than health protection.

I can't agree entirely with the ChatGPT response you report. If HPV DNA is detectable, most experts would consider the infection active, not dormant. And as noted above, I am unaware of scientific information that absence of cellular changes means the infection isn't sexually transmissible.

An important bottom line is that having genital HPV and transmitting it to partners is a normal, expected, and for the most part unavoidable aspect of human sexuality. The main strategy to avoid harmful health consequences are vaccination, which effectively prevents infection with the 9 HPV types that cause 90% of cancers and warts; and following Pap smear guidelines for women (and perhaps increasingly for men who have regular anal sexual exposures).

Some of this likely isn't what you were hoping or expecting to hear but I hope it's helpful. Let me know if anything isn't clear.

HHH, MD

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1 months ago

Thank you for your thoughtful response. This has been a challenging concept for me to understand and discuss with friends and potential partners. I don’t know my current HPV strain, only that it’s high-risk but not type 16 or 18.

From what I understand, a positive HPV test with normal cytology usually indicates a latent or dormant infection, not actively causing cell changes (Stanley M., J Clin Virol. 2010; CDC, STI Treatment Guidelines, 2021). Viral load studies show that higher viral loads correlate with active lesions and more shedding, while normal cytology typically reflects lower viral activity and minimal shedding (Moscicki A-B et al., J Infect Dis. 2013; Winer RL et al., J Infect Dis. 2003). Clinical guidelines (ASCCP 2019; ACOG Practice Bulletin No. 168, 2016) recommend surveillance rather than immediate intervention for HPV-positive, Pap-normal results.

Given this, would it be reasonable to conclude that my infection is likely less transmissible than an active infection associated with an abnormal Pap smear? Any additional insight you have would be greatly appreciated.

H. Hunter Handsfield, MD

1 months ago

I have no argument at all with test results like yours supporting "surveillance rather than immediate intervention". However, you should understand that we STI experts have little experience in following, treating, and evaluating abnormal Pap smears and cervical HPV infections. That's a domain for ObG, not STI experts. So while I agree based on my general understanding, I can't say more about your situation.

My main focus on your question has been the potential for transmission to partners. On that, I continue to believe and advise that if you test positive for HPV, the infection can be sexually transmitted. As I've said, I don't think that's very important. However, you obviously have some medical expertise or at least awareness of some of the relevant medical literature. You also appear to have examined the relevant medical literature more recently and more closely than I have. Do whatever you think best.

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1 months ago

Thanks for the additional input. Probably more important for me is acceptance of my situation and the idea that partners can still receive HPV from me and how to adequately handle the stigma. For OCD purposes, I have to share or I will feel guilt. Do you have any additional advice on how to explain HPV to potential partners? It’s really difficult for me to navigate as I am not in a serious relationship.

H. Hunter Handsfield, MD

1 months ago

Given HPV complexities, it's difficult to give a brief reply about discussion with partners. But to me it makes sense to include (or start) with the information that having HPV is a normal, expected, and pretty much unavoidable aspect of human sexuality; that the large majority of sexually active persons have been infected, often more than once; and that fortunately the large majority of infections are harmless and never cause symptoms.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes to you.

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