[Question #138] HPV and Pap Smear

37 months ago
Dear Dr. Handsfield/Dr. Hook,

About 2.5 months ago, my partner pap smear was slightly abnormal and some other high risk HPV was detected. Recently, she repeated her pap and HPV DNA test (cobas 4800). Pap smear is normal and HPV DNA test negative (type 16, 18 and other high risk not detected). However, prior to the HPV test, the gynaecologist did a colposcopy and find some mild changes (HPV only and not Cin). We are rather confused and will like to seek assuring and solid opinions from you rather than probably, likely etc.

1. Why is it that the recent report shows HPV negative but yet there are still some mild changes? Do the mild changes mean low risk types or low level of uncleared high risk type? Over time, will the mild changes become normal?

2. Does it mean that once colposcopy cannot detect anymore mild HPV changes and HPV remains undetected, it is conclusive to say that the virus has been eradicated from the body? Or it is conclusive to say that the virus is just dormant in the body?

3. When HPV is not detected in the cervix, does that mean possible HPV at the vagina area or vulvar area are also cleared since these two areas are not mentioned?

4. After HPV is cleared (pap normal and HPV negative), what is the recommended time frame before we resume sex? I saw from your past forum that you do advise some time frame to people.

5. When we say cleared, does it mean eradicated from the body or stay dormant in the body? How do we know if HPV is dormant or eradicated? Are you able to give the percentage of each and what is the chance of recurrence if stay dormant?

6. Some medical professionals say that dormant HPV is transmissible to partners since they are still present in human cells or body while others says it is not transmissible. Are you able to advise which is true?

7. Some medical professionals also say the HPV test is very sensitive such that it may detect both dormant and active HPV since the DNA is still present in human cells when dormant. However, there are some professionals or online sources that say HPV DNA test can only detect active HPV. May I know which is true as there are many different versions?

8. Is colposcopy more accurate in detecting HPV since it is done visually on the cervix? With both colposcopy and HPV DNA test, is it more accurate to give conclusive results on whether HPV is still present or not present?

9. Last but not least, just one question on HSV1. If someone has HSV1 but there is no outbreak, does that mean he/she still cannot kiss anyone due to possible transmission? 

That's all I have in mind at the moment. Thank you.


Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago

Welcome to our Forum.  I will try to answer your questions.  At the same time, I need to preface my comments to you with the statement that in medicine, there are no absolutes as each person can react somewhat differently to infections.  Thus most of the answers to the questions you ask are probabilistic.  Further, I need to remind you that with 9 questions, my responses must be somewhat limited in length.  On to your questions.


1. Why is it that the recent report shows HPV negative but yet there are still some mild changes? Do the mild changes mean low risk types or low level of uncleared high risk type? Over time, will the mild changes become normal?

This is a two part answer.  First- it is important to point out that HPV tests sample the genital tract and HPV can occur at different locations.  Thus occasionally infection may be missed through sampling error.  On the other hand with two or three successive negative tests, there is little chance that infection would be missed.  In addition, with respect to colposcopy, there are other processes than HPV which may appear abnormal culposcopically so that if your "mild change" areas were sampled and negative, you can be confident that they did not represent HPV.

2. Does it mean that once colposcopy cannot detect anymore mild HPV changes and HPV remains undetected, it is conclusive to say that the virus has been eradicated from the body? Or it is conclusive to say that the virus is just dormant in the body?

Persons can certainly have HPV without visible culposcopic abnormalities.  Culposcopy looks for the abnormalities that are early indicators of areas which MAY (although most do not) gradually progress to become caner.  Most HPV-related culposcopic abnormalities however go away by themselves.  When they do, they do not recur to become precancerous lesions.

3. When HPV is not detected in the cervix, does that mean possible HPV at the vagina area or vulvar area are also cleared since these two areas are not mentioned?

See above- HPV infections can be multifocal, occurring at different locations within the genital tract.   similarly all infected areas may not resolve at the same rate.

4. After HPV is cleared (pap normal and HPV negative), what is the recommended time frame before we resume sex? I saw from your past forum that you do advise some time frame to people.

I think you mis-read our prior posts.  For all practical purposes, nearly all sexually active persons have HPV and there is little data to suggest that sexual abstinence is needed for infections to clear on their own.  We do not suggest abstinence within a partnership if one person is found to have HPV.  If your HPV test is negative, your chance of transmitting infection to your partner is very, very low although they may already be infected. 

5. When we say cleared, does it mean eradicated from the body or stay dormant in the body? How do we know if HPV is dormant or eradicated? Are you able to give the percentage of each and what is the chance of recurrence if stay dormant?

This topic is debated and, in our opinions, is a largely semantic issue.  Some experts feel that HPV becomes "dormant" when it resolves based on the fact that residual DNA is sometimes recoverable.  When the infection resolves however and is no longer detectable, there is no evidence that it is transmissible or that it will progress.

6. Some medical professionals say that dormant HPV is transmissible to partners since they are still present in human cells or body while others says it is not transmissible. Are you able to advise which is true?

We would disagree with the opinion you mention.

7. Some medical professionals also say the HPV test is very sensitive such that it may detect both dormant and active HPV since the DNA is still present in human cells when dormant. However, there are some professionals or online sources that say HPV DNA test can only detect active HPV. May I know which is true as there are many different versions?

If HPV DNA is detected, infection should be considered to be present.  The terms "active" and "dormant" are not helpful and only act to confuse persons. 

8. Is colposcopy more accurate in detecting HPV since it is done visually on the cervix? With both colposcopy and HPV DNA test, is it more accurate to give conclusive results on whether HPV is still present or not present?

The HPV test is far more accurate for detection of HPV than colposcopy.  As mentioned above, persons can have HPV and yet have normal culposcopic tests

9. Last but not least, just one question on HSV1. If someone has HSV1 but there is no outbreak, does that mean he/she still cannot kiss anyone due to possible transmission? 

The majority of HSV infections (whether HSV-1 or HSV-2 are transmitted when lesions are not present as a result of asymptomatic shedding of the virus. At the same time, it seems that persons with asymptomatic shedding of the virus are less infectious to partners than persons with lesions present SO, it is a good idea for persons with HSV (1 or 2) to avoid direct contact of their lesions with others when lesions are present to reduce the risk for infection.

As I mentioned above, you have asked a large number of questions which took far longer than is typically allotted to answer so I will provide only brief clarifying responses if you need clarification.  If you have other, new questions, please post them separately.  EWH

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37 months ago
Hi Dr. Hook, 

1. May I know when we say hpv infection cleared, are we referring to the infection only or including the virus itself?

2. If the hpv virus is not totally eradicated leaving very small levels behind, what is the risk of recurrence regardless short or long term?

3. When hpv infection is present, what is the risk of passing it to the baby during delivery?

4. Last but not least, would you be able to advise what is the recommended time to wait for the virus to clear totally before we resume sex so that she can avoid passing me the virus? Please note that I'm referring to high risk hpv and we have not had sex so far.

Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago

1.  This is a rhetorical question.  By definition, the presence of the virus IS the infection.

2.  Again, I think your definitions are a bit off target.  If viable virus is presence, it can grow - this is not a recurrence.

3.  Astronomically low.  This does occur but terrible rarely and is not a concern.

4. Please re-read my response no.4 above.

My sense in reading your initial question, as well as your follow-ups is that you are overly concerned about the fact that your partner had a "high risk" HPV detected on PAP smear.  Few experts would recommend abstinence or action other than close follow-up going forward.  These are issues that she (with or without you present) should discuss with her doctor.  If the response is not satisfactory, she should ask another doctor.  It is not an emergency and not a cause for concern. The majority of women who are not vaccinated against HPV will acquired a high risk HPV infection at some time and the vast majority of those will control and clear the infection themselves without any therapy at all.  Regular testing (PAP smears) and possibly HPV testing and/or colposcopy are all that is needed.  Finally, I would urge you to stay off the internet regarding this topic. while much what is there is well intended, it is also overly dramatic and often misleading

EWH

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