[Question #1862] New HPV16 Finding with PAP

94 months ago

I am a 49-year-old female requesting help to understand next steps now that my recent pap (10 days ago) revealed positive for HPV16. The smear results remain pending. All previous PAPs have always been negative for both smear and HPV, including my last PAP/HPV two years ago in 2015, however, because I have been with a new partner for the past year, I felt I wanted to have a routine PAP (I am also in the age group accustomed to more frequent exams versus the new CDC recommendation of waiting 5 years if all is negative - now I wish I had waited until 2020). I was married for a long duration of my life and was considered low risk for years with the negative routine PAPs/HPV tests, but lost my spouse years back and started dating again a few years ago. Due to these new HPV16 findings, I am scheduled for an upcoming colposcopy.

Torn with how to manage this information with my boyfriend of one year and if we should adjust our sexual activities while I have an active HPV16 infection? I am also torn with guilt as I understand it is maybe impossible to know if the infection came from him, or if the active infection was triggered from exposure in the past? Feeling horrible guilt that I could have exposed him if this infection did not come from him? I had confidence that I was free from STDs in that my previous exam in 2015 was negative as were all others.

I find reassurance in reviewing the helpful responses to other’s questions on this forum, but I am wondering if my boyfriend and I can continue to pass the infection between us? I understand that the likelihood is that individuals will clear the HPV virus (including HPV16) on their own within in a year or two, but can we continue to pass back and forth if I have an active infection? Do we add additional risk with oral sex? What adjustments, if any, should be considered regarding sexual activity? And, how is the best way to explain what the positive HPV16 means to your significant other – providing information and perspective, but avoiding panic or undue worry?

Edward W. Hook M.D.

94 months ago

Welcome to our forum. I happened to be on the Forum just as your question arrived and so you are getting a far more rapid response that is the norm for our Forum Follow-ups may take a bit longer. I'll try to help.

We are still learning more and more about HPV. Your question suggests that you have looked at some of the other questions on our site and I than you for that. While HPV is most common among younger persons with well over 50% of Americans having been infected before they reach their early 20's, we are also learning that the infection may appear in older age groups for whom testing tends not be recommended as frequently. In general, the presence of HPV itself is not a concern, particularly if the PAP smear itself (as opposed to the HPV test) is normal. . Recent studies show that HPV is relatively common on women over age 50, occurring in 10-20% of women. Many of these infections are thought to represent re-activation of HPV acquired in the past which had been quiescent for years before. In your case, it is difficult to say whether or not your infection represents reactivation of a longstanding infection or acquisition of infection from your current partner. Irrespective, while it is typically a good thing to do to let your current partner know, we do not feel strongly about this as your infection has little or no implication for you, your partner or your sexual activity. He has already been exposed and unless he developed genital lesions, there is no recommended test or further management recommended for him . Your HPV may resolve on its own over the subsequent 1-2 years, may persist, or rarely may progress to cause abnormal PAP smears. There are no data however to suggest that, if the PAP smear (and/or colposcopy) is normal, that this is a reason for concern and all that needs to be done is to continue to have periodic PAP smears.

As for the implication of this finding for your sex life going forward, I see no reason to modify your activities, The concept of passing the infection back and forth does not clearly seem to influence outcome of infection, nor its resolution. Similarly, I see no reason to adjust your sexual activity. No reason to start using condoms if you do not already, no reason to worry about oral sex.

I hope this information will be helpful to you. EWH

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94 months ago

Dr. Hook, Thank you very much for your rapid response. I am greatly appreciative of your expert advice given to me and for the valuable information provided throughout this site. I am wondering if you may be able to address urgency/need for a colposcopy in the case of normal smears? With negative HPV on pap 2 years prior, would this be over testing with only having a positive HPV16 for likely less than 2 years? I understand if you are not able to advise and maybe better to error on caution and proceed with the colposcopy ? Any risks? Is it ever advised to wait a few months and retest to see if HPV16 cleared in case of a normal smear before proceeding with a colposcopy? Trying to gain perspective on colposcopy. Thank you, again, very much!

Edward W. Hook M.D.

94 months ago

Great question about an evolving situation. For women over 30, even with a normal PAP smear, many Guidelines recommend follow-up colposcopy if HPV 16 is present. Some would be OK with repeat PAP smear in 6 months but my understanding is that most recommendations for your situation would be to go and have the colposcopy. EWH
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94 months ago

Dr. Hook, Will do. Again, thank you so much for your expert advice and quick replies!