[Question #3323] Low risk HPV and PAP smear

38 months ago
Hello Dr. Handsfield and Dr. Hook:
It’s a bittersweet honor to speak to you    both. I have read a number of your thoughtful and thorough responses and in turn would like to gain some additional insight into low risk HPV detection.

I have recently visited my gynocologist’s office after having discover some minor bumps near the anus. The doctor responded that while the bumps do not meet the characteristics of common STIs such as herpes or HPV, to rule these out, a biopsy was taken and I am currently awaiting the results.

I am currently in a monogamous long term relationship and both myself and my partner had been abstinent for a number of  years prior.  I conduct PAP screenings as recommended and never returned an abnormal PAP smear.

In reading about HPV I understand that older infections may lie dormant in the body for years. My particular question relates to the correlation between low risk HPV and PAP smears. Are PAP smears able to detect low risk HPV or are they only designed to detect high risk.

My second question revolves coping with a potential new diagnosis of HPV in a long term relationship. While it’s safe to say that the partner would have also acquired HPV at that point, have you ever explored vaccines for the non-diagnosed partner (even though from my understanding, at that point, it would serve as a placebo effect).

Thank you both.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your kind words and confidence in our services.

Given your sexual history, I'll be slightly surprised -- but not greatly so -- if the biopsy shows your perianal skin bumps to be warts. But you'll just have to wait and see.

Low risk HPV types often infect the cervix and cause abnormal pap smears. As you may know, pap smear results are usually categorized as low grade intraepithelial lesions (LSIL), high grade (HSIL), and carcinoma in situ (CIS, early cancer). Low risk HPV types frequently cause LSIL but rarely HSIL and never CIS (or very rarely). High risk types can cause any of these. Although it is commonly stated that LSIL can progress to HSIL and eventually to cancer, this is now believed to be uncommon. Usual and safe practice is to follow LSIL findings with repeat paps, but usually not go further (e.g. to treat with cautery etc) because the pap abnormality and the HPV infection causing it usually clear on their own.

As for "coping with a potential new diagnosis of HPV", most likely this isn't going to be an issue. As implied above, I would suggest we address this in more detail if your biopsy finds warts/HPV. To my knowledge, there have been no studies that specifically vaccinated partners of persons with particular HPV types to judge their efficacy in preventing transmission. There generally would be little point in doing so, since the large majority of partners of persons with genital HPV already have it themselves; or if they do not, it's because they were infected previously with that particular HPV type and are now immune to it. Accordingly, even if your perianal bumps turn out to be due to HPV, or if you ever have an HPV-related pap smear result, I would not recommend HPV vaccination for your current partner. (That said, if either of you is under age 26, the usual age cut-off for HPV vaccine, it would make sense for you to be immunized, at least if there is any likelihood  your relationship will not continue and/or either of you is likely to have other partners in the future.)

Finally, would HPV vaccine have any sort of placebo effect? I suppose it could -- but "placebo effect" usually means controlling symptoms, not just making people more relaxed and less anxioius. In any case, I would not recommend vaccination for these reasons. It would be pretty expensive ($500 or more) simply for anxiety reduction!

I hope these comments are helpful. Let me know if anything isn't clear, and also feel free to let me know the biopsy result when you have it.


38 months ago
Thank you Dr. Handsfield:

I completely understand your explanation about the vaccine, plus being down $500 would probably increase someone’s anxiety! 

I will update the thread on the results, in the meantime I will stop googling HPV until the results are out.

 Thank you again have a wonderful weekend.
37 months ago
Dear Dr. Handsfield:

My results came in today and were negative across the board!

I wanted to take this opportunity to again thank you and your team for your  esteemed work. I’m confident this platform will continue to  provide support while clarifying misconceptions that often cause unnecessary stress.

All the best.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Thanks for the follow-up. Congratulations on the negative results. Thanks for your kind words about our services. Best wishes and stay safe!---